Monday, January 21, 2013

The Appointment

     "Tyler, where's your lunch box? Did you even remember to bring it home from school yesterday? You're going to be late for the bus again, and I'm going to be late for my appointment!" Her frantic search for the lunch box exhausted, Minerva rifled through drawers and cupboards for a brown paper bag, mentally cataloguing all the things Tyler had forgotten, seemingly on purpose, over the last 48 hours. There was the brand new pair of sneakers he'd left in the sandbox, now waterlogged by Sunday's late spring rain. "Mommy, can I go outside and play in the rain? Please?!" he'd begged, just as the rain was starting. He and Bob Boxley, their three-legged beagle, stood looking at her expectantly, hardly able to contain their anticipation. "Me and Bob wanna hunt for buried treasure in the sandbox!" She relented, letting out a long sigh. "On one condition, Tyler. You take those shoes off and put them on the porch so they'll stay dry. Do you understand?" Nodding furiously, Tyler promised "Yes, Mommy!" while reaching around her thighs for a hug. "I love you, Mommy!"

     Temporarily distracted by a can of tomato soup that had somehow escaped color-coded alphabetization, Minerva busied herself with a systematic re-organization of her pantry, while Tyler imagined his shoes were projectiles, first untying and loosening them, then launching them into the sheets of rain for Bob Boxley to catch on the freefall. The shoe snafu was discovered Monday morning, along with Tyler's missing homework. And, this was only Tuesday! Exasperated, running her fingers along the bristles of his bone-dry toothbrush, she exclaimed, "Tyler, how can you be so forgetful?" Grinning as his tongue explored a budding incisor, Tyler replied matter-of-factly, "I don't know, Mommy. I guess I'm good at forgetting to remember!" She cringed, thinking to herself, "Like father, like son." The bus arrived on time at 7:20. She handed Tyler his lunch and his books as he climbed aboard. "Don't forget to bring your lunch box home today, all right? I'm all out of paper bags, and I won't be able to go to the grocery store this afternoon." Before darting into the seat directly behind ancient Mr. Ernie, who'd also been her school bus driver, Tyler said reassuringly, "OK, Mommy. I'll remember today. Don't forget, I love you!"

     Minerva had exactly thirty minutes to put herself together before the appointment. Glancing in the mirror to apply her lipstick, she briefly waded into the emotional garbage she'd spent her lifetime hoarding: festering wounds of disappointment and rejection, scabbed over with resentments as tenacious as fly-paper, simmering away neatly just below the surface. Dissatisfied, she wiped off the lipstick, and started over again. She thought of Tyler's father, how wildly attracted they were to one another when they'd first met, but how quickly the newness of marriage and childrearing had worn off. Despite all the love and affection he'd given her, she'd never felt complete. There were parts of him she hated, especially his disordered inattention to detail, and now, she was seeing the same character defects in their son. No longer intimate, they slept in separate bedrooms. She shuddered with revulsion at every stray man hair she discovered in the sink, scrubbing them down the drain with abrasive cleanser, half-wishing she could erase her dysphoria with the same ease. Years of therapy, yoga, and Buddhist meditation hadn't helped. Neither had the Paxil, Zoloft, Prozac, Lexapro, Effexor, Wellbutrin, Xanax, or Abilify. No, she was one in a million, a real special case, someone that no one could ever hope to understand. It had to be genetic.

     "Honey, are you ready?" her husband called from the foyer downstairs. "Traffic's a mess this morning!" "How can anyone be that cheerful?" Minerva wondered as she shellacked her carefully coiffed asymmetrical bob with a final spritz of hair spray. "I'm coming," she replied, without attempting to conceal her irritation. He greeted her warmly with a kiss, disconcerted by her stiffness and thick makeup. Over the past few months, he'd seen her go from bad to worse, her bouts of near-catatonia interrupted by brief intervals of organizing canned goods and extensive primping in front of the mirror. He'd convinced himself that the girl he married was still in there somewhere. He sure did miss seeing the light in her eyes. But, her mind had always been like a steel trap, and she never missed an opportunity to dwell in negativity. It amazed him how easily she could retrieve decades of wrongs and hurts, as if they'd happened yesterday, yet remain so neglectful of the fondness he and Tyler showered upon her. In silence, they drove to her appointment.

     The schedule was running a bit behind, and the waiting area was already quite crowded. Minerva gazed ahead blankly, while her husband studied the faces in the room, half of whom were wearing the same expressionless mask as his wife. He was overwhelmed by a sudden urge to knock on their foreheads, saying, "Hello! Is anybody in there?" A woman's voice broke the silence. "Minerva? Minerva Cunningham? Hi there, Mr. Cunningham, we'll bring you back to see her as soon as we get her ready for her procedure." He watched as his wife was led through the door, wondering if all this was really necessary. "Why can't she get herself unstuck? Or, is it that she won't?" As someone who'd always just kept moving on, her inability to let go was exceptionally difficult for him to understand. "Mr. Cunningham, we're ready for you to come back now."

     An anesthesiologist was examining Minerva, inquiring about her teeth, and asking her to wiggle her toes. "We'll be inserting a bite block after you're asleep to protect your teeth, and if you don't appear to be asleep enough, you may hear us asking you to wiggle your right foot, in which case we'll give you more medicine. It's normal for your jaw to feel a little sore after this procedure." Minerva turned away as her husband leaned in to kiss her. Straightening himself to a standing position, hoping no one had noticed the air kiss, his eyes were met by the sympathetic glance of the procedure nurse who reassuringly squeezed his arm. "She's gonna do just fine. She'll get better, you'll see."

     Minerva lay on the stretcher as the nurse and anesthesiologist took off her right shoe and placed an array of monitoring devices, including blood pressure cuffs on her left arm and right ankle. "You'll feel that cuff on your left arm going up and down, Minerva. We won't inflate the one on your ankle till after you're asleep." As an oxygen mask was lowered over her face, the nurse wrapped an elastic band around her forehead, along with EEG pads on her temples and behind her jaw. Something felt wet. "Don't worry, Minerva, that's just some water-based jelly; we'll try not to mess up your hair." She could overhear the psychiatrist talking to one of his residents, something about titrating the stimulus to induce a really good bifrontal seizure. She barely felt the cuff on her right ankle being inflated, isolating it from the paralytic agent that was soon to follow. In a moment of clarity, somewhere between the methohexital and the succinylcholine, she thought of Tyler, and how unlike him, she was good at forgetting to forget.

Part II: Amplitude
Part III: Redemption
Conclusion: Insurance


Terminology
EEG: electroencephalogram. A waveform readout of the brain's electrical activity.
Bifrontal seizure: a seizure that occurs within both of the brain's frontal lobes simultaneously. A technique used in ECT.
ECT: electro-convulsive (shock) therapy. A controlled seizure used to treat refractory depression.
Methohexital: a short-acting barbiturate used to induce general anesthesia. Most commonly used in ECT.
Succinylcholine: a depolarizing paralytic agent, used in general anesthesia to prevent contraction of skeletal muscle.

18 comments:

  1. Such vivid details, Kris. One can feel Minerva's dissatisfaction, her anger, her hopelessness, her displacement from her surroundings.

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    1. Thanks, Marty. Minerva is a conglomeration of people I've known, along with my own personal observations from being involved with patients undergoing electroconvulsive therapy.

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  2. That's actually sorta disturbing.

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    1. Yes, but what's even more disturbing is the fact that some people are willing to dwell in the past and never let go.

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  3. Kris, that was so good! I want to read more. I have to agree that it is somewhat disturbing. I can't believe that this kind of stuff really happens to people. I imagine you have a brain full of stories like this. :)

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    1. Thanks, Kristina...good to hear from you!! There is a part II, but I have to think about it a little more. Yes, this is modern therapy for certain severely depressed patients, and many of them respond very well to ECT. The anesthesia side of it is absolutely fascinating. I do have lots of stories like this, and think I will enjoy writing them down in short story form.

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  4. very interesting. i like the way how you contrast, how Minerva cannot be forgetful as her son, and how easily she can do it at the end of the story.

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  5. Kris, quite a story and very well written with such empathy. Minerva’s appointment was shock therapy, right? My mother was bipolar and she had shock therapy more than once, so that’s what it felt like when I read it. Your descriptions are very vivid, and the characters are well-defined. Is this the start of a series of short stories from an anesthesiologist? I hope! :)

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    1. Yes, Madilyn, you're exactly right...this story is about a woman having ECT. RE: series of short stories, I'm definitely considering it because I have so many stories to tell. I think I'll be writing more :-)

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  6. Excellent, yet disturbing post.

    I felt as though I really understood the people in the story, and even know a person or two that fits each character in real life. Though this was a great look into Minerva life, I am very happy I do not live there.

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    1. Minerva is based on a few people I know, people I wish could just let go of what they've been holding onto. The story is a provocative look at the progressive loss of autonomy in someone who believes herself to be stuck.

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  7. Back to your blog after quite some time, and I'm glad I did so. As with all your posts, this story IMPELS your readers to think. Psychological/psychiatric issues are often misunderstood as deliberate misbehavior or negative personality traits by the people around - and the patients are socially cornered. Posts like this - that look into the minds of such patients as well their caregivers with an educated and empathetic mindset - should help to create more awareness among the people. Also, the way the story progresses and the situation unfolds itself is great.

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    1. Good to hear from you, Antara; thanks for stopping by! I'm glad you liked the story. While some of my colleagues in anesthesia seem indifferent to our patients' emotional landscapes, there are those of us who do make an effort to connect with them.

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  8. I like how Tyler has gotten good at forgetting and how the mom has gotten good at not forgetting. I like this story and everything detailed in such a short amount of time. I am no critic so I can't say much more. However, as a person not in the medical field I did find myself in dior need of a dictionary for the technical terms. Goes to show how what we right reflects what we live.

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  9. Pure excellence. I can't wait for you to write an entire book. It reminded me of a book I once read by Jeffrey Eugenides called The Virgin Suicides. It had the same sense of displacement and numbness. Who knew character development could happen so quickly?

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  10. I'd love to read part II. What a compelling story.

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    1. Christina, Thanks for reading it! You can access parts 2-4 at the very bottom of this blogpost, beneath the medical terminology.

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