Greetings, dear readers. Thank you so much for the reviews on the last chapter. I am getting my computer fixed this week, so updates should come more frequently from now on. This is another one of those chapters that requires you to excuse my blatant lack of medical knowledge. I am not a medical professional, so there are some things I, not to mention our dearly beloved Ms. Rhimes, cannot (or did not) explain, so again, I had to get a little creative. I hope you all enjoy despite the medical discrepancies.
"Dr. Hunt, it's been twelve days. She has regained all of her motor skills, and her PET scans show completely normal brain activity. I'm going to once again strongly suggest that we move her up to psych, immediately."
Cristina was lying on her side in her hospital bed as she had done for twelve days now, listening to Dr. Hurst give Owen his spiel for the fifth day in a row. Her breaths were even, her eyes, dead. Just let him do it, Owen. Get me out of your hair, already.
She could see the disgust on Owen's face at the doctor's suggestion. He scoffed and shrugged the man off. "If she's fully recovered, then under what pretenses do you feel she needs to be up in psych?"
Dr. Hurst, clearly agitated at this repetitive conversation, responded urgently, almost angrily, "Don't play dumb with me, Dr. Hunt. You and I both know what I meant."
Owen rolled his eyes. "This is ridiculous. I need to-"
"Has she spoken?"
"Dr. Hurst, respectfully, I am trying to run-"
"Has she gotten out of that bed?" His eyebrows were raised and he took a largely offensive stance. "Is she still having those episodes when she sleeps? Has she shown the slightest bit of emotion since she arrived?"
"In case you've forgotten, as her file states," Owen responded with agitation, slamming his index finger into the clipboard, "she did, in fact-"
Dr. Hurst crossed his arms and rolled his eyes. "Dr. Hunt, you're kidding yourself. She's catatonic! If she had shown that kind of emotion-"
Owen looked at the man incredulously, an intimidating half-smile, half-scoff crossing his lips. "If? Are you insinuating that I'm lying about the tears I distinctly felt on my hands?" Owen squared up to the doctor, taking a step closer to him. "Do you really have the balls to stand there and speculate that I would do any less for my patient, no less my wife, than give her the best care I can give? Is this what a man does, Hurst?" The opposing doctors had attracted quite a crowd with their argument. "Does a man berate his colleagues into doing his bidding by accusing him of neglect?"
Knowing that he had crossed a line, but unwilling to back down, Dr. Hurst met Owen's icy glare with a milder expression. "I'm simply requesting that you recognize the extent of her condition. If you'll just hear me out, you'll see that, though her physical condition has improved substantially, her psychological state is regressing. Things were looking up for a few days, correct? She began eating and moving her arms willingly, on her own accord-"
"She's still doing all of those things, Hurst." Owen spoke in a low, menacing voice as he challenged Dr. Hurst.
"Which means she is physically and mentally unaffected, but what troubles me is her psychological incapabilities. For a full week, she was able to express at least some emotion to you and to Meredith Grey, this I don't deny, but how long has it been since she's exhibited those behaviors?" Owen remained silent, continuing his stare down. "She's fully capable of getting out of bed, but she won't. She's fully capable of speaking, but she won't. Her brain is fully functioning. She can hear every word; see every detail, yet she remains completely mute and expressionless and has for five consecutive days." With every word, Owen's nostrils flared wider and wider. His knuckles were white against Cristina's file, which he gripped as a means of restraint. His eyes never faltered from Dr. Hurst's confident stare as he blocked out his opponents evidence. "She's suffering a psychotic break, which now presents itself as catatonia, this I'm sure you can agree with me on."
Owen gritted his teeth. "Catatonia presents itself in schizophrenic patients. Further, symptoms of psychosis consistently include violent behaviors, which Cristina hasn't displayed since her first day here."
Dr. Hurst heaved an exasperated sigh. "Yes, catatonia most commonly presents itself in schizophrenic patients, and yes, psychosis symptoms most commonly include violent behaviors, but you've been a doctor long enough to know that there are no absolutes in medicine, especially in psychiatry. If you would just give me three hours with her in psych, she will come out of it. I'm sure of it."
"I brought you onto this case for one reason and one reason only. You were supposed to tell me five days ago, why she was still unresponsive. That's it, and I still haven't heard a reason."
Dr. Hurst lowered his head and paused. He knew why. He just needed to structure his argument so that Hunt would listen to him. "Does she still have episodes in her sleep?"
Owen's gaze transformed from one of boiling rage to one of blatant confusion. He answered Dr. Hurst with a simple "Yes."
Dr. Hurst nodded. "My official diagnosis is psychosis presented in the form of catatonia, brought on by extreme trauma and sleep deprivation." Owen quietly listened to Hurst's evaluation. "The lorazepam allows her to sleep, but each time she falls asleep, she assumedly relives the crash over and over again, causing restlessness, correct?"
Owen loosened his grip on Cristina's file. "That's our best understanding, yes."
"Mine as well," he said with a solemn nod. "As I'm sure you know, this is a problem for a number of reasons. Firstly, when she arrived in Boise, she hadn't slept, eaten, or taken in any fluids for four consecutive days. Even if she had drank water and managed to find a scrap of food here or there, the exhaustion would have been astronomical. The fact of the matter is, as often as she has to either rouse herself or be roused from sleep to escape her nightmares, she is still, twelve days later, severely sleep deprived, which leads me to my second point. It's my understanding that you have stayed up several nights with her after she's woken up from a nightmare because she refuses to go back to sleep, right?"
"We have been administering heavy doses of lorazepam to try and get her to sleep through the night, and in the beginning, we would sedate her a few hours after she would wake from the nightmares to try and get her to sleep again, but she would always stir the same way. We figured it was more productive to give the heavy doses from the get-go instead of sedating her more than once in a given night. She does sleep more with the higher dosage, up to six hours, in fact." Had he really been so blind; so stubborn as not to realize that she needed psychiatric help? Owen's face contorted in confusion again. There was still one thing he didn't understand. "Bu-Hold on. If she's getting even that much sleep, she shouldn't still be sleep deprived."
"My second point is twofold. The nightmares clearly had their effect on Cristina in the beginning, but not so much so that she would fear sleeping. She has now had twelve consecutive nights of repeated nightmares, causing her to become anxious at the thought of sleep. Sleep has become associated with nightmares for her now, causing her to fight it off as much as she can, which is why you've upped her dosage of lorazepam. Unfortunately, the problem doesn't stop there. Even though she gets more sleep with higher amounts of sedative, her sleep is restless and further, taxing to her central nervous system, preventing her from entering REM as she needs to in order to achieve an adequate amount of sleep. It's a catch-22."
Owen thoughtfully considered the doctor's prognosis. His own fear of psych had allowed him to see what he wanted to see. She was improving, so he simply deduced that she would continue improving and if she didn't, he would take action, but he had to give her time. The reality, however, was just what Dr. Hurst had said. She had improved as much physically and mentally as she was going to, but her psychological state had run aground after a mere fraction of improvement. "What would your treatment plan be?"
Dr. Hurst suddenly looked insecure, rubbing the back of his neck. He struggled with his words, trying to approach his argument with hope, but in truth, he knew Hunt would not like his answer, hope or no hope. He needed something absolute. "Lorazepam is the drug of choice in treating catatonia, which means we can cross one option off the list, given that it hasn't yielded many results in Cristina's case. At this point, we have a few options. We can go down the list of BZPs, particularly diazepam, oxazepam, and clonazepam. She may simply be resistant to BZPs. In that case, many studies have found that zolpidem yields excellent results as well. Between those four optio-"
"Wait." Owen held his hand to his head, organizing his thoughts. "Are you suggesting that we just throw these medications at the wall and see if they stick?"
Dr. Hurst shook his head adamantly. "Not at all. I've done a lot of research on this, and one of these will almost assuredly work. You understand that I can't give you any absolute guarantees, but these are proven by clinical trial to have worked on catatonic patients; severely catatonic patients, I might add, far surpassing Cristina's condition."
"But we might have to pump her full of every one of these meds to get her there, right?" Owen crossed his arms over his chest.
Dr. Hurst shrugged. "It just depends. I tend to be a glass-half-full kind of guy, myself, so I like to remember that the odds are more in our favor that the first one we try will work."
Owen looked at the floor, dejectedly. "Psychiatry's never been my thing, so correct me if I'm wrong, but it's my understanding that you have to perform several trials on her with one drug, increasing the dosage each time she doesn't respond to it, until she's maxed out on that drug, then proceed to the next one. Am I right?"
Dr. Hurst nodded. "That is standard procedure, yes."
Owen nodded thoughtfully, staring at the floor. He was conflicted. He either took the risk of keeping her where she was, causing further regression, or sending her up to psych where they would keep her for months and simply experiment with drugs that could severely affect her brain chemistry. Catch-22 indeed. "Cristina's not a psychologically dysfunctional woman, never has been. Her coping skills aren't the best, I'll be the first to admit, but she's been through psychological hell in the last ten years, between suffering a miscarriage, being stranded at the altar, being strangled in her sleep by her boyfriend, performing heart surgery on her best friend's husband and Chief of Surgery with a literal gun to her head…" Owen paused, drawing in a breath. "and having an abortion…she has survived, and she will survive this, no experimental medications necessary. I appreciate your concern, but Cristina. Will. Overcome." Owen stared at Dr. Hurst determinedly. Owen walked around the psychiatrist then and into Cristina's room. Before he shut the door, he looked down at the floor and smiled. "She always does."
"I'm not giving up, Hunt," Dr. Hurst said as the door closed on him. Owen ignored his threats and made his way over to Cristina, who had the same blank expression as she had for twelve days. The difference was not in Cristina, but in Owen. In the midst of his debate with Dr. Hurst, he realized the true magnitude of the woman he married. Despite all of the tragedies she had endured and the setbacks that resulted, she had prevailed-and this time would be no different. With that realization at the forefront of his mind, he brushed her hair behind her ear and pressed his lips to her sunken cheek.
She tilted her eyes toward him, making him smile genuinely for the first time in a week. She reveled in that smile; committed it to memory, because she knew it wouldn't be long before the genuine smiles turned into half-hearted, pity smiles, and then smiles would be replaced altogether by looks of resentment for being married to what amounted to not much more than a vegetable. Meanwhile, she would waste away in this hospital, day after day, year after year, because this wasn't being left at the altar. This wasn't being strangled in her sleep. This wasn't even having a gun to her head while she performed heart surgery. This was beyond imagine. This was beyond her reach. This was beyond help. This was hell.
You were wrong.