Roman had been dreading this for a long time. It didn't feel like a doctor's office as much in here. The room was actually bright and cheery. There was Spongebob playing on the TV and it was well lit with windows that had pastel blue sheer curtains. But it was still a doctor's office. The one Roman had been afraid of for ages, sitting in a pit in his stomach. Thomas was in the chair next to him in the waiting room reading something on his phone. Well, while Roman waited. He wanted to go in alone, and Thomas was fine with that.
"Go on in, Mr. Reinhart, he's almost ready," The receptionist said after another person his age came out of the room. Thomas rubbed his back while he swallowed nervously. Roman nodded to Thomas and got up to head into the office.
The room was… not what he was expecting. It didn't look like an inch of the place was free of cartoon memorabilia. It was much homier than the sterile doctor's offices he was used to. Well, cozy for a massive cartoon nerd, at least. Roman had seen enough cartoons while babysitting that he recognized most of them. He sat on the big brown couch against the arm. It was soft, but Roman didn't appreciate the way it creaked when he shifted.
"Ba-ba-da-ba-ba-ba-ba-ba," A voice trilled from behind the door. Roman jumped at the sudden noise and stared in disbelief at the guy in a bubblegum pink tie and tan cardigan standing behind it. He continued singing a little quieter behind the door, shoving his arms through the crack like some kind of eldritch beast. What the absolute fuck was happening and how the hell does he stop it?
"Hello, I'm Dr. Picani! Do you how do?" He spoke cheerily as he plopped down in a large plush chair right across from the couch. Roman blinked at him for a moment. "Did I dazzle ya too much?" He asked brightly, tilting his head. The strong mid-western accent was surprising.
"To… say the least?" Roman replied, completely unsure of how to deal with this person. He was used to doctors being old stuffy dudes who made everything out to be a technical issue and not a problem with a human being. This was a soft 30-something guy with poofy hair and a dopey smile.
"Well, it's nice to meetcha, Roman! Today will not be a typical session, just t'give ya a head's up," Dr. Picani informed him as he tapped around on a tablet.
"Yes, uh, I gathered that," Roman nodded, unable to tear his eyes away from this absolute Jigglypuff of a human being.
"So, first thing is first. Based on what I was told by your guardians and the referral, I've set up some questionnaires. This'll help me get a baseline to diagnose ya a little easier. The answers are private, only I'll know, and I need ya to answer with as much honesty as Applejack. Once I have some ideas, I'll ask ya some questions to finish narrowing it down," Dr. Picani explained and passed over the tablet he was tapping around on.
Technology really was something. Something he wanted to burn. He hated some of these questions and wished that the combination of words didn't even exist. He didn't like how most of them seemed to ask for details about stuff he specifically was trying not to think about. A few questions made Roman feel like he was obtrusive, pointing out things he did in a way he hadn't noticed before. Some of them were strange and asked if Roman thought he had magic powers or referred to something called 'jelly legs'. He was curious about what Patton and Thomas had told the doctor. The ones about his social preferences made him wonder what they were looking for, too. Some questions were nerve-wracking in general because that meant Dr. Picani already knew to ask them. Roman's brain felt fried by the time he handed back the tablet to the doctor.
"Why don'cha grab a water bottle while I take a quick look-see?" Dr. Picani suggested and pointed to a mini-fridge right next to the couch. Roman leaned over and opened the clear glass door to grab a bottle. He stared at the toy-covered top of the mini-fridge for a moment before he cracked the seal on the plastic bottle and took a sip.
"Is it bad?" Roman asked quietly. Dr. Picani's face was impassive as he looked at his tablet, and that was unsettling. He expected more of a reaction.
"Well, there is one thing that is concerning, and I'll get t'that in a minute, but your answers aren't bad. It's just some questions that help me narrow things down, not a gauge of you as a person," Dr. Picani explained, looking up and meeting Roman's eyes with a reassuring smile. Roman sighed and grabbed the throw on the couch to hold up the water bottle in his lap as he leaned back. "Alright, ya may have seen some confusing stuff on there that ya didn't relate to, and ya don't need t'be worried about that," He said, tapping the tablet a few more times before putting it down.
"That's good," Roman replied quietly, starting to peel at the label on the bottle.
"Can ya tell me a little about your hobbies?" Dr. Picani asked, and that was a surprise. He thought he'd ask about the 'concerning' one first. Unless his hobbies were what was worrisome?
"I like stuff I can do with my hands the most, but I'll try whatever," Roman tried to sound even but his voice was a scant shaky. He seemed nice enough, but Roman hoped he didn't have to get into anything too complex today.
"How are your relationships with your friends?" Dr. Picani asked brightly.
"Ah, I just moved here," Roman attempted to explain but didn't have the right words for it. "Um, so, we kind of talk online sometimes," He admitted sheepishly. Roman hadn't been messaging much with all that had been happening, either.
"There's nothing wrong with internet friends, kiddo! Not seeing Enzo doesn't mean he's not real!" Dr. Picani declared brightly, flourishing with his pen.
"Who the hell is Enzo?" Roman furrowed his brows.
"He's probably too old a reference for you," Dr. Picani smiled and wrote something down in his notebook. "How do ya feel when you get bored?" He continued on, and Roman was frustrated that he didn't just explain. He'd have to google it later.
"I hate it," Roman said intensely, pausing with his slow decimation of the water bottle to stare at the doctor emphatically.
"Would'ya say ya hate it as much as The Grinch hates Christmas?" Dr. Picani leaned back in the chair and made another note.
"If I could steal all the boredom from the planet and suffocate it in a sack then chuck it in a cave, I would. I'd be doing the world a favour," Roman replied severely.
"What would ya say ya spend most of your time doing? Other than school, that is," Dr. Picani asked, holding up his pen.
"Uh…" Roman paused. "I actually have no idea. I do stuff, I know I do…" Roman dropped his head and tried to think of what the hell he wasted all of his time with, but he kept drawing a blank or coming up with answers that weren't accurate.
"How do ya do with time?" Dr. Picani continued, and Roman was surprised he took 'I don't know' as an answer. Most people refused to.
"Terribly," Roman said glibly, looking back down at his water bottle to keep peeling off the label in a long thin strip.
"These next ones are a little uncomfy, and if ya need time to answer them, just let good ol' Dr. Picani know, alright?" Dr. Picani asked, and Roman looked up briefly to nod in agreement. "How do ya do with emotions?"
"Oh, uh, I don't get them, I think," Roman admitted. He knew he was bad at handling them, but he was even worse at parsing them. If Roman didn't feel them intensely, or felt them too intensely, his emotions got muddled and incomprehensible. "I mean, uh, understand them," He corrected his statement, realizing his first statement sounded like something different than he meant.
"Would ya say ya can't control them?" Dr. Picani continued to write in his notebook with a small scratching sound from the pen tip on the paper.
"Sometimes," Roman chewed his lip nervously. He didn't want to get into that. He peered up to Dr. Picani through his bangs, and he looked as pleasant as ever.
"Do ya get seemingly random mood swings that can be intense or overwhelming?" Dr. Picani's calm way of talking about this stuff was reassuring, but Roman didn't feel good about it. His anger issues were a sore spot for him. It sort of felt like there were things wrong with his head that were out there and he couldn't take them back, so he could probably give in to talk about some. But he still didn't want to admit he couldn't control his anger out loud.
"I mean, I wouldn't call them random," Roman replied quietly. "I usually have a reason for getting mad… or um, sad, or whatever, and I can settle down if I try hard enough, but I'm bad at controlling myself sometimes. And I don't swing to 'happy', either, if that means anything," He explained after a short pause. Dr. Picani nodded and made another mark in his notebook.
"Do ya often worry about people abandoning you?" The doctor pushed up his thick-framed glasses with his pen.
"Oh, no, I'm used to that," Roman chuckled and waved his hand. "I'm fine with being alone," He added, though his tone was much less amused.
"Do ya ever feel compelled to do certain things strongly? And not compelled to eat a particularly tasty looking cookie, I mean something like a comforting ritual," Dr. Picani twisted his pen hand in the air as he clarified.
"Kind of? I, uh, don't know where the line is between feeling compelled and being impulsive, to be honest. I'm impulsive as fuck," Roman explained, twisting the bottle in his hands to keep making the thin strip of the label.
"Huh," Dr. Picani tapped his chin with his pen. "I think for the sake of this we'll consider those distinct an' not related, but that's some food for thought. I would say a compulsion seems more rational than an impulsion, and that impulsions are more random," He said thoughtfully, looking up at the ceiling. It was strange that it hadn't come up before Roman. "How long d'your periods of depression last?" Dr. Picani continued on with his questions.
"What?" Roman looked up in surprise and furrowed his eyebrows at Dr. Picani.
"How long ya feel down on yourself, hopeless, and can't bring yourself t'do things? Maybe think about how long it is between times when you can enjoy things if that helps you," Dr. Picani elaborated and Roman still felt confused.
"Isn't 'periods of depression' kind of an intense way to say I get sad easily?" Roman asked, wobbling his free hand at Dr. Jigglypuff.
"Roman, while I can appreciate the optimism, you scored a 23/27 on the depression screening. That's severe depression, and with your other answers I already confirmed it. I just need t'find out if it's major depressive disorder or not," Dr. Picani shook his head sadly. "Ya said that some days ya wished ya were dead or sometimes think about hurting yourself. That's not normal sadness," He gave Roman a meaningful look.
"Oh," Roman breathed. "Um, I need a minute," He added and took a sip of water, staring at the floor. He kind of already knew, but it hurt to hear. Part of him thought he was being dramatic. A bigger part of him just didn't want to think about it. Acknowledging the truth almost hurt. His chest was heavy and his brain felt burnt to a crisp. Maybe he was feeling kind of numb or it hadn't fully sunk in. Roman exhaled and pulled at the label some more.
"Whenever you're ready," Dr. Picani nodded and looked down at his notebook. It kind of looked like he was doodling with the big loops Roman watched his pen take. He appreciated the doctor sticking his tongue out a little as he sketched. It sort of knocked him off the mental track he was on.
How long was the last… depression episode? The last time Roman wished he was dead actively was when he went for a devil's hour stupidity jog, but he was still fucking bummed about getting kicked out of the Finleys before then. He wasn't sure how many days that was if he counted that.
"Um, what's the difference between being upset about stuff in life and… that?" Roman asked, drumming his fingers on the water bottle.
"It's the difference between Tigger and Eeyore!" Dr. Picani piped up. What? What the fuck. Roman just blinked at the pink-tied poofball who very clearly had a one track mind. "When Tigger found out he had no biological family, he was sad, but he bounced back when he realized he had found a family in his friends already after a little time to heal. On the other hand, Eeyore is sad about everything. Sure, it's reasonable to be sad when your house falls apart, but Eeyore doesn't feel like he can bounce back from anything," He flicked his pen in the air as he spoke.
"Does that mean Piglet is anxiety? Was Winnie the Pooh a show about mental health problems?" Roman's eyes went wide.
"No, no," Dr. Picani held out his palms and shook them. "But yes, Piglet shows signs of moderate anxiety. Just like you! He's still able to do things, but he can't help but always worry. Ya probably scored a little less than he would if he could take the screening, but enough that I am already positive ya have it," He nodded slightly.
"Shit, how many things do I have?" Roman accidentally gripped the bottle and made a plastic-y crunching sound.
"It's not Pokémon, Roman! It's not about the number. Most mental illnesses have comorbidity. That means they come in groups. Patients who have depression have anxiety 60% of the time," Roman didn't have any idea what to say to that, so he looked down to the water bottle again and returned to peeling. "So, do ya know how long you're stuck feeling down in the dumps and incapable of anything normally?"
"What? Oh, uh, I guess a week or so the last time," Roman replied, having to take a moment to process. He was kind of distracted by the surprisingly mature themes he didn't realize were in Winnie the Pooh. Did the other characters show signs of things?
"Have ya ever acted on any of your thoughts about hurting yourself or wanting t'die?" Dr. Picani asked and holy shit that question hit him like a brick, knocking him out of Winnie the Pooh land in an instant and causing him to accidentally tear his water bottle label strip. "Are ya alright?"
"Yeah, uh, just a bit of emotional whiplash," Roman muttered and rubbed his head. "I used to do the… 'hurting yourself' one. I also tried the other once. I don't do either anymore," He admitted quietly.
"I'm happy t'hear that," Dr. Picani smiled softly, and it was so amazingly genuine Roman felt weirdly emotional over it. "I should give ya a heads-up that as a minor I'm afraid I have t'tell your guardians so they can keep an eye out for ya so you don't fall into those dangerous coping mechanisms again or make a dangerous decision while you're having a depressive episode," He sounded a little remorseful about that. "Well, if you promise you haven't done it in a long time and know you won't do it again, I will let it slide for now unless I see some concerning behaviors," Dr. Picani added.
"I… honestly don't think they'll be surprised. I don't want to bother them or anything but I had a reason for starting and if it comes up I'm not sure what I'll do. And I don't like feeling… well," Roman shook his head. He couldn't really finish his thought, but he hoped the doctor understood enough. He grunted in frustration when the label strip tore and he had to start a new thin strip.
"So you're not worried about your guardians reacting badly?" Dr. Picani asked kindly.
"Huh? Oh, yeah, I'm safe at home. They'll freak out, but I let it slip this weekend and I pissed off my brother and he kind of got told me off, so I dunno… I feel like I should listen to him. The foster parents freaking out just means I have to sit in the living room instead of my bedroom. It's not the worst," Roman shrugged dismissively. He was probably going to play that fighting game on the TV, anyway. He wanted more practice. Roman returned to peeling at the label of the water bottle to make a long, thin strip.
"Well, barring the results of a blood test, I think we've got our diagnosis, Robin!" Dr. Picani announced, holding his pen aloft proudly. "I'll have your guardian take you for labs, but I can tentatively tell you now if ya like. If ya think you might not want t'hear it, we can put it off until next time. We can also just discuss what t'do moving forward and not name 'em for now," Dr. Picani gave him his options as he started writing on a new page.
"Tell me," Roman responded quietly. He couldn't take not knowing.
"Severe depression and moderate anxiety, which I already mentioned, are two of them. I'd like to test your serotonin and dopamine levels to see if we should consider medications. With severe depression I generally recommend it, but prescribing things to teenagers can be tricky," Dr. Picani said distractedly.
"I'd rather not go on meds," Roman blurted out.
"Roman, there's nothing wrong with medication. It's here to help ya feel more functional and capable. It doesn't change who you are, and if it makes you feel a way ya don't like, we can stop. There're plenty to try," Dr. Picani tried to reassure him, but he'd still avoid it if he could. That was another thing he'd owe the Sanders and need going forward from any other foster parents and he couldn't stomach the thought right now.
"I just don't," Roman insisted, shaking his head.
"Alright. I'll respect your wishes, that's a part of therapy too. If things become worse or ya don't respond to therapy, I'll likely recommend them again. Sometimes your brain chemical stew needs the help an' there's nothing wrong with that," Dr. Picani reassured him. Roman paused, feeling astonished once more. This ridiculous pink person kept doing that. He thought he'd get forced to take them if a doctor wanted him to.
"Thanks," Roman nodded and took a sip from the bottle he was halfway through shredding the label off.
"Alright, the next one I think ya already know. Your guardians picked me because I have a specialty in PTSD, so I assume something came up. They mentioned you have panic attacks and disassociate. Ya also scored 100% on the screening. However, I think it may be C-PTSD. I'd need t'talk to ya more, but I'm pretty positive based on your medical record alone," Dr. Picani tapped the top of his notebook twice as he talked before resuming his writing.
"What's the difference?" Roman asked, hoping the variation wasn't even worse than what he'd already found out about it. Roman didn't want to look it up online and see how fucked up he was.
"C-PTSD is usually the result of extended, long-term trauma. Complex Post Traumatic Stress Disorder has a few more symptoms associated with it. You have an idea about emotional distress and physical symptoms for PTSD, right?" Dr. Picani started to explain. Roman nodded for him to continue. "C-PTSD also includes an inability to regulate emotions, extreme guilt, and a distorted perception of events. Your questionnaire reflects part of that, but your guardians mentioned those, too. If you're not ready t'talk about that, don't worry, we won't be doing that today," He said markedly, nodding a little.
"Oh," Was all Roman could think of to say. If his brain was fried before, it was burnt now. He didn't know how to process this, and he wasn't sure he even wanted to.
"Remember how we talked about co-morbidity? I checked for a few more things while I was at it. There're a few disorders that have lots of overlap. Ya scored enough on Bi-Polar and Borderline Personality Disorder for me t'double check, but ya don't seem t'believe ya have drastic mood swings, both from your own statement and the questions. I think you know you the most and if that's not something you struggle with, I trust your opinion over what the questionnaire implies. As for BPD, you're possibly too glib about people leaving ya, even if ya seem t'have troubles with similar symptoms. I may change my diagnosis later if I see certain things, of course, it's all a process. The blood tests will help with that too, but I've been working with these disorders for a while and I recognize the signs. That leaves attention deficit hyperactivity disorder," He explained evenly.
"Like Percy Jackson?" Roman perked up. He was a little lost there for a minute, but he at least had a general idea of what that was.
"Well, not exactly," Dr. Picani shook his head. "The representation in those books isn't super-duper accurate," He made a circle with his pen in the air.
"Yeah, but like Percy Jackson?" Roman asked again, finally finding something he could feel okay about.
"Yes, but only in a sense," Dr. Picani agreed tentatively. "I take it ya like the books?" He asked as he resumed writing.
"Hell yeah, I like the books!" Roman sat up straighter. "Percy's so awesome and I can appreciate all the 'bad parents' jokes and sword fights," He nodded brightly.
"Well, as I said, the representation isn't realistic, but it's helpful to have an idea, nonetheless! There're two kinds of ADHD, inattentive and hyperactive. Ya scored almost evenly for both, which means you're the' combined type,"
"I thought you said there were two?" Roman arched a brow at Dr. Picani.
"What can I say other than sometimes medical terminology is confusing," Dr. Picani shrugged. "I assume ya also don't want medication for ADHD?" He asked while he started writing in the notebook. Roman nodded mutely, not looking up. "Alright, then once again we'll be putting extra emphasis on lifestyle changes," Dr. Picani held up his pen and jiggled it a little in the air as he announced it dramatically.
"Does this mean I have to cut out sugar? Because I just got a bag of skittles and I'm finishing it," Roman said emphatically, narrowing his eyes at Dr. Jigglypuff.
Dr. Picani laughed, looking surprised. "No, the idea that sugar makes ADHD symptoms worse is a myth. And caffeine can help in some instances, too, it's not detrimental. You shouldn't over-indulge in either, and with your issues, I'm going to recommend no more than 150 milligrammes a day and no later than 4 PM for now. Don't go over that and try to keep it under five days a week. Prolonged caffeine consumption can cause migraines, and you're already at risk for those," He pointed out.
"I am?" Roman asked curiously.
"Yup! Depression and C-PTSD can both give migraines. That's about three cups of black tea or a cup and a half of coffee for those of you playing along at home, by the way," Dr. Picani winked at Roman, pointing at his eye with his pen.
"You are an absolutely bizarre person," Roman blinked at him.
"Thank you! I am a perky Pikachu! And don't worry, I am recording all of this down for ya and the guardians," Dr. Picani flipped his notebook to show a sheet with a long list of bullet points. There was a sketch of Buttercup from the older Power Puff Girls cartoon on the other side. He flipped it back and returned to writing. Yup. Roman's brain was absolutely a charcoal briquette, because he had no idea why he was laughing.