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Chapter Nine
"You were correct in your observations," Dr. Myers stated. He had invited Peter into an empty conference room, and they had each taken a chair near the end of the long table. "We have determined that Mr. Caffrey's state of unresponsiveness is a psychosomatic problem brought on by his recent trauma."
Medical personnel had assured him that Neal's initial lack of response at the scene had simply been a symptom of shock and trauma. After he had awakened in the ICU, they attributed it to a side effect of the medication. According to them, all indications was that Neal was doing well, he slept a lot, but he was improving. But whenever he did wake, Peter could tell something was very, very wrong.
As his physical condition improved, and he was more often awake, the hospital staff began to suspect that Peter's fear was founded. Neal did not respond to questions, nor did he respond to requests. He simply stared. He was also very still; he never even shifted body position. The only movement was the movement of his head, and occasionally, his hands. Peter explained that this, too, was very unlike Neal. If Neal was conscious he was moving, even if he was just fidgeting. When his lack of unresponsiveness didn't improve, Dr. Myers, a psychologist, had been consulted.
"I have read Mr. Caffrey's previous psych eval," he paused, looking at Peter, "this doesn't seem to fit with the current information I have."
Peter knew to what evaluations the doctor was referring. "I know Neal tested that way, but I am telling you, he is not a sociopath. He puts on a show," he tried to explain, "He doesn't express his feelings like most people. He's guarded; he's had to be. But his detachment, his coolness," Peter shook his head, "its all an act, part of his con man ruse. He cares about people. He's loyal to his friends, and he hates violence."
"These tests evaluate a subject's personality traits, Agent Burke, not necessarily their behavior. A sociopath wouldn't endure physical abuse to protect someone else." He looked at Peter. "So I agree with you about Mr. Caffrey on that topic as well. Now, on to my evaluations," he continued, shuffling through the file in front of him. "Early test did not show brain injury or any physical reasons for his lack of responsiveness, but I completed a neurologic examination just to verify those findings."
"What does that mean?" Peter knew his state of exhaustion was not helping his comprehensive skills. But even fully rested he doubted he could follow psycho babble.
"Its an examination of pupillary response, muscle tone, reflexes, and frontal release signs." He explained. "I assessed his response to stimulation, from light touch to deeper stimuli, as well as noxious but nonpainful stimulus. Due to his past trauma, I did not try to use rapid movement or a startle to elicit a response."
Psycho babble. "And what did all that tell you?"
The doctor did not answer his question but continued "I also have had staff observe Mr. Caffrey's reactions when people enter his area to….."
"That's the problem," Peter interrupted, frustration spilling over, "He isn't reacting. He just stares off into space like a zombie."
"A person reacts in many ways," Dr. Myers corrected, his voice remaining calm in spite of Peter's agitation. "Mr. Caffrey is reacting to external stimuli. Its minimial but he is aware of what is going on around him. He avoids eye contact," he explained. "When something comes directly into his line of sight, he shifts his head position, or simply closes his eyes. Also, staff has monitored his vital signs, and they also react when people come and go. These things tell us that he's aware of what is going on around him but is choosing to not respond to it."
"What," Peter felt his frustration change to anger, "you think he's just ignoring everyone? Have you looked in his eyes?"
"Agent Burke," the doctor said, "I have looked into his eyes," his voice was sympathetic, "He has blunted affect; he has withdrawn from his surroundings, and it's not something he is doing consciously. I think his state is a psychic response to the traumatic events he has recently experienced. He is simply bringing to the extreme the avoidance, numbness and lack of response often encountered in Post Traumatic Stress Disorder."
Peter was familiar with that term. During his years in law enforcement, he had seen many officers suffer from PTSD. Most came back with counseling; a few did not. One Captain, in particular, after seeing a teenager gunned down in front of him, had taken early retirement. Neal had witnessed a man executed in front of him; had been splattered with his blood. Could Neal come back from this?
"But the PTSD symptoms I've encountered with officers suffering from it was mostly flashbacks," Peter remarked, "like a person freaking out when a car backfired or something. I've never seen anyone just blank out like Neal has."
"Blunted affect, or emotional numbness," the doctor explained, "is a consequence of withdrawal from the external environment." He paused, eyeing the stack of papers in front of him "I have seen his injuries and read the reports: Mr. Caffrey was brutalized for an extended period. He was in great distress both physically and emotionally and at some point, he simply couldn't cope. He withdraw inside himself to survive. And that is where he still is."
Peter let out a deep breath. "So what is the treatment? How do we get him back?"
The doctor leaned back, "There are drug regiments I could prescribe, but its only been forty-eight hours since he was brought in. He has been through intense physical and emotional trauma. I think I need to give him a little more time before taking that route."
"So we do nothing?" Doing nothing was not working in Peter's opinion.
"No, Agent Burke," he replied, "I do nothing. I think you can do a lot."
"I don't understand," Peter stated, "I can't do anything. He won't talk to me. He won't even look at me."
"I told you that my staff had been observing Mr. Caffrey?" the doctor asked. At Peter's nod he continued, "Anytime anyone enters his area, his vitals go up; his heart rate, respiration and blood pressure all rise. Even if he does not respond, or even open his eyes, his body does respond. It goes into a hyper-vigilant state and remains there until they leave."
"Is he scared?" Peter asked quietly. The thoughts of Neal afraid in his silence was heartbreaking. It was too much like what Peter imagined he had suffered in that dingy basement two days before.
"Very possibly," the doctor admitted, "but he is definitely distressed when anyone is in the room with him. Except for you."
Peter eyebrows raised in surprise, "Really?"
"Yes, Agent Burke," the doctor said, "When you entered his room earlier, his vitals shot up just like they do with everyone else, but when he heard your voice they began to return to normal."
Peter hadn't been in Neal's room long before the Dr. had come. He had found Neal much as he had left him, staring and still. He asked him how he was feeling, not expecting an answer since the blankness of his eyes remained. He took his seat and told him that Elizabeth sent her love and would be to see him as soon as he was in a room. He even told him he had been to the office to check on the progress of the case. He talked to him, but Neal showed no indication that he heard him or was even aware he was there. Or so he had thought.
"When he heard my voice," Peter repeated. In spite of the blankness in his eyes, Neal could at least hear him. "Does he understand what I am saying?"
"It's unclear how much of what he hears he is able to process right now," the doctor admitted, "but the important thing is that he recognizes your voice and equates that with safety."
"I just have to keep talking to him." The weariness in his voice didn't even come close to the weariness he felt.
The doctor nodded, "Yes," He stood and picked up the papers. "He needs you to tell him that he's going to be okay, that he is healing, he's not alone and most importantly, that he is safe."
Peter knew that would he harder than it sounded. He had choked up on similar words as he crouched in front of Neal in that basement. He had tried to talk to Neal since he had regained consciousness in the ICU-about the case, Elizabeth's new client, even Mozzie's hospital-phobia, but with no response, no acknowledgment, his conversations had fizzled out. But if Neal needed to hear those things from him, even if it did choke him up, he would say them. "Then what?" Peter asked.
"Keep telling him, Agent Burke," the doctor advised, "It might take some time. He withdrew inside himself because that was the only safe place he had to go; only when he feels safe out here will he come back."
