Chapter 7- And Now What
So this one is going to dive into next steps a little bit before tackling ECT. It shall be another one with the different formatting, so be on the lookout for that. Also, this will be a little informative on what ECT is and how Jay handles the news of possibly facing that. Let's get going!
"If I were to tell you that Jay was coming back to work in a few weeks, what would your reaction be?"
Kim
"I would be elated! He deserves a second chance."
Kevin
"A little worried, if I'm being totally honest. Even if he'd been medically cleared, the stress that comes with everything could very easily set him off again."
Hailey
"Of course I'd want him back. He's my partner."
Adam
"As long as he'd been cleared and was being overlooked in terms of meds and stuff, sure. Maybe not going out on the streets. But desk duty, sure."
Voight
"I'd like to hear it was him, like him him, that made the call. It's time he took back the decision making of himself."
"Okay, now what if I said he was coming back to the 21st?"
Kim
"…Umm, well…"
Adam
"No way. I fully want to support him, but no."
Kevin
"….."
Hailey
"I'd be nervous for him, but be there for him. I can't imagine how he'd be going back to where…all of that happened."
Voight
"Keeping his best interest in mind, probably send him to another district. One close by, but I think that would be too much for him to come back to the 21st."
"Last question, Jay has been cleared to have visitors for an entire week now. Why haven't you come seen him. Asking in a purely inquisitive way."
Voight
"Space."
Kevin
"Space."
Adam
"Bad memories."
Kim
"Space."
Hailey
"We're being totally honest here? Like none of this will get back to him?"
"Whatever you say to me, Hailey, stays completely between you and I." She thumbed the chair she was sitting in, adjusted her weight against her criss crossed legs on the seat. She tucked a large section of hair behind her ear as she cleared her throat.
"Because I'm scared. Because I saw how he was that day and…as much as I want to help and see him get better, part of me is very scared to see him again. I don't know how I'm going to react and I don't want to upset him. But I don't know if our partnership is an actual thing or was it the disease guiding things." Things got pretty quiet after that, Hailey chewing the inside of her mouth while the scribbling of Daniel's pen ferociously darted across the pages. Hailey felt so terrible, guilty and evil in some way, but she had to get it out; tell the truth of her deepest feelings to someone. Sleep hadn't been coming along easily since that day, that weight pressing on her, hard.
"So, am I terrible for saying that?" Daniel looked up from his work, a surprised face meeting her dejected one. He took pity on her, very apparent to him that she almost regretted saying what she did.
"No, Hailey. You are not terrible for saying that. In fact, I think a lot of people would feel that way. If this wasn't Jay, would you want someone like that to walk back into the location of his deed and act like nothing happened? No, because people would be nervous that the smallest thing could set him off."
"I mean, I get that it's the schizophrenia that made him do all of that. He was living out what he thought was real, was best for everyone in some twisted way. But then that leads me to other things, like how much of him has been there all this time?"
"I don't mean to say this as a verbal slap or correction, merely a reminder. But Jay has been the same Jay all this time, it's just that there's another layer to him in a way. His mind is tricking him into thinking things, sounds, people are in and around his life when in reality they aren't. So he is still the same person as he was before the psychosis and break, it's just that he has this extra part that he's really struggling with."
"And over time?"
"Over time, with the right mixture of meds and some serious therapy, he's going to be able to live with this. It'll never go away, unfortunately, but he can lead a life, a meaningful and full life with this diagnosis." Hailey nodded, looking down to her lap and twiddling her thumbs. Daniel returned to his writing, brainstorming on how to present things to the board. This was a complicated one, a case that he really wasn't sure how it was going to end.
"Can he still…feel emotions?" Daniel looked up at her, simply nodding with his glasses at the end of his nose.
"Yes, he can still experience all emotions. He can drive, exercise, love, grasp life. There are some cases where people can't, but Jay can still do pretty much all he could before the break."
"How is he doing?" Daniel wanted to laugh so much, roll his eyes and moan. Since Jay's progression to the step down room, he was really testing Daniel's decision to move him. Some days he was completely cooperative and able to function with the hallucinations and voices, but then there were the days of the total opposite. The delusions and imaginary people were completely ruling him. It didn't matter what medication they gave him, he was totally gone. Daniel's mind wandered to the other day, a particularly awful day for Jay and all those caring for him.
"What happened," Will panted when he saw Daniel, the doubling over to breathe gave away that Will had sprinted here. A single worded text to him was all it took these days to be greeted with his presence. His dedication and persistent desire to be with Jay was uplifting, Daniel relieved that Jay had someone like that in his corner.
"He's pretty much locked himself in there. Is threatening to break the IV needle if someone comes in. The delusions are really strong today." Will sighed, loudly exhaling as he returned to a standing position.
"What's he saying?"
"Gibberish. When he isn't stuttering he's yelling random words, and I mean very out of nowhere and none of it going together."
"So…you want me to go in?"
"I think you're the only one that's going get through to him. Remember that it was you that he went to when he had the bigger breaks." Will nodded, looking at the worried medical team crowding outside the door. This felt like a hostage negotiation, except it was Jay on the other side. He couldn't have been more heartbroken and discouraged then in this moment.
"This is normal for treatment?"
"No, once we get him back under control we're going back to the drawing board, going to have to use the stronger, older medication. The side effects are far greater then what he's on.."
"But he could be doing much better then this." Daniel nodded, motioning for Will to go in. He looked to the waiting crowd and nodded a final time before heading to the door. Why was he nervous? This was just Jay, who didn't have anything dangerous on him.
"Jay," Will knocked?
"It's me, man. I'm going to come in all by myself." Will planted his hand on the door handle, pushing it down before pulling it out toward him. He took a breath, broke through the doorway, and closed the door behind him. He was in it now.
So let's start with the obvious, Jay had decided to remove all clothing and had managed to pull his IV line all the way to a corner, the plastic tubing stretched about as far as it could go. Jay was curled up in a ball, head bent in so the near top of his head was touching the top of his knees. Arms were linked to each other, legs crossed at the ankles; for lack of any other description Jay looked like Gollum from Lord of the Rings. This was the first time Will got the full picture of how much weight his brother lost. He essentially was close to skin and bones, bones and joints that shouldn't be poking out Will could trace very easily with a finger. The hair still hadn't come back yet, so the youthfulness and life and normal appearance had been swapped for this ghostly, dying image in the corner. Will was scared, petrified over what had happened to his brother. But right this very moment, Will didn't care. He just had to get him back and under control and clothed; we're dealing with essentials here.
"Jay?! Can you tell me what's going on?" A sniffle crept out from the curled up body, at least it was something.
"Jay.." Will inched closer, making sure to draw blinds shut as he approached his brother, no one needed to see him like this.
"Did something happen?" A blanket was grabbed from the bed, Will taking note of the clothing tossed all over the room, centralized at the bathroom door. Another sniff slipped out of Jay before his head slowly raised from its' perch. It didn't take a facial expert to see Jay really wasn't there. There was not much of him present right now, emotions gone and personality missing as the lost face met Will's concerned one.
"I can't do this anymore."
"Do what?" Keeping eye contact with Jay, Will crept ever closer with blanket still in hand.
"Trust people," Jay whispered.
"Okay…can I ask why?!" Jay rubbed the running snot off of his face, brushing away the residue of tears before contemplating the question.
"I'm not supposed to say."
"Jay, I get that you respect rank and file and confidentiality and all, but it's me. Whatever you tell me stays between us." Jay shook his head, returning to curling up as Will got eye level with him now. He didn't bother asking if Jay wanted a blanket on him, just gently and slowly pulled it over his back.
"No, don't touch me, man."
"Jay, it's just a blanket. Aren't you cold?" Jay eventually nodded. His body was shaking both out of lack of clothing and fear, Will wanting to hug his brother and take all of this away. But alas, things never worked that way.
"Can you do me a favor? Move back to the bed? I closed all the blinds so no one else can see. It's just you and me." Jay took that big leap of faith, undoing the arms first before allowing Will to help him stand up. At this point Will wrapped the blanket all the way around his body before locking him in a side hug maneuver. Once here they both made it to the bed slowly, but successfully. Will helped fixed the tangled IV line before taking a seat next to his brother.
"Now, why can't you trust people anymore?"
"Because…because I was told by a source that everyone in here is secretly waiting to inject the virus in me. I gave them a little bit and they're going to use that to get me to let my guard down." Will nodded, but inside was allowing the waterworks to flow out. This was a doozy of a delusion, one that Will wasn't sure where to go with.
"Who told you this?"
"No, no I can't tell you. I already said too much."
"Jay, remember what I said? It stays between you and I."
"The director." So apparently it wasn't that hard to make Jay break secrets.
"Jay, have you considered that this might be another hallucination of the director? Remember what Dr. Charles has said. You've made really great progress and have earned enough trust in them to be here in this room."
"Exactly, that's their whole plan. Get me to really trust them so they can harm me."
"Jay, I helped you too remember? I would never do anything to harm you, nor would I allow anyone to hurt you as well." That seemed to be the thing that got Jay to wake up, per say. Daniel was right, that despite whatever he or the medical staff did or said or gave to Jay, the two of them had built a trust bond, a deep one that even at this stage was overcoming all else. Will both cherished and hated it, in a way.
"Yeah…but it was so real. Like as real as things were before I got in here."
"I think that means were switching out some meds. These clearly aren't working."
"That or I'm just crazy and nothing is going to help." That was the final straw for Will. He looked his brother right in the eye, which was hard given that Jay was still struggling with that. But he did his best, giving a stern and serious look before speaking.
"Jay, I know a lot is going on inside you right now. I know you're hearing a lot of things and seeing stuff, but I need you to hear this: you are not crazy."
"Okay, whatever," he mumbled, feeling the glares of the director and handler and a random office manager behind Will. It appeared the people hallucinations were increasing.
"Say it back to me." Now the three people were shaking their heads, all yelling terrible things that will not be repeated.
"Shut up."
"Jay, come on. You can do it." Will brushed a hand on Jay's back, fully aware Jay was seeing and hearing very real things right now, hoping a physical touch could grab his attention back.
"I'm not crazy," was mumbled once again.
"Say it again." Jay closed his eyes, shook his head once before going again.
"I'm not crazy." Jay opened his eyes to see nothing but Will. No director, handler, office manager, they were all gone. Oh but don't worry, their voices were shouting in his head. But nonetheless, they were no longer glaring at him.
"Holy shit they're gone." Will eyes went wide, floored that something good came about all of this.
"What do you mean?"
"They're gone, the director and stuff."
"Jay, that's awesome. See? Things are working!"
"Yeah, for now…can I put clothing back on?"
"Dr. Charles?" Daniel jolted back to reality, his daydreaming instantly vaporized as he met Hailey's concerned face. They were back in his office, returned to the midday meeting about where to go next with Jay and who would welcome him back. Hailey was still sitting in the chair and the clock was ticking off seconds faster then ever, Daniel was convinced.
"Daniel?"
"Oh, yes. I'm so sorry. The mind and it's wandering what was the question?"
"Jay, is he doing okay?"
"He's…progressing. It's a long process with a lot going on, but everyday he's coming a little more to the surface." Hailey only nodded. It wasn't the answer she was looking for, Daniel concluded. But in actuality none of them were sure of what she was looking for. There wasn't a miracle that was going to take all bad things away and keep Jay perfectly in tact. This was him now and forever, over time they'd all accept that.
"I'm so sorry, Hailey. But I have to get to another meeting," Daniel announced as his timer went off on his phone. They rose from their seats in unison, Daniel collecting his things while Hailey stretched herself out before putting her jacket back on.
"Can you…tell Jay that I hope he's doing okay?"
"Of course. And can you do something for me?"
"Yeah, anything."
"Think about coming to see him. It doesn't have to be tonight or tomorrow or the next day, whenever you feel comfortable seeing him again." She could only nod her reply, side stepping him as she headed for the door. She couldn't wrap her head around why was she was so scared of Jay. Was it the fear of a possible reality, or a dread in knowing it could likely be true. That was a question to answer on another day.
…
One of the many wonderful features of the step-down floor is the homey-ness to the place. There is a kitchen, living room, dining area and workout department down towards the outskirts of the floor. The point was to try as best as possible to simulate home life while also residing in a hospital that provides medication and schedules and control from the outside. This was the floor where long-term patients spent the most amount of time, thus the reason to help them feel as at home while being stuck in a hospital. Daniel walked around the department in a rather frantic pace, his search coming up empty in the bedroom, workout area, family room before sighing as he watched Will coaxing Jay into eating something he made. It was a PB & J, we're talking very basic introductions to food here. Jay was just staring at it like it was a snail while Will perpetually coaxed him into taking a single bite. It was both humorous and heartwarming to see the progression since that bad setback day a little over a week ago.
"One. Bite. That's it! You won't get sick, Jay. I swear everything is kosher and wonderful and you'll like it."
"Kosher? As in salt?" Two things were vastly different with Jay. Difference number one was PIC line. That was installed in his forearm about four days ago. It took sedation and coaxing and a few tears may have slipped out as well, but now it was close to impossible for Jay to pull his IV out ever again. The second difference was a more encompassing one: he was far more subdue. The older, stronger medication was providing a night and day difference. What was once all over the place and experiencing breakthrough days and gibberish conversations was now fairly calm, floating, even keel chunks of life during the day. The side effects of this was extreme nausea and headaches and big mood swings if medication wasn't given in time, but things were finally, mercifully, improving. Furthermore the visual hallucinations were coming down in number. Three was down to two and those weren't as scary and constant as before. Some days it was all the time while other days it was clumps of time here and there. Jay often described them as just sitting, taking notes and looking at him, but weren't as daunting and demanding as they were before. The audible hallucinations were also getting more manageable as well. Jay said it was more like sitting in Starbucks in the midmorning, hearing all talking happening behind him. He could pick up a word here and there, but the death threats and terrible commands were starting to back off as well. Finally, after almost a month of trial and error, something was finally giving them headway. Perhaps the biggest, most upsetting side effect was the monotone, mechanical tone and characteristic to Jay, but for now they were okay with it. So one may ask why they still needed to talk about ECT, that if drugs and therapy were working then why take such a drastic step. Well, let's get into that.
"Hey you two," Daniel greeted them, Will rolling his eyes in frustration as Jay kept eyes glued to the food in front of him.
"You laced this with something. You didn't let me watch you make it."
"Do you not recall me saying that I wanted you to trust me? Jay, I swear there's nothing else in here except for peanut butter and jelly. Please? A single bite." Jay stared at the sandwich for ten seconds, thirty, forty-five before picking it up and staring again.
"You're sure?"
"On my life, I swear there's nothing in it." This time the staring was a full minute, but then Jay opened his mouth, pushed food in and bit before pulling back. In about five chews the contents of the sandwich were heading into the digestive system.
"Yeah, it tasted fine."
"High five! That was awesome, Jay." Will was way too excited and Jay was severely drugged, so the meeting of the two at the hand was comical yet comforting. They were finding their way through this new rhythm of life.
"Okay! Now that we have eaten, let's talk about ECT." ECT, or electroconvulsive therapy is a non-invasive procedure that dwindled down to things is an induced a seizure in an effort cause changes in the brain chemistry. The way in which ECT induces a seizure is through electrodes placed on the temples of the head and electrical currents are passed through the brain. The seizure is done under anesthesia and lasts about a minute at the most. While there isn't cut and dry evidence that ECT works effectively every single time, multiple studies have proven that the procedure does change various parts of the brain, depending on the patient and their brain chemistry. The big taboo surrounding ECT is thanks in part to its' not so humble beginnings. Early on large amounts of electricity were passed through a patient, which understandably lead to terrible side effects like permanent memory loss and broken bones. But thanks in part to large medical advancements, ECT is far safer and appears to be more effective then it's beginning uses. All of this was told to Jay who neutrally stared at Dr. Charles presentation. It was just words to him, none of it really making sense nor was he seeing how it applied to him. Will meanwhile kept his eyes fixed on Jay. He figured this would be upsetting to hear and possibly set things back for them, but the fact he stayed in the room and had questions afterwards showed signs of hope.
"So is this a one time thing?"
"The whole thing takes about half an hour and unfortunately requires multiple session in order to see true changes."
"But how does this apply to schizophrenia?"
"Well, it's not a common treatment, that's for sure. Most of the time it's used for very bad depression, but in some cases it can be used for those with schizophrenia. When you have prolonged catatonic states, which you do have, and bad psychosis, which we know you have, the use of ECT has strong evidence that it does something to help change that. It could either lessen the symptoms or maybe make them obsolete for a time." "But what about the delusions and hallucinations?"
"Unfortunately it won't help with those, that is one of the great mysteries pertaining to schizophrenia. We aren't totally sure what causes it. You can't scan a brain to find a deformity or do blood work to find insufficient things. It's just there and with medication and therapy we can help make that more manageable."
"So I'm deformed?"
"No, no your not," Will was quick to jump in.
"He meant that with a brain tumor or something, you can see where something is wrong and fix it. With schizophrenia it's invisible to the human eye, so while we can't see it, we know it's permanent and know that the meds and therapy help."
"Could this make the schizophrenia worse?"
"We don't know for sure, but I can't recall any research that supported that."
"So this is basically to help with things that could happen in the future and the black outs."
"Yes, and who knows. Maybe it'll help with other things."
"Am I awake for it?"
"No, you'll be asleep the whole time. You might wake up with some confusion and definite soreness, but you won't feel the seizure."
"Will it get me out of here?"
"Wow, it only took you three weeks to ask that."
"I've been in here for three weeks?"
"Yeah, welcome to being in the psych ward." Jay shook his head, sighing as he went back to the original question.
"Will it?"
"Yes. I'd like to do the first couple of sessions while you're still an inpatient and then, depending on how you do, I'd like for you to take part in our outpatient program. We'll talk more about that when we get there."
"Then let's do it. I can't stay here forever. I don't think I could make it."
"And that is never my goal, Jay. More then anything I'd like for you to leave here and live as normal of a life as possible. No one should live in a hospital forever." Jay looked over to Will who was beaming with excitement at Dr. Charles, who was also unable to hide his happiness. It took some time, but there he was after all. The downside was that at this point it would be a quick glimpse between seasons of out of character periods of time, but to hear Jay talk like that brought so much light and hope to the moment. Poor Jay was so lost and foggy that he was having a hard time figuring out why the two of them were behaving this way.
"What."
"Oh, you just sounded like you for the first time in awhile."
"Oh…okay," Jay responded while taking a second bite of his PB&J.