Not even sure why I thought I needed to split today's update into 2 chapters, but my brain is fried from pain right now. Plenty of triggers of the variety mentioned in the fic summary, as well as the mention of emotionally & physically abusive parental behavior. Can't think beyond that, so tread lightly.
There's something about complete silence in group that makes it almost intolerable. A room full of people saying nothing is like a loaded gun - at least it is today.
Kate can tell Zach isn't loving the situation, either. She exchanges glances with him - let it brew, this means something, just wait - but even before he opens his mouth, she knows it's a lost cause. Not a good day for Mateo to be on sick leave.
"Doesn't usually get this quiet in here," Zach says, and Kate watches as a few people nod. Others keep their eyes down.
Heather clears her throat. "I'm sorry if I - - maybe this wasn't the right thing to bring up in group."
Kate raises her hand. "It really is. I think it's important. And I feel like many people in this room can relate, which might be why it's gotten so quiet."
Heather shrugs. "I guess. I don't know. It's just - - I don't know if I can - - umm." She smiles sheepishly. "Sorry, I lost my train of thought."
"You were saying that you miss feeling like you're part of a unit. A family."
Heather sighs. "Right. And it's not like I don't have any family, on paper. We're just not - - not really connected."
"In what way?"
"Well, my brothers and I barely speak. And my parents - - I don't think I was ever what they expected." The young woman moves uneasily in her seat, her eyes lowered. "I don't know what kind of kid they were hoping for, but I wasn't it. And they let me know."
Kate studies the faces of everyone sitting in the circle as Zach gently says, "things got rough."
"No. I mean, sometimes. Not physically, at least not that much. But they really - - I really felt like they hated me. Like I was messing up their whole deal. All these issues, all the anxiety, all the things they had zero patience for. I was exhausting to them. I stuck out like a sore thumb in that house."
"And they let you know this how?"
We really need to have a one-on-one later about tact, Kate thinks, but all she can do right now is smile encouragingly at Heather as she struggles with the words.
"They - - well, they'd tell me. And I think if I had half a brain in me I would have kept quiet and, you know, not given them more to work with. But I never could. I got really combative after a while. That got me punished. Like, a lot."
The effect of the last sentence on a few of the participants isn't lost on Zach, and Kate appreciates it when he says, "we don't need to go into too much detail about that in group, but I would like to hear a little about how it made you feel. To constantly be punished."
As Heather considers what she wants to say next, Kate finds herself watching Sam's expression. She's been observing him extra closely since Dean started visiting on a daily basis - which, she still has no clue how he secured that unusual permission, but she has the sneaking suspicion that it's better not to look too much into it.
Anyway, she's been watching Sam this entire week. She's well aware that they're at a dangerous juncture; that having his brother back might throw open some doors that Sam's mind has managed to keep closed before, when he didn't have the safety of Dean's presence in his life. She hopes she's wrong, because they don't have the time to process anything new that might come up. Sam's time limit here doesn't take into consideration therapeutic progress, not really, and she's used up whatever leverage she had with Adams. She is left with watching and worrying.
Apparently, with good reason. Sam was fidgeting before, which is pretty much his go-to reaction when parental conflict comes up in group. But he isn't moving now; he's looking intently at Heather, his eyes wide and unblinking.
Which is, again, how Kate can see it happen. She sees the shift as Heather says, her voice low, "well, they - my mom used to lock me up sometimes. We had this closet - - yeah, I probably shouldn't go into that."
As Zach tries to navigate the conversation to slightly safer ground and sidestep the actual details, Kate can tell it's too late for Sam. She can almost hear something click, like an actual trigger has just been pulled; Sam's eyes go distant, no longer focused on Heather. He doesn't move or make a sound, but Kate can see his closed fists loosening in his lap, his mouth dropping slightly open. Drifting away and into some memory that's too painful to face. Stop stop no wait - -
But there's no unringing that particular bell. As she helplessly watches Sam get pulled under, the discussion continues; people chime in about their own place in their original families, about siblings who had to pick a side, about a loneliness that became too overwhelming way too early.
Sam doesn't speak during the quick round they do before the end of the group session. He nods blankly when Zach asks if he's feeling okay, but neither of them is sure if he actually understands what he's being asked.
As Luke practically leads Sam out of the room, Kate reminds herself that there's not much she can do. Sam will be out in the world in no time; she won't be there to catch him when he falls. Letting him figure his way out of situations like this is the only support she can provide him with at this point. Which she hates with a passion.
She shares her thoughts with Zach when he comments on how dazed Sam seemed; tries to find reassurance in the fact that Zach agrees with her about having to wait and see. They go through their session notes, sum things up, the usual routine.
She can't chase away the feeling, though, that there's something ominous about how immediate Sam's response was to Heather's mention of being locked up. It makes her wonder about what old wires may have tripped. Who it was that once had Sam trapped, jailed, maybe literally.
Takes her about fifteen minutes of staring into her coffee to realize that she's not going to get much done today unless she checks on him. Just a quick talk, she tells herself, just see that he's surviving this like he always does, and then you move the hell on.
She rolls her eyes at her own worry as she walks down the hall. And then chokes back a curse as she opens the door to see exactly what she was hoping not to find.
Sam is lying on his bed, motionless. His eyes are two dull, frozen lakes in this light, open and unseeing, tears still pooling between unmoving eyelashes; he must have been crying just before he stopped blinking. He does that when he recedes too far in, sometimes - just seems like he forgets to blink. There's something about him losing even that tether to his body that makes the situation feel absurdly urgent to her, like the thing he'll lose next is remembering to breathe. She knows that's not true, that these shutdowns don't work that way, but it sure as hell feels like they might.
She's watched him check out like that the first time they had to suture his wounds in the ward, one especially bad night, to avoid sending him to the ER. Jay was gone by the time they could get to it, so it was Sam who went through that. And though he's far from squeamish, something went wrong halfway through, because he was suddenly gone. Like he completely left his body, with no one else taking the wheel that time.
She remembers the doctor on call trying to rouse Sam when they finally had to send him to the ER anyway, remembers the way Sam just flopped against the gurney as that clueless, overconfident prick tried shaking him to bring him back. She gave the guy a piece of her mind, but being manhandled like that while he was helpless pretty much made sure that Sam wouldn't resurface. And he didn't, not for hours. Her shift was almost over by the time he was truly conscious again.
She hates the thought of another one of those episodes, but yet again, there's only so much she can do for him right now, if anything. Which might be the hardest part to make peace with. And she knows she'll still struggle to bring him back; some defeats are unacceptable.
She's tried to ask him about what he remembers from those dead moments (hours, a full day once, on his first week here); has done her best to find out whatever she could, careful but insistent. Sam isn't her only dissociative patient who shuts down like that. She actually sees these episodes often, probably because people are at the peak of their pain when she meets them here, running on empty. And for some reason she can't leave it alone, can't accept not understanding what exactly goes on underneath that unresponsive blankness, that absence.
Sam's face when he shuts all the way down makes her think back to a drawing she saw on one of those listicle websites, one day on the train. The post was something like 25 Images That Will Keep You Awake Tonight, or something else equally clickbaity. And most of it was what you'd expect - creepy statues, disturbing old portraits- but even on the smudgy screen of her old smartphone, one of the images was jarring enough to actually make her stop scrolling. A beautiful sky over a serene seascape; a boat resting lazily on the water, its occupants laughing and lounging in the sun; a dark underworld of nightmarish sea monsters filling the entirety of the ocean below, beaks and claws and tentacles and teeth pressed against the glassy surface, not one of them breaking through.
She's seen that sort of visual metaphor for the subconscious before, but that one image still got to her. It dug in like a thorn, persisted in her memory, and now it comes up whenever she wonders about what happens to her patients as they get pulled under like that - what ancient horrors they share their own deep waters with.
Sam's switches she can handle, but on the few occasions when his lights seemed to just go out, it was impossible for her to make peace with not knowing. Because sure, he might be gone, out of reach and momentarily protected even from his own pain; but he might also be struggling just under that calm, blank surface that only reflects her worry back at her, mute and impassive.
It's first and foremost instinctive worry and sorrow that she feels when this happens, but she also needs to better understand these states as a therapist; knowing what's actually going on beneath that silence determines how to go forward. Whether you intervene, or give a patient some time until their mind somehow knows it's safe for them to be present again. This isn't just true for Sam's case, either.
But she's never gotten a real answer from Sam about what exactly happens to him during these shutdowns. He doesn't seem to know.
Either way, it's as disturbing as ever to watch; there's a helplessness in witnessing it that she can't tolerate. She feels so goddamn useless. Something can be done when Sam is in other kinds of crisis, no matter how challenging - like when he can't quite wake all the way up from one of his nightmares; when he remains terrified, half-asleep, trying to escape. That doesn't scare her - a 200lbs man barrelling down the ward hallway, irrational with fear, she can handle just fine. She can spring into action then. Use grounding techniques, talk him through the maze.
But it's when Sam is clearly, painfully awake and still unreachable, that she has to remember what brought on his condition in the first place; that this man has been through something so persistently agonizing that he's had to learn how to do this. That something in him has taught itself to be there in body only.
Watching him like this only makes it clearer than ever that he was, at one time, truly and hopelessly trapped - and worse still, that it would have happened when he was just a child. DID forms painfully early, sometimes decades before it makes its presence fully known. And Sam going absent like that - not switching, but becoming practically catatonic and gone - is a devastating reflection of his younger self, a child who had nowhere to go but oblivion.
It's not a notion that gets easier to revisit, even though it's her job to gently help Sam accept the possibility that this is how his condition was formed. That this isn't some accident, or something he was randomly born with.
Sam's evasiveness about his childhood may not be conscious avoidance as much as it is pure amnesia; if his memories from growing up are that few and far between, that alone is a red flag for possible trauma, and she's been honest with him about that. But it's not just that. What little he does know and does share feels toxic in a way that she's long ago learned to recognize.
Beyond his circumstances, beyond what sounds like neglect and tragedy in the immediate family, there's a sense that some adults in his life - she isn't sure in which circle, yet - weren't quite right. She has little doubt that at least one alter is carrying far worse memories for him, though none of them seems to feel safe enough to share them at this point. Which makes total sense to her.
Either way, right here and now, she has to decide. And she lands on the side of trying to bring Sam back. They don't normally try to force him back to the surface when one of the others is there, not unless there's real danger to his well being; his alters need their time, too. But this emptiness, this non-responsiveness, worries her. Finding Sam like this means that something in the discussion sent him into a spiral of distress so severe, so unrelenting, that all his system could manage was to shut down as many facets of awareness as possible.
She tries calling his name, and when that doesn't work - which she expected - she takes a risk. "Sam, I'm going to place my hand on your arm, okay? There we go. Can you feel this? Can you hear me?"
Sam's ten thousand yard stare doesn't meet her eyes; he doesn't make a sound, not yet. He does give her the hint of a flinch, though, and that's a sad, small comfort. Maybe he's not as far away as he appears to be.
She thinks back to the first time she ever saw this happen. How much it scared her, how helpless she felt.
The patient was a man in his late twenties, arms and chest lined with scars from years of apparent self-injury that he said he didn't really remember. The staff was suspicious - it was back during her first rotation, in the ER rather than a psych ward, so awareness of that kind of complex post-traumatic amnesia was about as non-existent as you'd expect - and Kate remembers having trouble believing him. She didn't know much about dissociative disorders then, certainly not about the high end of that spectrum.
And so she nodded with an inner raised eyebrow when the man told her he had no memory of how he got his most recent injury, either; she reported nothing to the nurses and to her supervisor when she saw the patient's gaze drift off and his face change mid-conversation, just as he was asked about his home life. When she saw him looking around like he was taking in his surroundings all over again. When he seemed not to know who Kate was, but wouldn't acknowledge it.
He's stressed and confused, that's all. You're not going to suggest that this patient has fucking multiple personalities. No one here will ever take you seriously again.
She didn't say a thing. Played it safe. And she went on to deal with other patients during the never-ending wait for someone from Ortho to come down and take a look, determine if the tendons in the young man's right arm were damaged enough to require surgery. When hours passed, she found herself avoiding what she knew she needed to do: get on the phone, nag the attending to get his ass down there. Barring that, she could go see how the patient was doing, at least.
In a minute.
When she finally did walk over to the corner of the room to draw the curtain and check on the guy, it was because Anna, a resident and a friend, came down to do a psych eval. And by then there was pretty much no one to talk to. She'd never seen a patient go that dead-eyed, that still, without losing consciousness; watching Anna try to communicate with the man, then give up and call upstairs to check for an available bed, was beyond disturbing.
"What the hell was that?" She asked Anna later, as they shared a rare coffee break out in the hall. "I don't think I've ever seen someone in that sort of... state."
Anna sighed. "Yeah, that kind of non-responsiveness can be scary. Might be something called a dissociative stupor. It's hard to define, really depends on who you're asking, but I think that's what we're dealing with here. It's like the mind's way of protecting itself when there's extreme emotional overload, like… like the mental equivalent of fainting from extreme physical pain, I guess."
She shook her head, watching the ER doors. "It'll fade away, but you guys need to keep an eye on him while he's like this. Makes patients vulnerable, and I don't need to tell you this but I'll say it anyway, lots of predators are opportunists. I got someone kicked out of here last year for trying to take advantage of a situation like that."
Kate's skin crawled at the thought. "Shit, really?"
"Yeah. These bastards are like sharks, they home in on vulnerability. You'll see, if you're serious about specializing in trauma. Severely dissociative patients have to deal with a lot. I mean, not all of them deal with the same exact shit, obviously, but you know." She shrugged, looking down at her cup."The world isn't a kind place as it is. It can be a fucking snake pit when your brain has the habit of shutting down on you."
Anna was right, of course. Kate learned how much she was right. But back then, she hadn't yet heard story after heartbreaking, enraging story about people being abused at their most vulnerable; she wasn't quite as jaded yet. She did keep an eye on the man as much as she could, though. And he was alert and coherent again later that night, which made them cancel his move to psych. He wasn't staying; they rarely do.
She also remembers the guy's face when she asked him if he had anyone she could call for him, anyone he could talk to. He said no; that there were people in his life, but no one who really knew. No one in the waiting room. No one he felt like he could call. She didn't know it then, but that, too, would turn out to be something she'd hear over and over from her patients, especially (though certainly not exclusively) ones with DID.
Sometimes the persistent unfairness of prolonged trauma, of how isolating its aftermath can be, how punishing, is almost too much to consider. She often thinks about how it feels to actually live that unfairness. To see that shadow of disbelief on way too many faces, to experience the way in which so many people drift away, unable to contain the pain and chaos.
She's become deeply familiar with that heartbreaking pattern and the many, many factors that are woven into it, interpersonal and cultural. Some of her more sociable, outgoing patients do maintain a circle of close friends and support, but the rule usually seems to be that, the more devastated you are, the lonelier you find yourself. People's patience and compassion in the face of constant, severe crisis tend to wear thin after a while, relationships tend to become imbalanced, to not last. And that's another reality that many of the people she meets in the ward have come to expect.
"No one stays," one of them told her once, and she didn't know how often she'd hear - and think - that phrase. Definitely not for all of her patients, but for too many.
Sam's blinks are coming faster now, the rhythm of his breathing is slightly different. It's like watching ice thaw, slow but undeniable. Kate can see awareness seeping in, can tell that he's coming back. She wonders how long he'll be present before he's snatched away and pushed to the back again. At least if one of the others is in control there's someone there; better than this emptiness.
When Sam finally turns his head to her, his eyes struggling to focus and his lips forming a question he doesn't have the words for just yet, she smiles at him.
"Hey there. You're okay, take it easy. Just breathe."
Sam is slow to react, clearly finding her words hard to comprehend. He blinks at her again, tries to sit up, but can't seem to. He sinks back into the mattress, looking bewildered.
She's seen this, knows the body takes a while to find its sync after being forced into a state of near-unconsciousness. It can be a slow climb back up from that lowland, sometimes. "Sam, give it a sec, okay? Just keep looking at me, for now. Let's work on that eye contact".
Sam obeys, studying her face like he can't quite remember what a face is, his eyes slowly regaining focus. After a few minutes of this, and the occasional, soft "hey, stay with me" when his gaze starts to drift again, something seems to finally connect. He takes a hitched breath, and she can see that final part of his awareness filter back in. See that weight start to settle, a heaviness that follows initial recognition.
"Hi," she says, and as Sam struggles up again, leans on his elbows and rasps a tired "hey," she's relieved beyond what she could have expected.
"You were out of it for a little while. How are you feeling?"
Sam doesn't seem to know how to answer that, looking around the room, gaze landing on his roommate's empty bed.
"Where's - - " he struggles with the name, and Kate resists the urge to help him. She watches him search his memory. This, too, is a way of pulling him back from where he just was; another thread he needs to pick up.
"...Luke. Where's Luke?"
Good. "I think he's in session with his therapist. Or maybe in group. Why?"
Sam struggles to sit the rest of the way up, succeeds this time. Lowers his feet to the floor. "What time is it?"
"Almost noon. There's still half an hour before lunch. Think you'll be up to eating in the dining room, with everyone? I think that might do you some good." Too much information all at once; she should know better. She can imagine Jay's voice, let the guy come around before you start bombarding him like that, what the hell, doc.
Sam blinks at her. "Huh?"
Kate waves her hand. "Never mind, forget it. I'm just glad you're talking." She wants to say glad you're awake, glad you're responsive, glad you came back this time. She wonders if Sam senses how deep under he just was. Maybe he can feel it, somehow.
There's no time to contemplate that, though, because it's then that his head begins to slump. Still not all the way out of the woods, apparently. Shit.
She reaches out, doesn't warn him this time, just grabs his arm. "Sam."
He flinches, looks up at her like he thinks he's in trouble. "S- sorry. What - - "
"Don't fade on me, okay? Let's try to keep you focused. Can you stand up? Maybe walk around the room a little?"
Sam bites his lip, nods. "Yeah."
She watches as he gets up slowly and walks over to the window. His balance seems a bit off, but that's to be expected. Okay.
Luke chooses that moment to storm into the room. "Shit, man, I - - woah, sorry, didn't know you were in here. Should I - - do you need me to -" He gestures towards the hall.
"No, it's your room. That's okay. I was checking on Sam, but he's doing a little better now, so I'm going to leave you guys alone. Sam, keep walking for a bit, okay? Don't lie back down yet. Try to stay focused."
Sam looks away from the window, tries hard to smile. "Promise."
Luke's raised eyebrow tells her he's on the case. His protective streak is strong as it is, but nothing catches his attention like Sam's bad spots. He knows his roommate well enough to figure out, especially after Heather's words in group, what Sam is struggling to come back from.
"See you at lunch," he says as she makes her way out, and Kate doesn't have to turn around to know that he'll be spending the time left until then making sure that Sam is up and talking.
Sam's got some good friends in here, she thinks, and the warmth of that knowledge lasts a full 30 seconds before the thought of release dates and zero safety nets dumps the usual bucket of ice water on that rare comfort.
She makes it a point to pass by the small dining room later, and she catches a glimpse of Sam at the table in the back - he always picks the back, since day one, by the window and with no one sitting behind him - and she is intensely grateful to see that he's smiling. A pale, tired smile, but still.
Luke is knee-deep in what appears to be less of a story, and more a true-to-life dramatic reconstruction of some incident he had in a bar once, arms waving. People around him seem unfazed, familiar by now with his particular brand of storytelling style and more interested in their meal; but Sam clearly appreciates the distraction, and he's actually laughing now, fork in hand, looking almost okay. It's hard to believe that he was unresponsive and stone still less than an hour ago.
Tha sort of change is the one constant that Kate feels like she can count on. Jay once told her, if you don't like Sam, wait five minutes. Leave it to Jay to put it like that. But she finds it hard to truly be relieved as she watches her patient climbing up from yet another abyss.
Because she wants so much more for Sam. She wants a life where his mind doesn't have to turn itself off and leave him dead to the world because someone, at some point in his life, thought locking up a scared child was a good idea. She wants a life for this man where he doesn't have to guess when he last took a shower or how he slept; where questions like what day it is, or whether he's eaten today, aren't a challenge.
And some days, like today, she wishes she could go back in time and face whoever did this to him.
She sighs as she enters the nurses station, where Megan is filling up a row of tiny paper cups in the medication tray. The nurse looks up at her. "Well that's not a happy sound."
"Huh?"
"Nothing. We still up for tonight?"
"...Tonight?"
Megan raises a critical eyebrow at that. "First Tuesday of the month? Horror flick night? Ring a bell?"
Oh. "Shit, yeah. Sorry. Yes, absolutely. At around 8, maybe - that okay? Wait, I haven't picked anything. Sorry, I'm all over the place this week."
"Really, couldn't tell. That's okay, I'll find us something. I can bring some junk for us to munch on, too. But you better feed Angus his catnip, I'm telling you right now. I WILL be shrieking and grabbing you and Kiran every 30 seconds, you know that."
Kate laughs. "Oh, I know."
Megan shrugs, marking the meds on her chart. "Hey, not even gonna apologize - this was your bright idea. You want me there, busted eardrums are the price of admission".
"Yeah, yeah."
"So are you clocking out?"
Kate nods. "Yeah, in a minute. Anything you need me to do before I go?"
Megan hesitates before she says, "No, but I - - I just wanted to show you something."
"Sure, what?"
The nurse opens the bottom desk drawer, takes out a folded piece of paper, hands it to her carefully. "Have a look at this."
It's a drawing of what looks like a stick figure of a man, arms and legs decorated with stains of red watercolor. The entire page has been painted grey, the now-dried water making the paper wavey and crisp. There's a big circle of black filled in around the human figure; the watercolor must have proven insufficient, because it's painted over with crayon, and with such force that the page is slightly torn. The man's face is all eyes, no mouth or nose. She has no idea how it still manages to look so sad with just those two black dots, but it does.
She has to squint at the text scrawled in the corner of the page to read it; the small letters written in pencil say SAMY IN THE HOL.
"Makes the little hairs on the back of your neck stand up, right?" Megan shakes her head, looking troubled. "Poor kid."
Kate's eyes are still stuck on the text. "Yeah, that's an understatement. Did Evan draw this?"
"No, someone younger. And very scared, too - they couldn't talk."
Kate tears her gaze away from the paper. "Wait, when was this?"
"Last night. I meant to show you this earlier, but it sort of got away from me. Zach was on night shift, and he found Sam hiding under the bed. Well, I mean he - or whoever it was at the time - was trying to hide under the bed. Probably didn't know how tall Sam was."
Kate sighs. "Yeah, they forget. And then what?"
Megan's eyes soften as she says, "Zach got him - her? I don't know - to come sit with him in the station. Brought them some paper and all kinds of stuff from Art, to keep them busy. Looks like it worked."
They both stare at the drawing for a while.
Megan speaks first. "What do you think that means, 'Sammy in the hole'?"
"I don't know. Nothing good."
The nurse sighs. "Yeah, that's pretty clear. You want that for his file?"
Every cell in Kate's body says no, no thank you, no need for one more image of what this tortured man has been subjected to. But she reaches out, takes the piece of paper. Folds it up neatly.
"Yeah, I'll take it."