Disclaimer: I do not own CSI or the characters.
Chapter 2: The Referral
Dr. Carla Reese just finished up a session when her receptionist buzzed in with a phone message. "Dr. Reese, a Dr. Daly left you a message regarding a patient she is referring to you."
"What?" Carla Reese was stunned, "Dr. Adrienne Daly, in San Francisco?"
"Yes, I think that was her first name," Donna replied from her receptionist desk.
Carla ran out of her office, "Let me see that."
Carla, I'm sending you a patient. The phone call is just a head's up to let you know I sent her chart to you overnight. You should have it already. I must warn you, don't thank me yet. She's the toughest nut I've tried to crack in a while, an immense challenge, and she's leaving the area to move there, against my strongly worded advice. Give me a call once you've reviewed things. I'm available to help in anyway I can. Thanks, Adrienne.
"It reads like she dictated all this."
"No," she shrugged, "I took a little break, and it was on the voice mail."
Donna reeked of cigarettes and was chomping on some gum, but Dr. Reese didn't want to worry with that at the moment. "Oh, my, this is incredible," Carla was beaming, trying to make sense of the referral.
"What's the big deal anyway?" Donna asked, "People send you patients all the time."
"Not her!" Carla was still looking at the message, "She doesn't send anybody patients. People send her patients. It's the other way around." Pacing now, "And, what's the rush? Why the overnight chart?" she wondered, rubbing her temples.
Donna held up a package, "You mean this little stack of light reading?"
Dr. Carla Reese's eyes lit up like a kid in a candy store, but she had work to do. Her next patient just arrived; so it was back in her office, the referral would have to wait.
Dr. Reese was embroiled in a session that would try any psychotherapist. This patient had minor issues by comparison to most patients, and even more minor will to work on them. Carla managed to slog through it. She gave this poor victim of everyone and everything some constructive things to work on in the coming week; although, she was warned that those tasks were too trying for him to tackle. So it is, who knew? Nothing was as frustrating as someone seeing problems bigger than they were or someone not wanting to help them self. Both of Dr. Reese's pet peeves wrapped into one patient. Little did she know, the referral she was so anxious to get started on was the exact opposite in both respects. Sara Sidle was someone who minimized huge problems, but once acknowledged, had the resolve of a powerful army when it came to defeating them.
Mercifully, the end of her schedule was finished, and she could take home and peruse the reading she had been positively salivating over.
Carla Reese was perfectly suited for an adult psychiatric practice. She went to medical school a bit squeamish, but always thought she'd get over all that. While that is the typical case, she was the exception; she got worse. Psychiatry was a natural choice for her; no blood or physical pain, no life and death drama. Even in her private practice she gravitated away from hospitalized patients, and preferred talk over drugs any day. An area of interest for her was adults with attachment trauma issues. These patients were adults who suffered emotional or physical traumas as children, and were now suffering the effects into adulthood. They typically displayed difficulties in relationships, and were particularly rewarding to help. She thought about specializing in that type of patient exclusively, but didn't want to court burn out. Her mentor in the field was Dr. Adrienne Daly. Dr. Daly did nothing but adult attachment patients, and enjoyed a national reputation in the area. To get this referral from her, clearly a challenging patient, and with an offer to provide insights along the way, might have been the crowning achievement of her practice thus far.
She ripped into the package. It contained a summary statement on top, and dictated notes from every session Dr. Daly had with the patient.
Transfer of Care Summary prepared for Carla Reese M.D.
Date: 1/22/2008
Name: Sara Sidle
Referral Source: Eric Sidle, brother
Diagnosis: Adult Attachment Disorder, Acutely exacerbated by a Post Traumatic Stress Episode
Social History: 35 y.o. white female, never married. No children. Estranged from a brother and a mother. Father deceased. Until recently, employed by Las Vegas Police as a crime scene investigator. Very impressive intelligence and education.
Clinical Summary: The patient was fairly functional despite severe attachment disorder, until late summer of last year. She was in a stable, long term romantic relationship, and was engaged to be married. She had several close friends; however, she finds it nearly impossible to open up to her friends. She even kept her romantic relationship secret from everyone she knew. For that reason these relationships don't seem genuine, although she definitely has people she cares about, and care for her back.
Her life changed when she was the victim of an abduction by a serial killer. She spent hours alone with her life in the balance, and was truly lucky to survive the episode. She endured being lost in the desert for the better part of a day before she was rescued, half dead of dehydration. That was when things started to unravel for her. That trauma rocked her world, the ghosts of her past jumped out, and she hasn't handled anything very well since. She admitted that she would not have sought out therapy if it had not been for that recent event. She basically just walked right out of her own life. She quit her job, left her boyfriend, and moved away.
She sought help from her estranged mother and brother. Her brother has successfully achieved fulfilling family relationships after 5 years of therapy with me. He has recovered from substance abuse issues, and is happily married for 8 years, with two children. He brought her straight to me.
All three of them were victims of physical and verbal abuse by the father. Their mother reciprocated much of the abusive behavior, occasionally taking it out on the children, but significantly culminating in the stabbing death of the father at the hands of the mother. While it's hard to imagine that not being self defense, a court of law did not see it that way. The mother went to jail and the children were split up shortly after entering foster care.
The goal of therapy has been for the patient to face what happened in her past and learn to live with it. Her compensatory mechanism has always been to hide it, from both herself and others, and, as expected, that no longer works for her. She is completely unable to confide in people, except her boyfriend, but even that became difficult after her abduction episode. Early sessions were hampered by her inability to share, even in the sanctity of my office. She was near a breakthrough in that regard. She was starting to talk more freely about her childhood.
Despite this progress, she has abruptly decided to return to Las Vegas. Her stated reasons are that she no longer feels she needs to be near her family to continue to heal, and she would like to return to her relationship.
Dictated by Adrienne Daly, MD, PhD.
In long hand at the bottom of the page was written:
Carla, good luck with this woman, she really deserves to overcome this, but it will be difficult. Call me when you get through the clinic notes, we'll chat. I'll help from here in any way I can, Adrienne.
PS, on a practical note, her contact information is listed below, if you do not hear from her within a week, I think it would be prudent to contact her. I'm afraid she may try to go back into hiding from all of this….
TBC...
A/N: Attachment disorder is a real diagnosis, and it does fit with Sara, but the exact expression and treatment may vary from this story. In other words there is plenty of dramatic licence at work here! Just FYI.
