I fired my imaginary beta yesterday for allowing an "egregious error" (tm
Julie Andrews). In the last chapter I alluded to how Kirsten thought Ryan
looked sweet with his hair tousled. Well, I got rid of the poor boy's hair
in chapter 9. Sloppy work like that will not be tolerated. I'm going to
"Petsmart" and getting a real beta. It might work better.
Legalities have been mentioned ad nauseum.
Tuesday, January 20. 8:05 pm
Sandy fell back onto the bed. He had never been so exhausted in all his life. Kirsten was asleep on the couch in the living room. Seth was in one of the bedrooms of the huge home Caleb called a beach house. He tried to keep his brain from replaying the events of the last 24 hours. The frantic phone call to Dr. Rodriguez... The desperate attempts to get a response from Ryan as he sat on the floor of their front hallway, knees to his chest, arms wrapped tightly around them, rocking back and forth, his eyes empty... The look on Kirsten's face as they all realized Ryan had fled from reality, locking himself away from the world.
Sandy had picked the boy up, startled at how rigid he was. He brought Ryan to the family room couch and laid him on his side, trying to coax his frozen arms from around his knees. Seth had retrieved the throw blanket from Ryan's room. Kirsten took the blanket from him and wrapped it around Ryan, speaking quietly...telling him he was safe. They would protect him.
It was now Sandy's turn to sleep.
Wednesday, January 21.
Seth was the first one up that morning. He padded into the kitchen and tried to familiarize himself with it. He looked for the coffee maker, opening up all the cupboards until he found it, built into the wall. It was one of those ridonculously expensive German-made models. All he needed to do was press a button and a precisely measured amount of coffee beans were ground and deposited into the gold plated filter. A few seconds later, hot water dripped through the ground beans into a stainless steel carafe.
Seth figured out what was wrong with the whole process. There was no coffee smell. The entire procedure was very sterile. Focusing on the product of German design and manufacturing kept his mind off Ryan. The distraction wasn't very long though. His parents had a meeting with Dr. Rodriguez that morning. They all had spent the previous day at the clinic. It was nothing like Seth thought it would be. It looked like a house. Shit, it could have been built by his grandfather. It blended in with all the other Mcmansions in the area. It wasn't as scary as he thought it would be. Everybody looked pretty normal. No one was wearing a strait jacket, but Seth wasn't sure what was normal anymore. Ryan looked 'normal', but Seth wasn't sure if he could ever be 'normal'. A beeping noise startled him. It came from the coffee maker. Seth poured himself a cup and went outside to watch the "stink potters" exit the marina.
* *
Kirsten and Sandy now sat in the office with Dr. Rodriguez. The doctor looked at the Cohens. They were exhausted. She wished she could have been more encouraging. They had gone to see Ryan before the meeting. Kirsten fought back tears as she watched Ryan propped up in the bed, his knees still bent, still rocking back and forth, his hands clenching and unclenching the blanket from home. The only sound in the room was the whirring and clicking of the pump that slowly and deliberately pushed a thick beige liquid through a naso-gastric tube inserted into Ryan's nose and threaded down into his stomach. He sat in the bed, unblinking, unaware of his surroundings. His rhythmic movements didn't stop as Kirsten reached out to touch his cheek. The only colour in Ryan's face was from the new bruises he acquired when he fell to the floor during his desperate escape from the table Monday night. Even his normally blue eyes were faded to a pale grey.
Sandy heard his name and looked up. Dr. Rodriguez was speaking.
"I hope you were able to get some sleep last night...?" She said, looking at the two of them.
"A little..." Sandy said ruefully. "It was too quiet though..."
Kirsten squeezed her husband's hand. She hadn't slept well either, but she stayed on the couch hoping at least Sandy would have gotten some sleep.
"This is rough on all of you." Dr. Rodriguez said sympathetically. "I need to discuss Ryan's treatment with you..." She paused and took a deep breath.
"Ryan is in an extrinsic catatonic state. What that means is there's an identifiable cause for his condition. The underlying reason for his catatonia is emotional trauma. There is no physiological explanation for it. The tests we ran yesterday confirmed it."
"So what do we do?" Kirsten asked. "Do we just wait for Ryan to 'snap out' of it?"
The doctor shook her head.
"Ryan doesn't have that kind of time. Because of the nature of the trauma, he's internalized himself, shutting everything out. The longer we wait to bring him back, the more likely it will be that he won't come back."
Sandy swallowed hard.
"What kind of treatment are you suggesting...?"
Dr. Rodriguez hesitated for a second.
"We've had some success treating extrinsic catatonia with Benzodiazipines, such as Clonazepam or Lorazepam, but they're not without the possibilities of serious side effects.
Kirsten held tightly to Sandy's hand. The only way she could get herself through this was to treat this as a business negotiation. To ask questions and expect answers back. Sandy was also slipping into lawyer mode. Dr. Rodriguez recognized the coping methods. She knew she was right about this family. They could deal with this... With Ryan.
"What kind of side effects?" Kirsten asked, her voice strong and clear.
Dr. Rodriguez pulled out some papers.
"These will help explain them..." She pushed the papers across the desk towards the Cohens. She cleared her throat.
"Benzodiazipines aren't usually used in treatment for someone as young as Ryan, but I don't think we have much of an option..."
The Cohens were staring at her intently.
"We will be prescribing Lorazepam. He'll get 3 injections daily, in either his stomach or backside. There will be some pain associated with the injections. There's also the possibility of respiratory depression or a partial airway obstruction and because his liver had been injured in the accident, we'll be using the lowest dose we can since the drug's effectiveness may be prolonged..."
Kirsten paled at the statement, but said nothing, absorbing the information. Sandy continued with the questioning.
"Anything else...?"
Dr. Rodriguez nodded.
"Excessive sleepiness, confusion, delirium, hallucinations, dizziness, hyper or hypo tension... It could even drive him further into a depressive state..." She hesitated again before continuing. "Suicidal tendencies may be present... We'll take protective measures..."
Sandy shook his head, shocked.
"Is this the only way...? The treatment sounds dangerous..."
"There are some risks with the treatment, yes, but I also feel it's the best shot we have at bringing Ryan back. I assure you that every possible precaution will be taken... I will give you both some time to discuss this... Do you have any other questions...?"
"If we agree to this, can you give us a timetable as to when we could expect an improvement in Ryan's condition, since you said that we don't have a large window of time...?" Kirsten asked.
"Benzodiazipines tend to work quickly. Lorazepam in particular, isn't prescribed for more than a week at a time. It wont be a cure, but it should bring Ryan back enough so his emotional trauma can be dealt with. Barring complications, we could see an improvement within 24-36 hours... I'll leave you alone now. You can page me when you've come to your decision..."
Dr. Rodriguez left the office, closing the door behind her.
It only took a minute for Kirsten to break the silence.
"We should do it... Let's start the medication..."
Sandy looked carefully at his wife.
"Are you sure...? It sounds risky..."
"Waiting would be riskier Sandy... You heard Dr. Rodriguez... She said Ryan probably wasn't going to just come out of it on his own. I know in my heart that this is the right thing to do..."
"We should talk to Seth..." Sandy said quietly.
"We'll tell Seth what we decided Sandy. We're the adults... It's killing me inside that he has to know as much as he does about Ryan, but it would be wrong to keep this from him. Ryan and Seth are brothers... they're our sons..."
Sandy held Kirsten tightly. He prayed they'd made the right decision.
* *
Caleb unlocked the door to the beach house. He brought the first load of suitcases in and returned to his Jaguar for the second. Rosa had packed the bags for the Cohens. As soon as she had let herself into the Cohen's house on Tuesday, she knew something was terribly wrong. Dinner from the previous night was still on the table and on the floor. Plates had been overturned and broken. She called the family, but after getting no answers from their cell phones, she called Caleb. He explained the situation, stressing the need for discretion. Rosa took care of everything. She cleaned up the mess and packed 4 suitcases for the family, tucking in a personal note of best wishes in Kirsten's bag.
Caleb put the last 2 suitcases by the stairs and went to the back of the beach house. Looking through the kitchen window, he saw a pair of long legs draped over the deck railing. Further investigation revealed the long legs belonged to Seth, who was slouched in a chair, watching the boats.
"I could spend hours out here..."
Seth looked up and saw his grandfather standing behind him.
"Hey Grandpa..."
Caleb slid into the deck chair next to Seth.
"How are you holding up?"
Seth shrugged.
"Okay, I guess... I just... I don't know... How could that psycho bitch do that to Ryan...? Her own kid...?"
Caleb had no answer.
"I don't know Seth..."
They sat there quietly, watching boats launch and boats dock.
"Mom and Dad are at the clinic. They had a meeting with Dr. Rodriguez..."
"Oh... Okay..."
Seth eyed his grandfather.
"Aren't you going to ask about Ryan?"
Caleb shrugged.
"I know Ryan's in very good hands... Right now, I'm concerned about you."
Seth slouched further down the deck chair.
"I'm okay, I guess...I'll be better when Ryan gets well and comes home... It was scary watching him flip out like that... and then... nothing... He was gone... I feel like... like someone's playing this nasty joke on me..."
He turned to his grandfather.
"I always wanted a brother. I finally get one and I almost lose him on New Year's. He was just starting to get better and now this happens."
Seth sighed and closed his eyes, feeling his grandfather's hand on his shoulder.
* *
The Cohen's met again with Dr. Rodriguez to inform her of their decision.
"Okay..." Dr. Rodriguez gave them a reassuring smile. "We'll do some blood work and get started..."
Sandy and Kirsten sat with Ryan as a nurse took vial after vial of blood. Ryan hadn't flinched or reacted when the nurse tied the rubber tubing around his arm and found a vein. He just kept rocking. The feeding pump had been disconnected and the end of the naso-gastric tube had been capped and taped under his nose. After the nurse finished drawing blood, she quickly put a band-aide on the site and squeezed Ryan's hand. She smiled at the Cohens and quickly left the room.
Kirsten and Sandy spent the next hour trying to get any type of response from Ryan, although they both knew he couldn't. The whispered "I don't deserve a family." repeated constantly in Sandy's brain.
He wished he could make Ryan believe how much he did.
* *
Sandy and Kirsten went back to the beach house to pick Seth up for lunch. Lunch ended up being a foursome at a restaurant by the docks. They told Seth and Caleb about their choice regarding Ryan's treatment. For Seth's sake, they played down the possible serious side effects. Seth knew his parents weren't telling him everything. He'd gone on the internet and looked up information on catatonia and how it was treated. He decided not to let his parents know he knew as much as he did. It made him feel better though, that they made the decision to use medicine to help Ryan recover. That's what he'd hoped they would do.
After lunch, Caleb and Seth returned to the beach house. Now Sandy and Kirsten were back in Ryan's room at the clinic watching the preparations being made for his first shot of Lorazepam.
The head of the bed was lowered. The rocking motions continued. Gentle hands held Ryan's shoulders and legs. Kirsten spoke softly to him... telling him Seth was waiting for him. They all were. The clinic doctor lifted Ryan's t-shirt and swabbed an area on his abdomen. The injection was over quickly. An angry red welt appeared almost immediately. Sandy and Kirsten held their breath, waiting to see if Ryan's breathing was compromised. One minute turned into two, to five, to ten. There was no change, just a steady in and out. The top half of the bed was raised again. The rocking motion returned. The feeding pump was brought back to Ryan's bedside, a long tube was coupled to the one in his nose. It was time for lunch.
Legalities have been mentioned ad nauseum.
Tuesday, January 20. 8:05 pm
Sandy fell back onto the bed. He had never been so exhausted in all his life. Kirsten was asleep on the couch in the living room. Seth was in one of the bedrooms of the huge home Caleb called a beach house. He tried to keep his brain from replaying the events of the last 24 hours. The frantic phone call to Dr. Rodriguez... The desperate attempts to get a response from Ryan as he sat on the floor of their front hallway, knees to his chest, arms wrapped tightly around them, rocking back and forth, his eyes empty... The look on Kirsten's face as they all realized Ryan had fled from reality, locking himself away from the world.
Sandy had picked the boy up, startled at how rigid he was. He brought Ryan to the family room couch and laid him on his side, trying to coax his frozen arms from around his knees. Seth had retrieved the throw blanket from Ryan's room. Kirsten took the blanket from him and wrapped it around Ryan, speaking quietly...telling him he was safe. They would protect him.
It was now Sandy's turn to sleep.
Wednesday, January 21.
Seth was the first one up that morning. He padded into the kitchen and tried to familiarize himself with it. He looked for the coffee maker, opening up all the cupboards until he found it, built into the wall. It was one of those ridonculously expensive German-made models. All he needed to do was press a button and a precisely measured amount of coffee beans were ground and deposited into the gold plated filter. A few seconds later, hot water dripped through the ground beans into a stainless steel carafe.
Seth figured out what was wrong with the whole process. There was no coffee smell. The entire procedure was very sterile. Focusing on the product of German design and manufacturing kept his mind off Ryan. The distraction wasn't very long though. His parents had a meeting with Dr. Rodriguez that morning. They all had spent the previous day at the clinic. It was nothing like Seth thought it would be. It looked like a house. Shit, it could have been built by his grandfather. It blended in with all the other Mcmansions in the area. It wasn't as scary as he thought it would be. Everybody looked pretty normal. No one was wearing a strait jacket, but Seth wasn't sure what was normal anymore. Ryan looked 'normal', but Seth wasn't sure if he could ever be 'normal'. A beeping noise startled him. It came from the coffee maker. Seth poured himself a cup and went outside to watch the "stink potters" exit the marina.
* *
Kirsten and Sandy now sat in the office with Dr. Rodriguez. The doctor looked at the Cohens. They were exhausted. She wished she could have been more encouraging. They had gone to see Ryan before the meeting. Kirsten fought back tears as she watched Ryan propped up in the bed, his knees still bent, still rocking back and forth, his hands clenching and unclenching the blanket from home. The only sound in the room was the whirring and clicking of the pump that slowly and deliberately pushed a thick beige liquid through a naso-gastric tube inserted into Ryan's nose and threaded down into his stomach. He sat in the bed, unblinking, unaware of his surroundings. His rhythmic movements didn't stop as Kirsten reached out to touch his cheek. The only colour in Ryan's face was from the new bruises he acquired when he fell to the floor during his desperate escape from the table Monday night. Even his normally blue eyes were faded to a pale grey.
Sandy heard his name and looked up. Dr. Rodriguez was speaking.
"I hope you were able to get some sleep last night...?" She said, looking at the two of them.
"A little..." Sandy said ruefully. "It was too quiet though..."
Kirsten squeezed her husband's hand. She hadn't slept well either, but she stayed on the couch hoping at least Sandy would have gotten some sleep.
"This is rough on all of you." Dr. Rodriguez said sympathetically. "I need to discuss Ryan's treatment with you..." She paused and took a deep breath.
"Ryan is in an extrinsic catatonic state. What that means is there's an identifiable cause for his condition. The underlying reason for his catatonia is emotional trauma. There is no physiological explanation for it. The tests we ran yesterday confirmed it."
"So what do we do?" Kirsten asked. "Do we just wait for Ryan to 'snap out' of it?"
The doctor shook her head.
"Ryan doesn't have that kind of time. Because of the nature of the trauma, he's internalized himself, shutting everything out. The longer we wait to bring him back, the more likely it will be that he won't come back."
Sandy swallowed hard.
"What kind of treatment are you suggesting...?"
Dr. Rodriguez hesitated for a second.
"We've had some success treating extrinsic catatonia with Benzodiazipines, such as Clonazepam or Lorazepam, but they're not without the possibilities of serious side effects.
Kirsten held tightly to Sandy's hand. The only way she could get herself through this was to treat this as a business negotiation. To ask questions and expect answers back. Sandy was also slipping into lawyer mode. Dr. Rodriguez recognized the coping methods. She knew she was right about this family. They could deal with this... With Ryan.
"What kind of side effects?" Kirsten asked, her voice strong and clear.
Dr. Rodriguez pulled out some papers.
"These will help explain them..." She pushed the papers across the desk towards the Cohens. She cleared her throat.
"Benzodiazipines aren't usually used in treatment for someone as young as Ryan, but I don't think we have much of an option..."
The Cohens were staring at her intently.
"We will be prescribing Lorazepam. He'll get 3 injections daily, in either his stomach or backside. There will be some pain associated with the injections. There's also the possibility of respiratory depression or a partial airway obstruction and because his liver had been injured in the accident, we'll be using the lowest dose we can since the drug's effectiveness may be prolonged..."
Kirsten paled at the statement, but said nothing, absorbing the information. Sandy continued with the questioning.
"Anything else...?"
Dr. Rodriguez nodded.
"Excessive sleepiness, confusion, delirium, hallucinations, dizziness, hyper or hypo tension... It could even drive him further into a depressive state..." She hesitated again before continuing. "Suicidal tendencies may be present... We'll take protective measures..."
Sandy shook his head, shocked.
"Is this the only way...? The treatment sounds dangerous..."
"There are some risks with the treatment, yes, but I also feel it's the best shot we have at bringing Ryan back. I assure you that every possible precaution will be taken... I will give you both some time to discuss this... Do you have any other questions...?"
"If we agree to this, can you give us a timetable as to when we could expect an improvement in Ryan's condition, since you said that we don't have a large window of time...?" Kirsten asked.
"Benzodiazipines tend to work quickly. Lorazepam in particular, isn't prescribed for more than a week at a time. It wont be a cure, but it should bring Ryan back enough so his emotional trauma can be dealt with. Barring complications, we could see an improvement within 24-36 hours... I'll leave you alone now. You can page me when you've come to your decision..."
Dr. Rodriguez left the office, closing the door behind her.
It only took a minute for Kirsten to break the silence.
"We should do it... Let's start the medication..."
Sandy looked carefully at his wife.
"Are you sure...? It sounds risky..."
"Waiting would be riskier Sandy... You heard Dr. Rodriguez... She said Ryan probably wasn't going to just come out of it on his own. I know in my heart that this is the right thing to do..."
"We should talk to Seth..." Sandy said quietly.
"We'll tell Seth what we decided Sandy. We're the adults... It's killing me inside that he has to know as much as he does about Ryan, but it would be wrong to keep this from him. Ryan and Seth are brothers... they're our sons..."
Sandy held Kirsten tightly. He prayed they'd made the right decision.
* *
Caleb unlocked the door to the beach house. He brought the first load of suitcases in and returned to his Jaguar for the second. Rosa had packed the bags for the Cohens. As soon as she had let herself into the Cohen's house on Tuesday, she knew something was terribly wrong. Dinner from the previous night was still on the table and on the floor. Plates had been overturned and broken. She called the family, but after getting no answers from their cell phones, she called Caleb. He explained the situation, stressing the need for discretion. Rosa took care of everything. She cleaned up the mess and packed 4 suitcases for the family, tucking in a personal note of best wishes in Kirsten's bag.
Caleb put the last 2 suitcases by the stairs and went to the back of the beach house. Looking through the kitchen window, he saw a pair of long legs draped over the deck railing. Further investigation revealed the long legs belonged to Seth, who was slouched in a chair, watching the boats.
"I could spend hours out here..."
Seth looked up and saw his grandfather standing behind him.
"Hey Grandpa..."
Caleb slid into the deck chair next to Seth.
"How are you holding up?"
Seth shrugged.
"Okay, I guess... I just... I don't know... How could that psycho bitch do that to Ryan...? Her own kid...?"
Caleb had no answer.
"I don't know Seth..."
They sat there quietly, watching boats launch and boats dock.
"Mom and Dad are at the clinic. They had a meeting with Dr. Rodriguez..."
"Oh... Okay..."
Seth eyed his grandfather.
"Aren't you going to ask about Ryan?"
Caleb shrugged.
"I know Ryan's in very good hands... Right now, I'm concerned about you."
Seth slouched further down the deck chair.
"I'm okay, I guess...I'll be better when Ryan gets well and comes home... It was scary watching him flip out like that... and then... nothing... He was gone... I feel like... like someone's playing this nasty joke on me..."
He turned to his grandfather.
"I always wanted a brother. I finally get one and I almost lose him on New Year's. He was just starting to get better and now this happens."
Seth sighed and closed his eyes, feeling his grandfather's hand on his shoulder.
* *
The Cohen's met again with Dr. Rodriguez to inform her of their decision.
"Okay..." Dr. Rodriguez gave them a reassuring smile. "We'll do some blood work and get started..."
Sandy and Kirsten sat with Ryan as a nurse took vial after vial of blood. Ryan hadn't flinched or reacted when the nurse tied the rubber tubing around his arm and found a vein. He just kept rocking. The feeding pump had been disconnected and the end of the naso-gastric tube had been capped and taped under his nose. After the nurse finished drawing blood, she quickly put a band-aide on the site and squeezed Ryan's hand. She smiled at the Cohens and quickly left the room.
Kirsten and Sandy spent the next hour trying to get any type of response from Ryan, although they both knew he couldn't. The whispered "I don't deserve a family." repeated constantly in Sandy's brain.
He wished he could make Ryan believe how much he did.
* *
Sandy and Kirsten went back to the beach house to pick Seth up for lunch. Lunch ended up being a foursome at a restaurant by the docks. They told Seth and Caleb about their choice regarding Ryan's treatment. For Seth's sake, they played down the possible serious side effects. Seth knew his parents weren't telling him everything. He'd gone on the internet and looked up information on catatonia and how it was treated. He decided not to let his parents know he knew as much as he did. It made him feel better though, that they made the decision to use medicine to help Ryan recover. That's what he'd hoped they would do.
After lunch, Caleb and Seth returned to the beach house. Now Sandy and Kirsten were back in Ryan's room at the clinic watching the preparations being made for his first shot of Lorazepam.
The head of the bed was lowered. The rocking motions continued. Gentle hands held Ryan's shoulders and legs. Kirsten spoke softly to him... telling him Seth was waiting for him. They all were. The clinic doctor lifted Ryan's t-shirt and swabbed an area on his abdomen. The injection was over quickly. An angry red welt appeared almost immediately. Sandy and Kirsten held their breath, waiting to see if Ryan's breathing was compromised. One minute turned into two, to five, to ten. There was no change, just a steady in and out. The top half of the bed was raised again. The rocking motion returned. The feeding pump was brought back to Ryan's bedside, a long tube was coupled to the one in his nose. It was time for lunch.