Owen carried his sandwich and coffee back to the sleep clinic for his noon appointment, and Dr. Davies was waiting for him. A pleasant guy in his late 40s, with greying temples and a nearly perfect Grecian profile, Davies was the epitome of laid back. Owen could see how he must have been attracted to sleep as a specialty, because he exuded an aura of relaxation that could only be a positive when dealing with patients who were probably out of their minds with insomnia. They had already done a complete history at his first appointment, so after a few pleasantries, they wasted no time and sat right down in front of a video monitor.
"I could pore over the graphs and show you your sleep patterns, but I think in this case a picture is worth a thousand words," he said as he turned on the screen. Owen saw that the tape was cued up, with him lying frozen on the bed. The night vision technology gave everything a ghostly glow. "Ready?"
"As I'll ever be."
"Ok, this was about 45 minutes after you fell asleep. See, here you're sleeping normally, and then... here we go..."
Owen's sucked in a breath as he observed his eyes popping open suddenly. He saw himself sit up in bed, gazing blankly into space. Even from a distance, he found the vacant stare terrifying, and wondered with dismay if this was what Cristina had been looking at when she'd fought to get him off her. Then he watched in amazement as he turned in place, grabbed his pillow in both hands, and began squeezing it violently as if he was wringing out laundry. This went on for several minutes, at which point he dropped the pillow on the bed and commenced punching it with his left hand, over and over again. Up until now, everything had unfolded without a sound, but now his grunts of exertion could be heard over the monitor. Owen couldn't tear his eyes away from the scene in front of him, and watched in horrified silence as this assault went on for another 5 minutes or so. Then, as suddenly as it began, it was over. He lay his head back down on the pillow and closed his eyes. Dr. Davies shut off the monitor.
"From the look on your face, I gather you have no memory of having done this?"
"No, none at all. I had no idea." Mortified would not be too strong a word for how he felt.
"This is pretty straightforward, then. This is one of several parasomnias. You've probably heard of all of them: sleepwalking, sleep talking, sleep terrors, nightmares, and even teeth-grinding to name the most common. This would fall under the category of sleep terrors, or night terrors. Yours is a bit different than what I typically see because most people shout or scream when they start, and you don't, but otherwise it's a classic case."
"So it's not a nightmare?"
"No. Lots of people think they're the same, but there's a big difference. See how you got up and were very physical, with your eyes wide open? With nightmares, if you get up, you're awake. If your eyes are open, you're awake. And if you awaken during REM sleep, you'll remember the dream you were just having. With nightmares you don't get up and do things in a sleep state like... like what you did there. So no, it's not a nightmare."
"So it would be possible for me to hurt someone when this is going on, and not be aware of it?"
"Absolutely. It's very common, in fact. People can become quite belligerent, and it's very difficult to rouse them. There are many cases where bed partners have been injured by someone in the midst of a night terror."
Owen nodded. This confirmed what Derek had told him a few days ago. Although he knew what he had experienced, the validation helped. Until this moment, he had entertained a tiny frisson of doubt about his version of the events, borne of the judgment of others and his own intense self-criticism. With this evidence in front of his face, he could no longer deny what had happened, and it was as much of a relief as it was a shock to see himself in that state. He had been fully asleep. He had not been aware of what he was doing. There was proof now, empirical evidence, and even if it didn't change what he'd done to Cristina, he really could give himself a break.
"Have you?"
"Excuse me?" Owen had been lost in his own thoughts and missed the question.
"Injured someone. Have you?"
"Yes. My girlfriend. I... I choked her."
Davies nodded but stayed very low key. It was clearly not the first such story he had heard. "Is she all right?"
"Yes... I mean physically, yes. Emotionally...I'm not so sure. Her roommate woke me up but if she hadn't..." Owen imagined himself in the second stage he had just observed, punching the pillow repeatedly, and he felt a wave of nausea when he considered that it could have been Cristina's face he was pounding.
"You're very fortunate. It's not always possible to awaken someone from this state."
Owen nodded. He didn't feel very fortunate right now. This is it, he thought. I can never sleep with her again. He was so lost in his own misery over this that he almost missed Davies' next comment.
"There's a drug I'd like you to try. It's been very successful for people with PTSD-based night terrors, and it's been tested extensively with combat veterans. I'm hopeful it'll help you."
Owen perked up at this. Was it possible a drug could hold the answer? "What is it?" He had read up on all of the libido-killing anti-depressants and was not too keen on taking any of them.
"It's called Prazosin. You've probably heard of it for..."
"... blood pressure?" Owen interrupted.
"...and prostate problems. That's right. It's already being used widely for those, and as a wonderful serendipity it's been found to improve sleep and reduce or even eliminate night terrors in most of the people who take it. Side effects are minimal, and it's been tested so well over so many years that it's extremely safe. You really have nothing to lose."
"Won't it affect my blood pressure?"
"No. It doesn't do anything if your blood pressure is normal. And yours is normal. You might experience some dizziness when you stand up during the first week or so as your body adjusts, but that goes away."
"Forgive me for asking so many questions, but do we know how this works?"
"We do. In a nutshell, it blocks norepinephrine, and norepinephrine lightens sleep. Night terrors occur during light sleep or disrupted REM sleep. By increasing your healthy REM sleep, your dreams will normalize and you will likely stop doing... that," he gestured toward the video. "This doesn't mean you'll never have another nightmare, but it should be the typical kind, not something where you do anything dangerous. And you can work on the nightmares in therapy."
"How long does it take to start working?"
"Not long. You start at a low dose and taper up over a period of 4 weeks. We should know by then if it's working or not. I'd like to have you come back at that point and do another sleep study."
An unfamiliar surge of optimism was coursing through Owen's system as he considered the possibilities. Could it be this simple? He was loathe to get his hopes up and be disappointed in the end, but it was better than the despair he'd been feeling since the incident happened.
"Make the appointment on your way out," Davies suggested. "I squeezed you in this time, but we do get pretty booked up."
"No problem." He waited while Dr. Davies scribbled the prescription on his pad and handed it to him. "Take it at bedtime. Just follow the dosing schedule on the bottle. Call me in a couple of weeks and let me know how it's going."
Owen's mind was racing at a mile a minute as he processed all this new information. He could hardly wait to leave and drop off the prescription downstairs. He got up and shook Davies' hand. "Thank you. I'll be in touch."
Just then his beeper sounded, and after a glance at it he handed the prescription back to Davies. "Would you mind calling this in for me downstairs instead? Looks like I've got a major trauma rolling in."
"No problem."
Owen walked out with his cold coffee and untouched sandwich in his hand. He had been so wrapped up in the session he'd forgotten to eat. He dumped them in the trash as he jogged down to the PIT to face the rest of his day.
---------
Friday afternoons tended to be difficult, and this Friday was no exception. When he reached the ER, the EMS units were just pulling up, and he was greeted with the aftermath of a drive-by shooting. The worst cases were two kids with multiple gunshot wounds, one who looked to be about 14 and the other with a driver's license that said he was 17. Apparently they were the targets, and their gang insignia and colors told the story they were unable to tell. Several cars pulled up afterward with a few bystanders who had been in the wrong place at the wrong time and had absorbed some ricochets. Nothing too serious there. He passed the easier cases off to the Residents and interns, and focused on the two boys.
The 14-year-old, unfortunately, was brain dead by the time Owen reached him, and there was nothing much to do but call in the transplant team in the hopes of getting some benefit out of this situation. He was yet to be identified, and finding the boy's parents for consent was probably going to be the biggest hurdle there. He struggled all afternoon to save the 17-year-old in the OR, and after repairing a punctured lung, removing a spleen, and patching multiple holes in the boy's bowel, he had hopes that he would recover. He had called Shepherd in for a neuro consult and they had worked together to remove a bullet lodged next to the spine. They wouldn't know until he woke up whether or not he had any paralysis, but the initial signs looked promising. He breathed a sigh of relief as he stepped out of the OR and washed up. Avoiding a gunshot to the head had been this kid's saving grace.
In the midst of all this, a small corner of his mind was working on another problem. When he had set his schedule for the week, he had taken both Saturday and Sunday off in anticipation of enticing Cristina to go away with him somewhere. At the time they had been getting increasingly close, and he had sensed they were ready for a couple of days together. Now the weekend loomed ahead with nothing to fill the hours. He knew Cristina had both days off too, and he longed to pick up the phone and call her. Perhaps he would. But a thought had crept in unbidden during the course of the afternoon and it wasn't letting go, even though he'd tried to shake it off numerous times. By the time his shift was over, he knew what he was going to do on Saturday.
It was time to go visit his mom.
When he examined his motivation, he had to laugh at himself just a little. What months of guilt and Cristina's intense disapproval had failed to accomplish, an appointment with a shrink had expedited almost effortlessly. He'd never been to therapy before, but he imagined himself - like it or not - spilling his guts, and the last thing he needed was something this big in the pile of shit that was likely to come out. Much like making a long overdue apology just prior to going to confession, or flossing for the first time in months before seeing the dentist, he wanted to get his ducks in a row before starting therapy. And now that he'd done the sleep study and had a plan for that situation, things didn't look quite so bleak to him. For the first time since arriving back stateside, he felt strong enough to do it.
Tomorrow, then. He would go see her tomorrow.