Freedom of Sketch

Caged

In the middle of the night, an hour slips away with plans to return in November. The sun hangs around later in the evening, its sunset palette of oranges and pinks drawing us out to the courtyard after dinner. Talia talks at me while I sit in silence, stunned that I've been locked up for an entire month now.

When Jenny flips the page on the kitten calendar in the nurse's station, my throat closes up and I feel a strong pull on my bottom lip. I clench my teeth but the tears come on fast and copious. I turn to face the wall so no one sees them spill down my cheeks. In my head I bargain with God, offering anything and everything to be able to go home. But it's just not enough.

During my session with Dr. Fox, I try to bargain with him. He's playing god with my freedom. The doctor is the ultimate dictator, deciding what pills you take and how many calories you eat, in addition to determining whether or not you can shave (with supervision) or have markers in your room or most importantly, go home.

"I've been here a MONTH," I say, feeling that tugging on my bottom lip again. I cover my mouth with my hand and count the rings in the wood grain on Dr. Fox's desk. "Please don't keep me here any longer. I've been good; I've been trying really, really hard and I haven't acted out in forever."

"Shiloh, it's not all about being 'good'. Ms. Gabriel reported to me that you've missed more than half of your scheduled lessons due to..." he squints at the paper and adjusts his rimless glasses, "...'increased depression and anxiety'. If you're truly doing better, why are you still having symptoms significant enough to interfere with your daily activities?"

"I just say those things to get out of class," I quickly explain. "I don't have any symptoms."

The psychiatrist shakes his head and interlocks his fingers. "I'm sorry, Shiloh. Meredith, Jenny, Ms. Gabriel, and I have recently discussed your care and we all agree that we just haven't seen the level of improvement necessary for a successful discharge." He looks at his hands. "You're rushing through treatment and that's part of why we feel you're not ready."

Me: "But--"

Dr. Fox: "--You're too focused on leaving. Recovery is a complicated process. I'm glad that you've decided to move in the right direction, but it's going to be a while before we feel comfortable letting you go."

The tears return, dripping and dripping, so much so that I can't keep my face dry for more than a few seconds at a time. My voice is strained. "Don't do this to me! I'm ready! Please let me go home; I can't take it anymore. I'll do whatever you want... just don't make me stay here!" Then I sob bitterly into my sweater, unable to hear his response through the pounding in my head. "I'd rather die than spend another day in this place," I whimper.

"Shiloh, are you having suicidal thoughts?"

"No!" I snap. "It's just an expression!"

"Do you feel like hurting anyone else?"

"No!"

"Can you contract for safety?"

"Yes! I'm only depressed because I'm in here," I sniff. "That's my only problem. I don't see things; I don't hear voices. I'm not going to hang myself or stab anyone." I wipe away another wave of tears.

Dr. Fox: "And that's great. Just keep it up, participate more, and try to figure out more ways of coping."

"May I be excused, please?" I reply, trying hard to ignore the heavy sobs threatening to explode from my chest.

The doctor studies me for a moment, his hand on his chin. "Okay. Keep taking your medication; you've been doing well with that. I also like that you're socializing a bit more since your admission."

Me: "What other choice do I have?" I stand up and walk out the door without looking back. I don't want anything to do with Dr. Fox or anyone right now.

In my room, I fling myself face-down on my bed and cry and cry and cry until my eyes swell and my nose clogs. I deflate, the sobbing gone, just tears silently traveling over the bridge of my nose and falling onto the damp pillow.

--

Clinical Notes:

Pt seen in session 03/11/2017 at approx. 13:30. Mood depressed, affect appropriate to mood. Tearful and anxious, speech rapid and elevated. Although she denies SI, pt commented, "I'd rather die than spend another day in this place." She does not endorse any hallucinations, delusions, or HI. Pt states she wants to be discharged and expresses frustration about being in the hospital for a month. She left the session prematurely.

Shiloh is very focused on going home. Her insight and judgment are grossly impaired. Pt minimizes her issues and is not making an effort to recover; still denies that she has a mental illness. Progress has plateaued. She has not required any more ETOs and is taking her meds. Pt attends Groups but her participation is limited. This writer informed pt that she has to be more invested in her treatment if she wants to leave. I will maintain her current treatment regimen, no changes in meds or orders at this time. There is no estimated length of stay as of yet. Will continue to monitor for unpredictable behavior. Condition guarded; not yet stable for discharge.

--

In therapy, I try to explain to Meredith that I don't want to be dead. I don't want to be dissected, sewn up, thrown into a box in the ground. Or burned to ashes and kept in a pretty container on my mother's mantel. I just want to be gone. "I'm in the way," I explain to her as she takes notes. "I'm just a problem to everyone." I now understand what Lizzie means when she says she takes up too much space, but I'm not desperate enough to stop eating. I wish there was some other way we could disappear... possibly together. I picture myself taking her cold, white fingertips in my hand and walking away into a thick fog. She's talking to me again, and promises to visit soon.

When I'm not in therapy, I try to draw happy things, things I find to be unrealistic and nauseating. Talia supports my work, praising me like every crayon scribble is a personal masterpiece. Deep down, I find her efforts to be bothersome. I feel like everyone's just wasting their time on me. I'm a project that can never be finished.

Meredith objects to this line of thought. "You're a project that hasn't decided what it means to be finished," she says. "You're still discovering yourself, and you don't like what you see yet. That's why you want to abandon this metaphorical project. Does that sound right, Shiloh? Do you want to disappear, or do you really want to start over?"

"I'm... not... sure."

She nods and writes something down in my chart. "Think about it, and let me know what you decide."

 "I will," I promise.