Ember Steiner- Victor
I didn't know where to start. I didn't know which hurt to feel first so I felt them all in a throbbing jumble. I must have been down on the floor for a few minutes as the nurses tried to soothe me. I think we all knew there was no soothing something like this. Then everything started to recede a little as whatever they'd injected me with took hold. The pain didn't stop but it became remote. Any feeling became remote. I felt like my own ghost- like the volume and saturation of my life had been cranked down.
The nurses kept their hands on my arm or shoulder while I drifted back down the hall. Probably we were going back to... wherever I was going to be staying. Surely I was going to be here for a long time, unless the Capitol just dropped me at the city limits and wished me good luck. That would have been my first guess if they hadn't at least brought me to Dr. Orb. No, it seemed someone was at least pretending to care about me.
Someone else wasn't pretending. The pain that had receded flew from my head entirely when I heard my father's voice.
"Ember!" My father's face appeared at the end of the hall as he wrestled through two medics trying to shoo him away. "Let me see her!"
When you're a little kid you see your father and know everything will be okay. When you're a grown woman you see your father and you still think everything will be okay. I heard my father's voice and felt my face light up. Our eyes met and we both broke free of our handlers to run at each other. I jumped into him and he grabbed onto me, suspending me off the ground as I clung around his neck. I snuggled my face into her shoulder and started to disjointedly tell him all that had happened. Dad squeezed me against his chest and stroked my hair while he said something back, neither of us really hearing what the other was saying but content just to hear it.
Dr. Cassia Orb- Capitol psychiatrist
CONFIDENTIAL: PATIENT INFORMATION
Ember Steiner
Ember presents with very severe post-traumatic stress disorder (the worst case I've personally seen) caused by extreme traumatic events both witnessed and participated in during Head Gamemaker Titian Qin's secret Hunger Games-like competition.
Symptoms observed:
Patient displays an overarching severe depression characterized by downcast affect, frequent crying, an attitude of hopelessness, and near-suicidal dissatisfaction with her life and the world around her. Patient is on suicide watch and will likely remain so for the remainder of her therapy. Patient does display moderate anxiety, though this is overshadowed by the depressive symptoms. Patient does not appear to be afraid of repeated trauma since she accepts that the Games are over and will not repeat. Her anxiety instead centers around unwanted flashbacks and inability to process and move past memories of the trauma and is expressed both in elevated nervousness and episodes of trochotillomania and psychosis.
Patient's expression of PTSD symptoms is complicated by the unusual character of the trauma. Patient does not display the jumpiness or startle response characteristic if PTSD because she was not in immediate danger for most of the Games. The danger was instead ever-present and lingering, leaving her with a vague and difficult to address sense of unease. Patient does not know where the danger originates and thus cannot address or work through it.
Neurological testing is largely normal. Patient has difficulty carrying a conversation and will not initiate one. Eye contact is limited. Situations involving choice or judgement are nearly impossible- patient fears reprisals or punishments in case of a "wrong" choice. Coordination is normal but spastic movements are episodic. Symptoms approximating epilepsy are evident occasionally- patient loses track of a conversation and speech trails off while face displays textbook "thousand yard stare". Concentration is limited and falters after a brief period.
Perhaps the biggest obstacle to patient's progress is survivor guilt. Patient expresses severe guilt both over being the only survivor of the Games and their her actions within the Games. Patient frequently expresses regret or lack of belief in her value ("I shouldn't have won", "I deserve to die").
CURRENT TREATMENT:
Patient has started a regimen of .6 milligrams of lethoxomine augmented by .4 milligrams of naprozomene. Medications have reduced patient's insomnia and self-harm behaviors and have slightly reduced her depressive symptoms. As patient's mood stabilizes she can progress to lumin therapy. In-person therapy is conducted five times per week with hopes that as patient progresses the visits can be reduced.
TREATMENT PLAN:
Once patient's condition has stabilized to where cognition is permanently established and suicidal ideation is managed treatment can progress to intensive CBT. Journaling and other safe expressions of trauma will likely prove effective. Medication will be adjusted as necessary. Contact with anyone but patient's parents will be limited at this point as well as exposure to uncontrolled environments. Plan revolves around guiding patient through a safe exploration of her trauma to allow her to safely process it until she feels she is in control. Patient must be given back her autonomy and control.
PROGNOSIS:
Patient will very likely continue with treatment for her entire life. Trauma such as this is life-altering and will always be a part of her. Medication will mitigate physical symptoms and lengthy therapeutic efforts may allow her to regain a more normal life. The biggest advantage is that patient's trauma is not something she will be in danger of repeating. The Games are over and if patient is supported and encouraged she might be able to make a healthy new identity.
Ember's body is back from the Long Walk. It's gonna be a long slog but I'm not leaving this story until her mind is home, too.