Author's Note: Basing this mostly off various personal experiences with mental illness. Drop me a review if you want to see more of this! I'm planning to introduce Edward next chapter.
Bella Swan thought a lot about death.
Strictly speaking, this wasn't a bad thing. Confronting the fear of mortality was something most humans did at one point or another in their lives. They answered existential questions with religion, lifestyle changes, and sometimes plain denial. Thinking about death was healthy. Expected, even.
Wanting to die was another matter.
Trying to die was even more concerning.
The pain wasn't worth living with - that was what she kept trying to make them understand. Something jagged had been scooped out of her chest. It was a wound that never healed, no matter how many coping mechanisms and kind people she shoved inside. Bella Swan was an island unto herself, completely isolated. Utterly alone. And the pain of loneliness - that was something humans didn't confront so often. She'd heard that solitary confinement was used as a method of torture. That sounded correct - painful and effective enough to drag out agonized confessions. But how to proceed when the confinement was self-imposed? When the world around you was still populated by people, but none of them could touch you through the fog?
She curled her fingers around the sides of her mattress and breathed shallowly. Eventually, she would have to get up and walk to the bathroom. That was a human need which couldn't be ignored. She'd sat up instead of curling into the fetal position - that was a start. All she needed to do was swing her legs over the edge of the bed, walk the few feet from the bed to the bathroom, do her business. Bite-sized pieces. She tried to take a few more deep breaths, the way they'd taught in therapy. Then she slowly rose to her feet.
She managed to get all the way through the motions of using the bathroom and washing her hands before the panic attack hit. That was good. She couldn't bear the humiliation of not being able to attend to even her basest physical needs. But she also couldn't congratulate herself. She was a little too busy curling up in the corner of the bathroom and hyperventilating. Her heart beat so fast she could hear it in her ears. Her face pressed against her knees, a scream coming out muffled against her skin.
There were room checks every fifteen minutes this side of the ward. Whoever needed to look would be alarmed by the empty room and closed bathroom door. It didn't lock, so they'd come inside and open the door and look her over and think, Thank goodness. She didn't try to strangle herself with a bedsheet on my shift.
She did not want to inconvenience the staff. Their jobs were hard enough with patients who were much more difficult than her. She sobbed against her knees, her breath pitching painfully upward. Then she tried to drag herself to the door. Easy does it, easy does it. All she needed to do was cross the tiles. Reach up, turn the doorknob. Crawl outside the door. Whoever looked into her room would see that she was safe. Just - just resting a little, outside the bed.
She couldn't do it.
She tried. But it was all she could do to keep from shrieking hysteria into her hands. Plenty of other patients were anxious - she didn't want to scare them. She already frightened enough people with the nightmares she had nightly. That was why she hadn't been given a roommate even though most of the residential patients shared space.
The door opened eventually, like she knew it would. She was still crying, try as she might to hold herself together. It was hard to look people in the face these days, so she didn't try. It was hard enough just to hear other people speak.
"Isabella?" a soft voice said.
She finally looked up, expecting someone in scrubs with shadowed eyes. Instead she found a young man in casual clothing, nothing but kindness and openness in his face. His blonde hair curled closely against his temples, and he smiled at her, holding his hands out as though to prove he wasn't a threat. "My name is Carlisle, or Dr. Cullen if you prefer."
She swallowed. A new doctor. What a way to find her.
"Do you need help?" He hadn't moved from the doorway, everything about his posture carefully put together to lack aggression. He was trying harder than anyone had in a while, so she nodded. Maybe it would make him feel useful to help her up. And she really wasn't sure she could get back to bed by herself.
He offered a hand, letting her take it in her own time. She wasn't sure how long that was. The gaps between needing to do something and actually following through tended to be longer for her than other people. But he was patient. It was easier to walk back to her bed with his hands in hers, although she curled up almost immediately when she laid down. The doctor, worried about invading her personal space, retreated to a folding chair by the door. He must have brought it inside with him. She could not imagine anything that heavy and metal being allowed near her without also being bolted down.
"Isabella," he said. "I'm a new doctor on the ward. I'll be acting as a combination of therapist and psychiatrist for you. Sometimes combining therapy and psychiatry can be helpful, especially when there are complex issues at play. It's important to get to the root of which symptoms are chemical versus behavioral. Does that make sense?"
She nodded, staring at the wall behind his shoulder. Maybe it would look like she was making eye contact. She probably wasn't blinking enough, though. She blinked once, twice, and almost missed what the doctor said next in her attempt to look normal.
"I know it can be disorienting to have a change in doctor…" - he checked the chart on his lap - "...three months into your residency. If we don't click, there are other doctors on the ward you can be matched with. If you prefer, we can have your social worker present when we first get acquainted."
She should have been curious, but all that permeated the fog was a dull apathy. So her last doctor had given up on her. Or they were trying a new approach altogether? Or the doctor had quit after one too many sessions with dead-eyed patients like her. Really, their jobs would be easier if they let people who were meant to die die. But then they wouldn't be in the life saving profession, she supposed.
It was just that some people were too far gone.
Too late, she realized he was waiting for some response from her. She uncurled just enough to give a shrug.
"Is it okay if we talk one-on-one?"
She nodded. It didn't really matter either way.
"Okay." He gestured at the chart. "I have some of the notes that your last practitioner made. In cases like this, where we're getting acquainted partway through your treatment cycle, I like to act like it's a normal intake appointment. That way I can make sure all of my information is up-to-date, so that you can be treated as well as possible. You might have heard some of these questions before. Does everything sound okay so far?"
Nod.
"Do you want a sheet of paper so you can write your answers?"
A pause. She shook her head.
"Okay. I can phrase them as yes or no questions if you'd rather not speak. Is that okay?"
Nod.
"You were admitted to the residential program three months ago, following a suicide attempt?"
Nod.
"Before that you'd had two temporary hospitalizations following suicide attempts, but you were released with an outpatient treatment plan?"
Another nod. She hadn't lied in the first hospitalizations. She really had planned to follow the treatment plans. She hadn't wanted to break her parents' hearts. But that was before she'd realized how much better the world would be if she wasn't in it. Even this doctor - he should be helping someone who needed the help more than she did, someone who was more responsive, someone who could walk to the bathroom and breathe right -
"Are you still with me?" he asked, gentle. He must have seen something on her face.
She swallowed and nodded.
"You've been tried on a wide variety of SSRIs and atypical antipsychotics?"
Nod.
"Nothing's helped so far?"
A shrug. Whatever they had her on now wasn't working well enough for her to use the bathroom without hyperventilating. Nothing else had fared much better. She'd stopped paying attention to the pills they gave her a while back. It was best to make their jobs easier by just swallowing them and laying down.
"You have a history of complex trauma?"
She flinched. Nodded.
He skirted over specific questions about the trauma. If he noted her flinch, he didn't show it. "The diagnoses I have here are a severe case of major depressive disorder mixed with a panic disorder. Would you like to talk about those at all?"
A shake of the head.
"Okay. I'll work within the framework of those diagnoses for now, but we can work together on making sure they're correct. We don't need to do that today. I do like to start a treatment plan by setting goals, though. Would that be okay with you?"
A shrug.
"Did you have any goals set with your previous doctor?"
Honestly, she couldn't remember. She did the safe thing and shook her head.
"Would you like to set some today?"
The correct answer was obviously yes, so she nodded.
He stood up. "I'm going to come give you a piece of paper so you can write. Is it okay if I come closer?"
Nod.
He crossed to her and handed her a blank white sheet of paper. For half a second, she wondered how sharp the edge was. But that was ridiculous. Nobody had ever died from a papercut. Or from stabbing an artery with a pen. And he'd probably get in trouble if she did manage to die on his first shift.
She thought hard for a few minutes. What was an acceptable goal? The only one in her mind for months had been to die. Everything else seemed impossible, insurmountable. To leave this room and sit in the circle of chairs used for group therapy? To go into the recreation room and lay on one of the couches that hadn't been updated since the seventies and watch a bad sitcom? To play cards with the other patients? To walk on one of the trails on the spacious hospital grounds? To tread into the art and music therapy room to watch patients undergoing creative endeavors? She couldn't imagine doing any of that, let alone interacting with other people.
Finally she wrote, To use the bathroom without a panic attack.
It would have been an embarrassing goal if she still had the capacity to be embarrassed by her own inadequacy. As it was, she looked at him with dull brown eyes, expecting him to tell her to try again. That it wasn't good enough. But he didn't. He smiled and took the paper.
"That seems like a very practical goal," he said. From anyone else it would have sounded sarcastic, but there was an earnestness in his voice that couldn't be ignored.
She curled back up.
"Would you like to rest now?"
This probably hadn't lasted as long as a normal therapy session was supposed to. But she was so tired. She nodded.
"Thank you very much, Isabella. I'm looking forward to working with you."
He was halfway out the door when she whispered, "Bella."
He turned back. The surprise in his face only lasted half a second, and then he replaced the mask of professionalism. "Sorry? I didn't catch that."
"Bella," she repeated, her voice raspy but a little stronger now. "I prefer Bella. To Isabella."
"Bella," he said with another soft smile. "It's very nice to meet you."
She shrugged. He waited a moment, probably hoping she would talk again. But the words had taken all the energy she had left. He headed out, his footsteps echoing against the tiles as he walked down the hallway.
She closed her eyes and tried to sleep.