Work Text:
Commented session recording, Dr. Alenko with patient S, alliance naval hospital closed psychiatric facility, Vancouver.
Unscheduled session brought on by patient S's spontaneous outburst c.a an hour ago in the rec. lounge. Reports from staff point to another case of visual and auditory hallucination of 'reapers', making this the third such occasion since patient was brought in twelve days ago.
Patient brought to session escorted by staff, walking on her own, unsteady due to been given a sedative.
Initial physical assessment:
Pat. exhibited defensive posture/action: patient examined the room (likely noted the location of the available escape routes) before entering, behaviour consistent with previous sessions. Movm. slightly uncoordinated. Sat down in chair with view towards the door, also consistent. Clothing general hospital wear without note. Gen. appearance clean but untidy. Formal contact good, patient alert and aware of surroundings. Able to est+maint. eye contact. Emotional contact uncertain, prov. sufficient.
Transcribed audio recording, additional comments included in cursives:
Patient S: Doc.
Dr. Alenko: Hello S*. How are you?
*(nfr: Patient has expressed preference for being addressed by last name)
Patient gives me a weary look in response to polite greeting – consistent with previous sessions. Unlike her scheduled sessions however, I note several signs of nervousness as well as stress. She appears physically uninjured save for bruises on both knuckles, though considering patient history, I am aware that further injuries may not be apparent by superficial examination.
Patient S: I'm fine, thank you, how are you? Thanks for asking, I think I'll just go get some rest, how about that?
Patient makes no move to leave.
Dr. Alenko: Are you feeling tired, S?
Patient draws hands through her hair, which was already messy on arrival. Though patient has showed few signs of concern for physical appearance, untidiness is uncharacteristic.
Patient S: Honestly? Exhausted.
Dr. Alenko: Really? How come?
Another weary look. Patient responding negatively to obvious questions, shall attempt to lead conversation more directly.
Patient S: Didn't sleep last night, didn't sleep night before, didn't sleep... I don't know, I've lost count. And no, I'm not taking any more goddamn sedatives. They just trap me in the nightmares, remember?
Dr. Alenko: I remember. After this session, would you like to rest in the white room for a while? It might help you relax so you can sleep.
(nfr: "white room" is a resting space created with minimum sensory input in mind, used on voluntary basis for patients with difficulty filtering out unwanted impressions.)
Patient S: I... don't know. I think I'll fall asleep the moment my head hits something, soft or not.
Dr. Alenko: Very well. Offer will stay open though.
Patient S: Thanks.
Silence for approx. 2 minutes. Patient is leaned back in the chair, arms crossed, looking at me with tired eyes. Appears to be calming down. I let some more time pass. Patient does not initiate conversation, but does not appear uncomfortable by the silence.
Dr. Alenko: So, S. Shall we talk about what happened in the lounge?
Patient reluctant – expected. Attempts to derail session – behaviour believed to be understood by patient to not be likely of success.
Patient S: I... look, I probably fell asleep and had a bad daydream.
Dr. Alenko: Is that really probable?
Patient S: ...no, I guess not.
Dr. Alenko: Then what happened?
Patient takes a moment to choose words. Re-establishing calm unaided. Patient known to be highly verbal as well as charismatic when calm. Manip. of healthcare staff frequently attempted. Admits when confronted, but cessation freq. req. threats of removal of privileges.
Patient S: There was a... a noise. One of the other patients knocked over a potted plant. It shattered on the floor. The sound reminded me of windows shattering from a R... from a shockwave. It triggered a, well, we might as well call it flashback, because that's what I experienced.
Patient hesitation leaves me to conclude this to be a hallucination, not an actual relived flashback.
Dr. Alenko: Would you like to tell me what you experienced?
Patient S: No.
Patient closes body language deliberately, shakes her head. I expect another attempt at derailment, and am proven correct.
Dr. Alenko: Why not?
Patient S: What's the point? You're going to tell me it was a hallucination anyway, and if it's not real, why does it matter?
Dr. Alenko: It matters because if I can understand what you're seeing, then I can modify your therapy to help you deal with it. I'm here to help, S. Please, tell me what you experienced.
Another long pause, patient watching me, determining what to do.
Patient S: I... no. It's stupid anyway.
Patient stands to leave. I attempt to lead her with questions to dissuade her. I do not ask her to return to her seat as that would give her a target for acting out against.
Dr. Alenko: Why do you think it's stupid, S?
Patient S: Because I know what I sound like. Even I wouldn't believe me, if I was in your chair.
Dr. Alenko: You can tell me anything. S.
Patient S: Can I? If I asked you to forward my report on them to the navy, with the recommendation that we go to full wartime production, would you do it?
Dr. Alenko: Would you like me to?
Patient responds to reasonable tone with indecisiveness – strengthening my conclusion that patient knows her hallucinations are not real.
Patient S: I-... I don't know, honestly.
Dr. Alenko: And that's okay, S. Why don't you want to tell me what you experienced in your flashback?
Patient S: Because you already know I saw the Reapers.
Dr. Alenko: The reapers?
Patient S: Yes, the Reapers. Don't give me that look, Doc, we've been over this.
Here, I take a gamble. Patient bond sometimes poss. to create through humour. Sometimes backfires.
Dr. Alenko: You never told me what they look like. Big black coat and a scythe?
Patient amused, reluctantly.
Patient S: Heh, no. Like kilometer-tall shrimps, lobsters... I don't know, cuttlefish? Something.
Dr. Alenko: Fish, huh?
Patient S: Maybe more like insects, I think? And no, I don't have a bug phobia, or a fish phobia.
Dr. Alenko: No?
Patient S: No, definitely not.
Gamble successful. Patient returns to her seat. Smile stays a few seconds. We sit in silence approx. a minute.
Dr. Alenko: These reapers, can you tell me something else about them? Do they remind you of anything? Look familiar?
Patient S: No.
Dr. Alenko: What do they make you think of? Associations, things like that?
Patient S: Death.
Patient gives me a daring look, arms crossed. As she has given me opportunity by bringing the topic up, I will attempt to explore.
Dr. Alenko: Your death, S?
Patient S: Everyone's.
Not anticipated, as we believed potentially suicidal only.
Dr. Alenko: Why everyone's?
Patient S: What?
Dr. Alenko: Why do you think everyone dies, S?
Patient S: I... don't know.
Patient seems uncertain, whether this is due to questioning her hallucinations, or simply not having the answer, I can't say.
Dr. Alenko: Can you speculate?
Patient S: I.... No, I have... I don't know. I don't know. I don't want to--. Can we talk about something else?
Dr. Alenko: Yes, in a moment. I'd like to know a bit more about your thoughts on this, S.
Patient becoming agitated.
Patient S: I don't have any damn thoughts on this.
Dr. Alenko: But you associate the reapers with death?
Patient S: Because they kill everyone! Haven't you been listening to a word I've said?
Here, I inadvertently trigger the patient, who has consistently had adverse reactions to thinking she is not being listened to or believed. I attempt to calm her down.
Dr. Alenko: Easy, S. I have listened to every word you've said, and we've documented all sessions. If you'd like to see the transcripts, I can arrange that.
Patient S: I.... No, that's okay.
Patient closes down, crosses her arms defensively, avoids eye contact, but is sufficiently calm. I consider rounding the session off, but feel this may be the best opportunity to build understanding about her hallucinations we've had, so I prompt continuation.
Dr. Alenko: Alright. But offer stands, okay? Okay, then back to my question. Why do the reapers kill everyone?
Patient S: I... they.... Does it matter? Can we please not have this conversation?
Dr. Alenko: Of course, but could you clarify this one thing for me first? S, do you want everyone to die?
Patient S: Goddammit NO. What the hell is wrong with you, Doc?
Patient explodes out of the chair, begins pacing, runs her hands through her hair. I attempt to re-establish her calm, though am aware I will not be successful during this session. I still hope for a breakthrough in understanding her, however, and continue the questioning.
Dr. Alenko: I'm sorry, that must've seemed like a stupid thing to say. So, you don't want everyone to die.
Patient S: No. Absolutely not.
Dr. Alenko: But that's what you think will happen, when the reapers get here, right?
Patient S: Doc, I really don't want to talk about this.
Dr. Alenko: I'm sorry, just this one question, then we'll talk about something else, promise.
Patient reluctant. Am aware I am treading on very thin ice.
Patient S: Okay.
Dr. Alenko: Could you tell me, please, why you think the reapers kill everyone?
Patient suddenly becomes distraught, looks out the window, at the sky, then straightens visibly. Patient's voice changes.
Patient S: I'm sorry, Kaidan. I have to get back to the Normandy.
Session transcript ends.