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EXCERPT
:
Saylor
University Medical Center
Office of neuropsychiatrist, Karen Kain, M.D.
June 25, 1998
Dr.
Karen Kain walked into her office, clutching a stack of files
and a Styrofoam cup half filled with lukewarm coffee. “Morning,”
she greeted the woman waiting for her. “You know I’m
going to need your consent for this surgery, don’t you?”
The
woman kept waiting for dangerously close to an hour, sixty-three-year-old
Brooks Varga-Taylor, cocked her head and gave the doctor a
look that conveyed just what she thought of being kept waiting
so long. “And hello to you, too, Dr. Kain.”
Dr.
Kain sat down with her files and scanned the contents of her
desk, mentally noting, listing and prioritizing before looking
back up. “Sorry I skipped all the how-are-you, sorry-I’m-late,
would-you-like-some-coffee chatter.”
“Coffee
would be lovely, thanks,” Brooks replied.
Karen
grinned, despite herself. Brooks was old-money, Auburn, Alabama
raised with a delicious low voice and deep southern accent.
It made everything she said pleasant to the ear. It also meant
when she said something with a barb attached, it took a moment
to bite the listener, since everything sounded so polite and
civilized.
Dr.
Kain picked up the phone, buzzed her office assistant and
ordered coffee. “Now,” she said to Brooks, when
she’d hung up, “to the matter at hand—”
“Samantha
makes her own decisions,” Brooks interrupted. “I’ve
told you that numerous times.”
“Brooks,
you know that legally Samantha is considered beyond the point
of sound mind for consent.”
Brooks
dropped her head forward slowly while cocking it slightly,
a gesture that screamed say what? without her actually having
to say a word.
The
look was not lost on the doctor, but before she could respond
there was a knock on the door a fraction of a second before
it swung open and Jenna, her personal assistant, maneuvered
in with a tray. “Coffee,” she announced unnecessarily.
She set the tray on the table and handed a cup to Brooks.
“Thanks,
Jenna,” Karen Kain said, dismissing her assistant.
Brooks
got busy fixing her coffee. She dropped in sugar cubes, added
a little cream and stirred.
“You
have her power of attorney,” Karen began again.
“Legal
ramifications concern you,” Brooks ventured, “should
something go wrong with the operation. Is that it?”
“It’s
standard protocol,” Karen assured her. “You’ll
have to sign off on it or it’s not happening. It’s
that simple.”
Brooks
sat back and studied the doctor. “But you don’t
personally think Samantha is out of her sound mind?”
Dr.
Kain hesitated in replying.
“Damn
it, the least you could do is to fake it for an old woman.”
“Brooks,
I haven’t lied to you yet and I’d prefer not to
start.”
Brooks
looked down at her hands and inspected her manicure for a
long moment. “The past few weeks, she’s seemed
a little better.”
“That’s
a combination of things: a new drug therapy; a vitamin regimen
and the anticipation of the surgery. I think Samantha views
it like a long distance runner sees that finish line in front
of them. One way or the other, the effort to keep going is
about to end.”
Brooks
noticed the dying plants on the windowsill behind the doctor
and felt disturbed by them. “That new medication you’ve
got her on, what is that?”
“It’s
an antipsychotic drug called Haldol.”
“Antipsychotic?”
Brooks repeated, frowning.
“Yes.”
“Antipsychotic?”
“Yes.”
“You
think she’s psychotic now?” Brooks was shaking
her head, not believing her own ears.
“Psychotic
depression is just one of the types of major depression.”
“Well,
another new one. I thought she was melancholic.”
“Psychotic
depression is rare and exceptionally difficult to diagnose.
People who suffer from it lose touch with reality and often
develop hallucinations. She’s experienced that recently.”
Brooks
shook her head slowly. “You know what I wonder? I wonder
if all the drugs she’s taken haven’t reduced her
to this. We have tried every drug you people can think of
and cocktails of them when the single malt variety didn’t
work. Antidepressants, antipsychotics now, anticonvulsives,
blockers of this, inhibitors of that. Therapy of every kind,
including the shock variety. Everything fails and you think
of some new wonder drug. Last month the magical solution was
what? Bursts of magnetic waves through her brain that were
going to fix everything. How is the body or the mind supposed
to withstand all of that? Then you want to say she’s
not of sound mind, like you, very possibly, didn’t have
something to do with it.”
“I
know it’s frustrating, Brooks. She’s been misdiagnosed
several times, but there is nothing simple about diagnosing
or treating mental illness. That treatment last month, the
transcranial magnetic stimulation, has been very successful.
It’s worked in about sixty percent of the patients who
have been treated with it. Samantha is a stubborn case.”
“I’ll
hardly disagree with that assessment. She’s stubborn
all right and she wants this surgery. I don’t like it,
but I don’t have to like it. It’s Jammie’s
decision to make.”
“So
you’ll sign the forms?”
“I’ll
sign the forms.”
Dr.
Kain reached for the consent forms. “Where did that
nickname come from, ‘Jammie’?”
“That’s
a bit of a story.”
Karen
sat back. A story, a change of subject, might dissolve some
of the tension.
“Samantha’s
mother, Isabel, was my best friend in the world,” Brooks
began. “When she got pregnant, Isabel decided to name
the baby Jane. Jane Elisabeth. Isabel was a gifted psychic.
That’s psychic, not psychotic.” She paused, with
uplifted eyebrows.
“Was
she?” Karen asked, careful to keep her voice neutral.
“She
was. She’d go into these trances and come up with all
sorts of things. She used to call me with advice or the answer
to a problem before I’d even told her about it, but
I’m rambling. Anyway, when she was pregnant she went,
you know, wherever it was she went—” she waved
her hand in tiny circles, “and came up with that name,
Jane Elisabeth. She said it was the child’s name.”
Karen
cocked her head, wondering if perhaps the mother had not been
a mental case herself.
“Well,
Sam, her husband, had desperately hoped for a son, a namesake,”
Brooks continued. “When they discovered they’d
had a girl, he rather insisted on the name Samantha in lieu
of it. It had been very difficult for them to get pregnant
and they both knew this was going to be an only child.”
She shrugged. “Isabelle loved him and she gave in, sort
of. The child became Samantha Jane Elisabeth Bennett. Isabelle
called her Jane and Sam called her Sammie. When she was about
two and a half, she started calling herself Jammie and it
stuck.”
“It’s
lucky that she had you when her folks died.”
“Not
lucky, ordained.”
“I
do want you to have a basic understanding of the operation,
since I need your consent.”
“All
right, explain away.”
Karen
clasped her hands together, interlacing her fingers. “Through
neuroimaging, we have a picture, if you will, of Samantha’s
brain.”
“That’s
when you shot that radioactive stuff through her.”
“Yes.
A small amount of radioactive material was injected into her
bloodstream. It traveled to the brain and it allowed us to
measure the rCBF, or the regional cerebral blood flow. In
short, to see how her brain functions. How and at what rate.”
“Her
brain metabolism, so to speak.”
“Exactly,
her glucose metabolism. Now, some of this may be Biology 101,
but let me just ramble for a moment so I can cover all the
bases.”
“Fair
warning, I’m pretty sure I flunked biology.”
“I’ll
go slow,” Karen assured her. “The brain has hundreds
of billions of nerve cells, we call them neurons, and these
neurons communicate with each other by both electrical and
chemical processes. The sequence goes something like this:
An impulse in the brain, or an electric charge, travels along
to where packets of chemicals, called neurotransmitters, are
stored. The impulse releases the neurotransmitters which flow
to receptors designed to bind with them. The receptors relay
a message given by the neurotransmitter, the first messenger,
to the rest of the neurons through a chemical intermediary,
and this effects a second message, which effects a whole range
of chemical reactions which process the information. This
all happens in about a tenth of a second.”
“Lickety-split,
is what we call it in the south. You, being from Chicago and
all, I feel somewhat duty-bound to explain these things as
they come up.”
A
corner of Karen’s mouth quirked. “Now, sometimes
too many neurotransmitters are released or for some reason
they don’t bind with the receptors. Those have to be
reabsorbed or broken down by enzymes. That process is called
reuptake. You’ll recognize that word from the reuptake
inhibitors she’s been on.”
Brooks
nodded.
“One
of the neurotransmitters is called serotonin. Samantha has
an extremely low level of serotonin. That’s one of the
things we want to go in and stimulate both chemically, through
direct injection, and electronically, through electroconvulsive
therapy. She’s been through ECT before but typically
electrodes are placed on the scalp. This time we’ll
stimulate the surface of the brain itself.”
“Has
this been done before?”
“Not
in the treatment of depression. This is considered a radical
procedure, an elective and experimental surgery.”
“Who’ll
perform the surgery?”
“Elijah
Cross. I’ll be there, observing.”
“Elijah
Cross,” Brooks repeated. “Impressive.”
“This
is a groundbreaking procedure. There is sure to be a lot of
press on it. But, I don’t want to sugarcoat anything.
I need to tell you the odds of surviv—”
“Please
don’t,” Brooks interrupted, sticking her hand
up. “Please. I’ll sign a waiver on that if you
need. I don’t want to know. Her mind is made up, no
pun intended.”
“Brooks—”
“No,
really. I will accept whatever happens as God’s will.
The two of us have certainly discussed it often enough.”
Karen
Kain nodded, accepting it. “All right.”
“When
are you thinking you’ll do this procedure?”
“If
you sign the papers today, we can do it as soon as Tuesday.”
Brooks
sat in stunned silence for a long moment. “That soon?”
“Dr.
Cross has an opening and Samantha is eager.”
Brooks
licked her lips. “Tell me where to sign.”
Dr.
Kain slid the forms in front of Brooks. She’d already
highlighted the places for signatures. “Here,”
she pointed out. “Here and here.” She noticed
the older woman’s hand trembling as she hesitated between
signatures. “That should do it.” Dr. Kain pulled
them back, stacked them against the table and laid them down.
I
suppose that wasn’t so hard,” Brooks said. “Now
if I could only shake the feeling I just signed Jammie’s
death warrant.”
“Brooks—”
“No,
it’s all right.” She stood. “I’m just
feeling sorry for myself. This is what she wants. Good day,
Dr. Kain.
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JAYNA
INCARNATE
by Jane
Shoup
