Chapter Thirty-Seven

Progress Note

Doctor Virginia East

Progress note, Session one.

It is embarrassing to me how ill-prepared I am to deal with Patient X. I have never worked with a patient so badly damaged or so angry, and considering my usual clientele, that is really saying quite something. Apart from a slightly more creative than usual mocking of my surname and a totally inappropriate speculation regarding my relationship to the commander of this facility, he has not told me anything yet, but I am certain this man has been abused in every way we have a name for, and some we do not.

I feel a bit of a ghoul, frankly, for thinking it is a shame I will not be able to publish a paper about what was done to him and the effects it had. I am sure there is much to be learned from his experiences and if and how he recovers from them, but maintaining his confidentiality would be impossible.

It was absolutely necessary on my first visit to impress upon him that I had the strength to stand up to him and would not allow him to manipulate or dictate terms to me, and I have no regrets about that, despite the setbacks in his physical recovery it may have caused. It seems that even that small action on my part was enough to shatter any illusion of free will or hope of self-determination he had begun to build.

So, naturally, like an ignored child who misbehaves because negative attention is better than no attention at all, he used every means at his disposal to make his caregivers take what I am sure he regarded as actions against him. He has urinated on his caregivers, defecated in his bed and assaulted his physician. He was too heavily sedated during my last two visits to participate in any kind of talk therapy because he got himself so upset knowing I was coming that he made himself ill. After he twice escaped his bed, once in search of a weapon, and once in an attempt to escape, he had to be restrained once again, after which, I am convinced he resorted to self-harming behavior by urinating on his surgically transplanted vagina in what I am sure was an effort to stimulate some sort of infection. He was absolutely making every possible effort to alienate anyone who would try to help him.

He has been like a cornered, wounded, abused animal who cannot help but bite the hand that feeds him because he is so crazed with pain and fear that he does not know the difference between the hand that delivers sustenance, comfort and compassion and the one that deals a blow. Recently, though, I am told his primary caregiver has confessed her affections for him. I can read micro-expressions well enough to know that neither she nor the commander of this facility has given me the whole story. For now, though I can't imagine any other circumstances where such an intense relationship between a patient and a caregiver would be considered even remotely appropriate for a standard of care, it is sufficient to know that her endearments have forced a catharsis and knocked him out of the mindset of an animal who must fight because he cannot flee.

In the past week or so, he has calmed down tremendously, resumed his bladder and bowel training, taken his meds without complaint, and even started the tiniest bit of strength training. At the moment, it is as much as he can do to stand up and keep himself upright for a few moments with the help of a Zimmer frame, but after nearly a year of being strapped to a bed or kept floating drugged in a fish-tank, even that is just barely short of a miracle. It seems in his case, progressing by baby steps is still a while off.

At least he is being cooperative.

With everyone except for me.

"Our hour is up, General," I say, rising from the chair where I have been completing my progress note. This is not ordinarily something I would do while in the room with the patient. Usually, I write down just a few key words, and complete the formal write-up in my office later, but if he's not going to speak to me at all, I might as well use the time productively.

"Now that you're getting back on track, I'll be coming by six days a week," I tell him, and the look he shoots me could wither ivy right off a cottage wall. "You might as well start thinking about a plan and what you want to accomplish through counselling. I won't sit here and waste my time again. When I come back tomorrow, we can talk about how I can help you, or I can give you a lecture on neurophysiology. What you do tomorrow is entirely up to you, but Commodore Tucker is paying me well for my services and it would be wrong to take his money for doing nothing.

"You have a pleasant afternoon, sir. I'll see you again tomorrow."

He doesn't even bother to curse at me as I leave. I'm not sure if that's a good sign or a bad one.

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