Work Text:
Pine Hills Behavioral Health Center
Comprehensive Biopsychosocial Assessment
Patient Name: Parker, Collie J.
Date of Birth: REDACTED
Sex: Male
Race/Ethnicity: Native American
Primary Language: English
Referral Source: The Long Walk Organizing Team
Date of Assessment: REDACTED
Clinician: Dr. Jan Prescott, PsyD, LMHC
Assessment Location: Pine Hills Behavioral Health Center, Outpatient Wing
I. Reason for Referral
Patient was referred for a comprehensive biopsychosocial evaluation as a standard component of post-Walk Prize fulfillment protocol. Per referral documentation, patient is the surviving participant of this year's Long Walk. Patient's mother, Mika Parker (age 49), was present for intake paperwork but was not present during the clinical interview at the patient's request.
II. Identifying Information
Collie J. Parker is a Native American male from Sioux Falls, South Dakota. He is the eldest of four children. He presents as tall and physically fit, though notably underweight for his height and frame. He was dressed appropriately for the weather in jeans and a gray sweatshirt. His shoes were new. He sat in the chair closest to the door and did not remove his jacket for the duration of the interview.
When asked how he would like to be addressed, patient stated: "Collie's fine."
When asked if there was anything he wanted the clinician to know before beginning, patient stated: "Yeah. I'm not crazy."
III. Presenting Problem
Patient does not report a primary complaint. When asked what brought him in today, patient stated: "They said I had to come here before they'd process the rest of my Prize stuff, so I'm here."
When prompted to describe his current emotional state, patient paused for approximately seven seconds before responding.
[Transcript Excerpt]
DR. PRESCOTT: How have you been feeling since the Walk ended?
PATIENT: Fine.
DR. PRESCOTT: Can you tell me more about what "fine" looks like for you?
PATIENT: I don't know. Normal? My mom's been cooking a lot, so I've been eating. My sisters won't leave me alone. Gary says I should be nicer to them.
DR. PRESCOTT: Gary?
PATIENT: Yeah. He's… we were on the Walk together. He's kind of a pain in the ass, honestly, but he's… yeah. He's good.
Per Walk Registry records provided with referral documentation, all participants other than the patient are deceased. This is consistent with the nature of the event. Patient's use of present tense when discussing a deceased participant is noted and will be explored with care throughout the evaluation. It is too early to determine whether this represents a grief response, a dissociative process, or a more fixed belief system.
IV. History of Present Illness
Patient participated in this year's annual Long Walk as one of 100 contestants. The Walk lasted approximately REDACTED hours and covered REDACTED miles. Patient was the sole survivor.
When asked to describe the Walk, patient became visibly tense. He crossed his arms and looked toward the window for several seconds before responding.
[Transcript Excerpt]
DR. PRESCOTT: I understand this may be difficult to talk about. You can share as much or as little as you'd like.
PATIENT: It's not difficult. It's just boring to explain. You walk and if you stop, they shoot you. That's it.
DR. PRESCOTT: Were you aware of other contestants receiving their tickets during the Walk?
PATIENT: Was I aware? [laughs] Yeah, I was aware.
DR. PRESCOTT: How did that affect you?
PATIENT: It didn't.
DR. PRESCOTT: It didn't affect you at all?
PATIENT: What do you want me to say? That I cried? Well, I didn't. I just kept walking.
DR. PRESCOTT: Were there people on the Walk you felt close to?
PATIENT: [long pause] Define close.
DR. PRESCOTT: People you cared about. People whose company you sought out.
PATIENT: There was this kid named Barkovitch, Gary Barkovitch. He was… God, he was so fucking annoying. Like, genuinely the most irritating person I've ever met in my life. He'd talk shit to everybody and pick fights with guys twice his size. He was just a complete disaster of a human being.
DR. PRESCOTT: It sounds like he made an impression on you.
PATIENT: He's small. Like, five-foot-nothing with this big mouth that writes checks his body can't cash. Someone had to make sure he didn't get himself killed before—
DR. PRESCOTT: Before?
PATIENT: Before the end. You know, of the Walk.
DR. PRESCOTT: And were you able to do that? Keep him safe?
PATIENT: He's fine. He made it out. We both did.
Patient describes a protective dynamic with participant Gary Barkovitch. Patient directly states that both he and Barkovitch survived the Walk. This is factually inaccurate. Per registry records, Barkovitch received his ticket at mile REDACTED. Cause of death is documented as self-inflicted wound.
Patient's assertion is delivered with conviction and without hesitation. There is no evidence of deliberate deception; patient appears to believe what he is stating. This clinician is noting this as a potential fixed delusional belief vs. an extreme grief response. Confrontation at this stage would be clinically inappropriate and potentially destabilizing.
V. Psychiatric History
Patient denies any prior psychiatric treatment, hospitalization, or medication trials. He denies any history of self-harm, homicidal ideation, or suicidal ideation. When asked if he has ever experienced periods of depression or anxiety, patient stated: "Who doesn't?"
Patient denies prior trauma history. When the clinician noted that the Walk itself would be considered a traumatic event, patient stated: "I signed up for it. You can't be traumatized by something you signed up for."
Patient demonstrates a consistent pattern of minimization and externalization when discussing emotional experiences. This is consistent with the avoidant coping strategies commonly observed in Walk survivors. The belief that voluntary participation negates trauma is not uncommon in this population, though it warrants exploration in ongoing treatment.
VI. Substance Use History
Patient reports occasional alcohol use prior to the Walk, beginning at age REDACTED. He reports drinking "at parties, on weekends, whatever" and denies any history of daily use or negative consequences related to alcohol.
Patient reports cigarette use beginning at age REDACTED. He currently smokes approximately half a pack per day and expressed no interest in cessation.
Patient denies all other substance use.
[Transcript Excerpt]
DR. PRESCOTT: Have you noticed any changes in your substance use since the Walk?
PATIENT: I guess I smoke more, but that's about it.
DR. PRESCOTT: And the drinking?
PATIENT: Gary doesn't like it when I drink.
DR. PRESCOTT: Oh? Why is that?
PATIENT: He says I get mean, which is bullshit, by the way. I don't get mean. I just tell shit how it is and he can't handle it because he's a god damn baby.
DR. PRESCOTT: It sounds like he looks out for you.
PATIENT: Yeah, well. [pause] He's annoying about it, but yeah, I guess so.
Patient attributes behavioral changes (reduced alcohol consumption) to the influence of deceased participant Barkovitch. This suggests the delusional framework is functioning in a regulatory capacity. The internalized presence of Barkovitch is serving as an external locus of behavioral control. This is clinically significant.
VII. Medical History
Post-Walk medical examination documented the following:
- Severe bilateral plantar fasciitis
- Multiple stress fractures (left second and third metatarsals, right calcaneus)
- Significant muscle wasting in lower extremities
- Dehydration (moderate, treated with IV fluids)
- Malnutrition (BMI REDACTED at Walk completion; currently REDACTED)
- Blistering and infection of both feet
- Chronic pain, bilateral lower extremities
Patient walks with a noticeable limp. When asked about his pain level on a scale of 1-10, he stated: "Five. Maybe six. I'm fine."
VIII. Developmental and Social History
Collie Parker was born and raised in Sioux Falls, South Dakota. He is the eldest child of Mika Parker (age REDACTED, employed as a nursing assistant at REDACTED) and Thomas Parker (age REDACTED at time of death, deceased). Patient's father passed away when patient was REDACTED years old; cause of death was reported by patient's mother as a motor vehicle accident. Patient has three younger sisters: Nora (age REDACTED), Kaya (age REDACTED), and Winona (age REDACTED).
Patient describes his childhood as "normal."
[Transcript Excerpt]
DR. PRESCOTT: Tell me about your family.
PATIENT: My mom is the best person alive and I'm not just saying that. She works doubles at the hospital and still makes sure everybody's fed and the house is clean and my sisters have what they need. She's the strongest person I know and it's not even close.
DR. PRESCOTT: It sounds like you admire her.
PATIENT: I'd do anything for her. Anything. And my sisters… Nora's so smart it scares me sometimes. She's going to be something, you know? She's got this look she gets when she's reading like the rest of the world just stops existing. Then Kaya's the funny one and Winona's the baby. She's tough, though. Tougher than me, probably. She fell off her bike last summer and didn't even cry. [laughs] She's something else.
DR. PRESCOTT: It sounds like you're very close with them.
PATIENT: They're the reason I'm here. Like, alive, I mean. Every time I wanted to stop walking, every time I thought about sitting down and just dying, I thought about them. I thought about Winona waking up and asking where I was. I thought about my mom having to tell her. And I couldn't do that to them, so I kept walking.
Patient attended REDACTED High School in Sioux Falls prior to the Walk. He reports average academic performance ("B's and C's, mostly C's") and involvement in the school's wrestling team. He describes his social life as limited but adequate. "I had friends. I wasn't popular or anything, but I had people I hung out with when I could. I was just busy, like, working, or watching my sisters, or whatever."
Patient reports working part-time at a gas station beginning at age REDACTED to supplement family income. He was terminated from this position when he registered for the Walk.
When asked about his decision to enter the Walk, patient stated: "What else was I going to do?"
[Transcript Excerpt]
DR. PRESCOTT: And your friend Gary, how does he fit into your life now?
PATIENT: What do you mean?
DR. PRESCOTT: You've mentioned him several times. It sounds like he's an important person to you.
PATIENT: He's… [pause] He's from D.C. so it's not like we see each other all the time or anything, but we talk when we can. Usually he calls me, mostly at weird hours. Like, he'll call in the middle of the night and be like, "Are you awake?" and I'm like, "I am now, asshole." [laughs]
DR. PRESCOTT: When was the most recent time you spoke with him?
PATIENT: I don't know. Last week, maybe. Or maybe it was the week before. I don't remember. He's been busy with stuff back home. His family situation isn't great. His parents aren't in the picture and his aunt raised him and she's… I don't know. It's complicated. He doesn't like talking about it and it isn't my story to tell.
DR. PRESCOTT: I see.
PATIENT: He's the only one who gets it, though. You can explain the Walk to people and they nod and they say "that must have been hard" and you can tell they're already thinking about something else. Gary doesn't do that because he was there. He's lived it too.
DR. PRESCOTT: It must mean a lot to have someone who shares that experience.
PATIENT: It means everything.
Patient continues to reference Gary Barkovitch as a living, active presence in his life. He describes phone calls, conversations, and an ongoing relationship. Per registry records, this is not possible. Barkovitch has been deceased for REDACTED weeks.
This clinician notes the specificity and emotional coherence of patient's descriptions. He does not present as a person who is lying. He presents as a person who is telling the truth about a reality that does not exist.
When asked directly about the timeline of last contact, patient responded vaguely. This vagueness may indicate a partial awareness that the narrative cannot withstand close examination. Alternatively, it may reflect the disorganized temporal processing common in post-traumatic presentations.
Clinician has made the decision to not confront patient's belief system at this stage since the therapeutic alliance is still forming. Premature reality-testing could result in acute destabilization, treatment dropout, or a retreat into total avoidance that would be far more difficult to treat than the current presentation.
IX. Family Psychiatric History
Patient's mother reports a family history of depression "on both sides," including her own history of depressive episodes following the death of patient's father. She reports that patient's paternal grandfather "had a drinking problem" but denies knowledge of any formal diagnoses. Patient's mother denies any family history of psychotic disorders, bipolar disorder, or attempted/completed suicide.
X. Mental Status Examination
Appearance: Patient is a REDACTED-year-old Native American male who appears his stated age. He is tall and lean, notably underweight. He is dressed appropriately in casual clothing. Grooming and hygiene are adequate.
Behavior: Patient was cooperative throughout the interview, but maintained a guarded posture (arms crossed, jacket on, seated near exit). Eye contact was intermittent. He frequently looked toward the window during emotionally loaded questions.
Speech: Normal rate and rhythm. Vocabulary and articulation are consistent with age and education level. Mild flat affect when discussing the Walk; notably more animated when discussing family and Gary Barkovitch.
Mood: "Fine."
Affect: Restricted range. Congruent with stated mood. Brightened notably when discussing sisters and future plans. Warmest affect observed when discussing Gary Barkovitch.
Thought Process: Linear. Goal-directed. No evidence of formal thought disorder. However, patient maintains a coherent but factually inaccurate belief system regarding the survival of a deceased Walk participant. This belief is internally consistent and well-elaborated.
Thought Content: No suicidal ideation, homicidal ideation, or intent to harm self or others. No obsessional thinking noted. Delusional content present (see History of Present Illness and clinical notes throughout.)
Perceptions: Patient denies auditory or visual hallucinations. No evidence of perceptual disturbance during interview. (Note: Patient describes "hearing" Barkovitch's voice, but upon exploration, this appears to be metaphorical/remembered rather than hallucinatory. This is more consistent with an internalized attachment figure than an auditory hallucination.)
Cognition: Alert and oriented to person, place, and time. Memory appears intact for both recent and remote events. Attention and concentration adequate.
Insight: Severely limited regarding the central presenting issue. Patient demonstrates adequate insight in all other domains.
Judgment: Adequate in all areas except those pertaining to Gary Barkovitch.
[Transcript Excerpt]
PATIENT: Gary said he'd come visit when things calm down at home. He's got stuff to deal with first, but he promised he'd come, so I've been setting a place for him at dinner because I want him to know there's a spot for him. My mom does the same thing, like when my aunties come visit from Pine Ridge, she sets the table before they even leave their house. It's just how we do things. You get ready for the people who are coming.
DR. PRESCOTT: That's a beautiful tradition.
PATIENT: During the Walk, he said, "If we make it out, I'm coming to South Dakota." And I said, "Why the hell would you want to come to South Dakota?" And he said, "Because that's where you are, idiot." He's just running late. That's all.
Patient frames the place-setting behavior within a cultural context. The behavior itself is consistent with the broader delusional framework, but patient's attempt to normalize it through cultural reference may indicate a partial awareness that the behavior requires explanation.
The reported conversation with Gary Barkovitch is notable for its specificity and emotional weight. Whether this conversation occurred as described or has been constructed retrospectively, it is clearly functioning as a foundational narrative in patient's belief system.
This clinician is increasingly convinced that the patient's presentation is best understood as a complicated grief response with delusional features rather than a primary psychotic process. The delusion is limited to Barkovitch's survival, internally consistent, and emotionally motivated. It does not generalize to other domains of functioning.
XI. Clinical Impressions
Collie Parker is a REDACTED-year-old male with no prior psychiatric history who presents for evaluation following his participation in and survival of The Long Walk. He is the sole survivor of the event. He presents as guarded but cooperative, with restricted affect, severely limited insight regarding his central presenting issue, and strong orientation toward family obligation. He demonstrates remarkable psychological resilience in several domains, including future planning, motivation, and family attachment.
The primary area of clinical concern is patient's fixed belief that fellow Walk participant Gary Barkovitch survived the event. Per Walk Registry records, Barkovitch is deceased. Patient describes an ongoing, active relationship with this individual, including phone calls, conversations, and plans for a future visit. This belief is maintained with full conviction and is resistant to indirect challenge.
Clinician's working hypothesis is that the delusional framework serves a critical protective function. It allows the patient to maintain a relationship with the someone he perceives as understanding his Walk experience. Removal of this framework without adequate therapeutic scaffolding could induce an acute psychological crisis.
XII. Diagnostic Impressions
F43.81 — Prolonged Grief Disorder (with delusional features; circumscribed, emotionally motivated, non-generalizing)
XIII. Treatment Recommendations
Individual therapy, twice weekly, grief-focused within a trauma-informed framework
Gradual, patient-led reality orientation
Psychiatric evaluation for possible medication management
Nutritional consultation
Pain management referral
Family therapy consultation
Patient was informed of recommendations.
Patient's mother was also provided with a summary of recommendations. Afterwards, she said, "He sleeps on the floor. I figured he probably wouldn't mention that."
Pine Hills Behavioral Health Center
30-Day Follow-Up Progress Note
Patient Name: Parker, Collie J.
Date of Birth: REDACTED
Sex: Male
Race/Ethnicity: Native American
Primary Language: English
Referral Source: The Long Walk Organizing Team
Date of Assessment: REDACTED
Clinician: Dr. Jan Prescott, PsyD, LMHC
Assessment Location: Pine Hills Behavioral Health Center, Outpatient Wing
Patient arrived on time. He appeared to have gained some weight. His limp was less pronounced. He sat in the same chair, closest to the door. He did not remove his jacket.
Patient reports that he has been sleeping better, though he continues to prefer the floor. He reports reduced cigarette use ("down to like seven or eight a day.") He reports that his mother has reduced her work schedule and that renovations on their new home are underway.
When asked about Gary, patient's mood visibly improved.
[Transcript Excerpt]
PATIENT: He finally called last night.
DR. PRESCOTT: Tell me about that.
PATIENT: He's such a drama queen. He spent like twenty minutes complaining about his aunt, and then another twenty minutes complaining about how nobody in D.C. knows how to drive, and then he asked me what I was wearing. [laughs] Fucking perv.
DR. PRESCOTT: What was that like for you? Hearing from him?
PATIENT: What do you mean? It was normal. He calls, he complains, I tell him to shut up, he doesn't shut up. You know, normal.
DR. PRESCOTT: I see. And how long did you talk for?
PATIENT: I don't know. A while, I guess. I fell asleep on the phone and when I woke up it was the morning. He probably hung up when he heard me snoring.
DR. PRESCOTT: Falling asleep on the phone with someone sounds quite comforting.
PATIENT: Yeah, it is.
Patient reports another alleged phone call from Gary Barkovitch. The alleged calls are helping the patient sleep. The descriptions remain consistent in tone, detail, and emotional quality. Patient does not appear to be fabricating the experience. His affect when discussing these calls is natural and unrehearsed. The patient is either (a) experiencing vivid grief-based hallucinations that are ego-syntonic and indistinguishable from reality, or (b) constructing these narratives unconsciously as a continuation of the delusional framework identified at intake.
[Transcript Excerpt]
DR. PRESCOTT: You mentioned you're preparing a room for Gary in the new house.
PATIENT: Yeah, on the second floor. The window faces west so he'll get to see the sunset every night, which I know he'll have something to say about because he's never not had something to say about anything, but I think it's nice. I put a desk in there because he's always scribbling in notebooks. He writes stuff down constantly. Lists, mostly. Like, plans, or whatever. He always has a plan. [laughs] His plans are terrible, by the way. They just might be the worst plans I've ever heard, but he always seems to have one.
DR. PRESCOTT: It sounds like you know him very well.
PATIENT: I know everything about him. I know he hates being called short even though he is. I know he puts hot sauce on everything, including stuff that should never have hot sauce on it. I know his mom was the only person in his family who ever gave a shit about him and he watched his dad murder her when he was REDACTED. I know he talks in his sleep. I know that because I was walking next to him for days and sometimes he'd zone out and start mumbling and I'd have to…
DR. PRESCOTT: You'd have to what?
PATIENT: Keep him moving. I'd make sure he kept moving.
Patient demonstrates extensive knowledge of Gary Barkovitch that is consistent with prolonged, intimate observation under extreme conditions.
The shift in tense at the end of this excerpt from present ("he talks in his sleep") to past ("I was walking next to him") occurred seemingly without patient's apparent awareness. This is the first instance in which patient has referenced the Walk experience in a way that implicitly acknowledges a shared history with Barkovitch rather than an ongoing present. It may represent the earliest sign of the delusional framework beginning to thin.
[Transcript Excerpt]
DR. PRESCOTT: I want to revisit something from our last session. You mentioned having a recurring experience when you wake up in which your feet move like you're still on the Walk.
PATIENT: It's not a big deal. It happens to Gary too.
DR. PRESCOTT: It does?
PATIENT: Yeah. He told me that when he wakes up, his feet are doing the same thing, and he calls me and we just… well, I mean, we don't talk about it much, actually. Not really. We just breathe and listen to each other breathe and then eventually our feet remember they can stop. [pause] You know what's funny? On the Walk, the sound of someone breathing next to you was the scariest thing in the world because the second you couldn't hear it anymore, it meant they were gone, but now it's the only sound that makes me feel safe. Hearing Gary breathe means he's still… [stops abruptly] that we're both still here.
DR. PRESCOTT: That's a powerful observation, Collie.
The imagery patient uses carries significant clinical weight. On the Walk, the cessation of a nearby participant's breathing would have preceded or accompanied their death. Patient's fixation on Gary Barkovitch's breath as proof of continued existence is consistent with trauma-conditioned hypervigilance repurposed within the context of complicated grief.
Pine Hills Behavioral Health Center
60-Day Follow-Up Progress Note
Patient Name: Parker, Collie J.
Date of Birth: REDACTED
Sex: Male
Race/Ethnicity: Native American
Primary Language: English
Referral Source: The Long Walk Organizing Team
Date of Assessment: REDACTED
Clinician: Dr. Jan Prescott, PsyD, LMHC
Assessment Location: Pine Hills Behavioral Health Center, Outpatient Wing
Patient arrived 12 minutes late and appeared agitated. He was wearing a black t-shirt that was too large for him. When asked if everything was alright, he said: "I'm fine. Sorry. Got stuck in traffic."
[Transcript Excerpt]
DR. PRESCOTT: You seem a little different today. How was your week?
PATIENT: It was fine, normal. Nora had a soccer game and she scored twice. She looked up in the stands after the second one and when she found me, she did this little wave and I thought… nevermind. It's just… it was a good game.
DR. PRESCOTT: That sounds wonderful. What about things with Gary? Has he been in touch this week?
PATIENT: He's been busy.
DR. PRESCOTT: You mentioned he was planning to visit soon.
PATIENT: [stands up, walks to window] He'll come when he's ready. I'm not going to pressure him. He's got his own stuff going on. People have lives. I can't just expect him to drop everything because I— [Stops and presses his forehead against the window glass. He says nothing for approximately 19 seconds.]
DR. PRESCOTT: Collie?
PATIENT: I keep calling his number, but it's been going to a recording that says it's been disconnected, which doesn't make any sense.
DR. PRESCOTT: Have you tried reaching out to him any other way?
PATIENT: I wrote him a letter. He made me memorize his address during the Walk.
DR. PRESCOTT: Did you hear back?
PATIENT: [shrugs] The mail's slow.
DR. PRESCOTT: How long ago did you send it?
PATIENT: [pause] Five weeks, but it's whatever. I know he's going to write back. He's dramatic so he's probably just… I'm sure he wants to write something perfect because that's what he does. He overthinks everything. He'll have started ten different letters and thrown them all away because none of them were good enough. That's exactly what he'd do.
DR. PRESCOTT: Collie, I want to talk to you about something that might be hard to hear.
PATIENT: [sitting back down] He's alive. He's alive and he's in D.C. and he's going to come to South Dakota and sleep in the room I made for him and eat my mom's cooking and meet my little sisters and he's going to love them and they're going to love him because everybody loves him once they stop being scared of him. That's what's going to happen. That. Is. What. Is. Going. To. Happen.
DR. PRESCOTT: What are you scared of, Collie?
PATIENT: I'm not scared of anything.
DR. PRESCOTT: I think you are.
PATIENT: [standing] I need to go.
DR. PRESCOTT: Okay, sure, of course. I'll see you next week then.
PATIENT: Yeah, sure. [stops at the door] The letter's going to come. You'll see.
Patient demonstrated increasing difficulty maintaining the delusional framework when pressed for concrete evidence of contact with Gary Barkovitch. He reported reality intrusions that the delusion cannot accommodate. Patient is aware of the inconsistencies but is actively refusing to integrate them.
Document found in patient file, origin unclear. Placed in file by intake coordinator with note: "Found in waiting room chair after patient's session on [REDACTED]."
Dear Gary,
I know you're going to give me shit for writing a letter, but fuck you. You're going to say it's old-fashioned and who writes letters anymore and you're going to read it out loud in that voice you do when you're making fun of me. But I didn't know how else to reach you because your phone is disconnected and you're not answering and I'm trying really hard not to be pissed about it because I know you've got your reasons, but god damnit, you don't make it easy.
Anyways, I wanted to let you know that the house is done. Mom cried when she saw it. Nora has her own room for the first time in her life and she's already put up all these posters of bands I've never heard of and Kaya painted her walls purple and put these little gold stars on the ceiling that glow in the dark and Winona already broke a window playing catch inside. If you were there, you'd have lost your mind laughing. I can hear it already.
Your room is on the second floor. The window faces west so you get to see the sunset. I got you a desk and one of those lamps that changes color because I remember you said you liked them. There's a Coke in the mini fridge. I keep replacing them when they get warm. I know that's stupid. I know that's
I sleep on the floor outside your door sometimes. Not every night. I'm not a pussy. I only do it when it's bad and I need to be close to the place where you're going to be. I know you're not in there yet. I know that. I just need to be near the door so I hear you when you get here.
I want to tell you about Nora's soccer game. She scored twice. The whole time, I wanted to turn to you and say "that's my sister" but you weren't in the seat next to me. You weren't there. And for a second the whole world
Pine Hills Behavioral Health Center
90-Day Follow-Up Progress Note
Patient Name: Parker, Collie J.
Date of Birth: REDACTED
Sex: Male
Race/Ethnicity: Native American
Primary Language: English
Referral Source: The Long Walk Organizing Team
Date of Assessment: REDACTED
Clinician: Dr. Jan Prescott, PsyD, LMHC
Assessment Location: Pine Hills Behavioral Health Center, Outpatient Wing
Patient's mother called the clinic at 7:42 AM. She reported that the previous evening, patient set the table for seven and told his sister Kaya to "scoot over and make room for Gary and his meemaw." When Nora asked who Gary was, patient said: "You're going to love him. He's loud and he's a pain in the ass and he's the best person I know."
Mika then reported that Nora said, "Collie, nobody's coming."
Patient reportedly stood very still for approximately thirty seconds before he picked up both extra plates, walked to the kitchen, and stood at the sink holding them for a long time without washing them. When Mika approached him, he said, "Don't."
He went to Gary's room and did not come out for the rest of the night. Mika reported hearing nothing through the door.
Patient was contacted the next morning and agreed to come in. He had not slept.
[Transcript Excerpt]
DR. PRESCOTT: Thank you for coming in today, Collie.
PATIENT: I know my mom called you.
DR. PRESCOTT: She's worried about you.
PATIENT: She doesn't need to be.
DR. PRESCOTT: Tell me what happened last night.
PATIENT: Nothing happened.
DR. PRESCOTT: Your mother said you told Kaya to make room for Gary and his "meemaw".
PATIENT: [silent for approximately 6 seconds] I don't remember saying that.
DR. PRESCOTT: Collie, I think it's time we talk about Gary.
PATIENT: We talk about him every session. That's all we ever fucking talk.
DR. PRESCOTT: I mean it's time we talk about what happened to him.
PATIENT: [pacing] You don't understand what you're asking me to do. You sit in this chair and you ask your questions and you write your little notes and you've never been on a road that eats people alive. You've never listened to someone get chewed up by the Walk while you kept putting one foot in front of the other because the alternative was getting chewed up too. You don't know what that sounds like. You don't know what that smells like. You don't know what it does to you to hear some boy's body hit the ground and the only thing you can think is "that's one less person between me and going home." You don't know any of that. So why don't you just fuck off?
DR. PRESCOTT: You're right. I don't know those things, which is why I'm asking you to help me understand.
PATIENT: There was a boy on the Walk who was small and loud and mean to everyone and nobody liked him. The other Walkers wanted him dead from the moment he opened his loud fucking mouth. They talked about it openly, like he wasn't even there.
DR. PRESCOTT: But you liked him?
PATIENT: I didn't like him. [pause] I needed him.
DR. PRESCOTT: Tell me more.
PATIENT: He said he had this plan. He wouldn't tell anyone what it was, but he talked about it constantly, like if he just believed in it hard enough it would keep him alive, but it was bullshit. We all knew it was bullshit, even him, but he believed in it so much that sometimes I almost believed it too. [sits back down] He was just scared and pissed off. He never pretended to be okay with any of it, not once.
DR. PRESCOTT: And what happened to him, Collie?
PATIENT: [silent for approximately 47 seconds] He started seeing things near the end. Mostly his grandmother. He was talking to her like she was right there on the road with us, but apparently she'd been dead for years. And I tried to keep him here. I grabbed his face and I said "stay with me" and he tried, he really tried, but he was already so far gone and I couldn't… [presses both palms flat against his thighs] For some reason the only part I can really remember vividly are his fingernails. He just sort of… dug into his throat, like he was trying to pull something out of himself. Oh, and fuck. Fuck, yeah, no, I remember too that he was smiling. He said… he said, "I'll be with you whores forever now." And then his hands went into his throat and there was… fuck, there was so much blood. You wouldn't think a person could do that to themselves with just their hands, but he did. He did it like it was easy, like he'd been practicing for it his whole life.
PATIENT: [sits with his head between his knees for approximately 4 minutes] I was maybe twenty feet away when it happened. I had gotten a warning and I had to pick up my speed and he was drifting away from me and I should have been closer. I should have been right next to him. If I had been close enough, I could have grabbed his hands. I could have held them. I could have—
DR. PRESCOTT: Collie, what happened to Gary was not your fault.
PATIENT: [laughs] Everyone keeps saying that.
DR. PRESCOTT: Can you help me understand the phone calls? The letters? The room?
PATIENT: [pause] If I stop pretending he's alive, then I have to be the person he died in front of, and I don't know how to be that person. I don't know how to walk through a house I bought with a hundred boys' lives and eat breakfast and watch Nora play soccer and tuck Winona in at night and be okay. I don't know where to put all this pain. I've been trying to find a place to put it and there just isn't one. It's too big. It doesn't fit anywhere. So I just… I keep hearing him. I keep hearing "keep walking, Collie" in his voice and so I keep his room ready and I set his plate at the table and I know; I know none of it's real. I know that the truth is he's dead and I'm alive and I didn't save him and I keep waking up every morning and my feet are still going and there's no one on the phone and there's no one in the room and there's no one, there's no one, there's—
DR. PRESCOTT: Collie, breathe.
PATIENT: [breathing hard] My mom let me do it because she didn't know how to make me stop without… She loves the wrong version of me.
DR. PRESCOTT: I don't think there's a wrong version of you, Collie.
PATIENT: [whispering] You didn't know me before.
Patient acknowledged, for the first time, that Gary Barkovitch is deceased and that the ongoing "relationship" he has described is a constructed framework designed to prevent the full integration of grief and survivor's guilt. He didn't believe Gary Barkovitch was alive because he'd lost touch with reality; he believed it because reality was uninhabitable.
Patient's description of Barkovitch's method of death is consistent with Walk Registry records. However, the specific details patient provided are not documented in the registry file. The registry notes only "self-inflicted wound, throat, fatal."
Updated Diagnostic Impression
309.81 — Posttraumatic Stress Disorder
F43.81 — Prolonged Grief Disorder
Updated Treatment Plan
Maintain 2x weekly therapy sessions
Begin grief-focused protocol now that patient has demonstrated readiness for reality orientation
Introduce EMDR when patient is stabilized
Family therapy strongly recommended
The following items were found taped to the inside back cover of the file folder: a Polaroid photograph, slightly overexposed, of two place settings at a wooden table. One has a plate, a fork, a knife, and a glass of water. The other has a plate, a fork, a knife, and a can of Coke.
Written on the back, in handwriting that does not match the patient's:
Two place settings at a wooden table. One has a plate, a fork, a knife, and a glass of water. The other has a plate, a fork, a knife, and a can of Coke.
He'll come home when he's ready.
I'll keep his plate warm.
Love, Mom.