Progress (The Progress Series) (18 page)

“I’m here, I’ll try. But I can’t guarantee that I’ll be able to remember all of the appointments I set. I’m having issues with…time.”

“Understood. Why don’t you just make two appointments a week? My caseload isn’t overwhelming right now, so just set something up with Shelly at the front desk and you can try to make it to one of the appointments you set each week. Sound good?” Doctor Jackson said.

Jesse nodded.

“Now, you said you’re having issues with time. Has this been ongoing or is this new?”

“It’s new I guess.” Jesse shrugged.

“When was your initial bipolar diagnosis, again?” The doctor retrieved Jesse’s file from his desk and began thumbing through it. “Ah yes. Now I remember. It was your little sister--”

“Yep.”

“Would you like to talk about her?” Jackson asked.

“Nope.”

“No pressure. What
would
you like to talk about?”

Jesse shifted in his seat and looked away.

“Okay. Well, we’re not getting anywhere here, Jesse.” The doctor exhaled, “Why don’t you tell me about your current state of depression and when it began...”

The hour passed slowly. Jesse tried his best to answer the doctor’s questions, but his focus was on his drooping eyelids and need for a drink. After scheduling a month’s worth of appointments at the front desk, his pace quickened to get out the door. He moved faster than he thought he was capable.

A week passed with only slight improvement in his mood. But his interest in anything besides sleep, and booze, was minimal.

He managed to remember
an appointment with Jackson the next week. Finding himself in the lobby with his arms crossed over his torso, he slung his ankle over his knee.

“You can go on back, Jesse,” Shelly said.

Walking into Jackson’s office, Jesse found it empty. He took a seat where he had the week before and looked around the room. There were framed certificates on the walls, photos of family on the desk, and a child’s artwork sitting on the floor patiently waiting to be hung. It wasn’t typical of a highly-paid psychiatrist, more like a therapist that volunteers at a sliding-fee community center.

Jesse saw his case file on top of the stack on Jackson’s desk. He quickly grabbed it and opened to the first page.

Case File # 121774-3249
 

Subject Name:
Jesse James Anders (Jesse James Sanborn)

D.O.B.:
17-November, 1987

Address:
1816 Burnsville Parkway, Burnsville, MN  55337

Contact:
953-443-4309 (last known working phone, no longer in service)

Single Caucasian Male

0 children/dependents

No religion specified

Chief Complaint from Patient: UPDATED:
“I’m having troubles with time. I can’t remember when I’m scheduled to work. I don’t know what to do anymore. I feel numb. And, I’m drunk.” – Message taken by staff member Shelly Gleason over the phone on September 6, 2012.

Notes:
Patient first seen in by Dr. Jackson on August 4, 2003, after complaints of previous doctor not using effective treatment methods. After refusal of psychotherapy, patient has been seen regularly by Dr. Jackson to update his prescriptions.

Initial Diagnosis:
ADHD, victim of severe physical abuse by biological parents and two foster fathers before the age of 15.
Other detachment disorders noted, but not specified as patient is reluctant to discuss childhood.

Date of Diagnosis:
March 1997 by Dr. Ralph Carlson, MD, before referred to our offices in 2003. (see attached notes from Dr. Carlson)

Current Diagnosis:
Bipolar I (initial diagnosis retracted after prescribed medication failures to ease symptoms). Many of his symptoms are atypical of a standard bipolar 1 diagnosis and patient has been urged to explore psychotherapy.

Date of Current Diagnosis:
December 2003

History:
Born in St. Paul, MN to John and Melinda Sanborn. No known complications with childbirth or mental health history before ten years of age. Father, John, worked for a manufacturing plant, and mother, Melinda, a domestic engineer. Mother had a bipolar diagnosis but remained unmedicated throughout patient’s childhood. Have not been able to reach patient’s biological parents for confirmation.

Patient describes his social life before ten as “normal.” Received good grades, had many friends, adjusted well to new situations, etc. Patient refuses to discuss the death of his sister, Mandy, and when asked general questions about his family life through childhood, he chooses not to respond. (see attached interview with father and Dr. Carlson, discussing initial diagnosis and circumstances surrounding “Mandy’s” death.)

Marriage, Education and Occupational History
:
Patient is single, but dating. One significant relationship to date. Patient is heterosexual with a history of promiscuity with multiple partners.
High school diploma and one year complete of community college. Social situations through school presented challenges for patient in communication and focus.

Occupational history includes: restaurant industry, warehouse, USA Cycling National Championships cross-country and other competitions, and briefly, the US Marines.

High risk behaviors include:
Alcohol abuse, marijuana abuse, aggression, and a history of police confrontation.

Current living/social situation
: Lives with friend, Jake, and Jake’s father, Dennis, in a single-family home in suburb of Minneapolis, MN. He rents out a single room in the home. Patient describes social situations as solitary or few friends of note. Patient is highly intelligent (see attached MMPI and Weschler results), but prefers an environment of low risk and low challenge.

Summation and Notes:

Initial visit in 2003:
Patient was brought by acting foster mother, Lily Lamoureaux, to our offices at fourteen years of age. Patient’s overall appearance was clean and appropriate. Eye contact minimal and very few words spoken. Ms. Lamoureaux described patient as “sad, confused and broken.” Patient evasive and bouncing knee with arms folded in front of chest. Posture was slouched and showed ambivalence. Patient was alert, but hostile when asked specific questions of state-of-mind, depression and previous foster care. Ms. Lamoureaux described his past situation as “unfortunate and unloving” and “abusive, neglectful and punishable.” (see enclosed audio recording of initial visit - #A3328)

Anxiety visibly increased in patient as Ms. Lamoureaux described previous foster living arrangements and previous biological parental abuse, along with the death of patient’s sister, “Mandy.”

Initial diagnosis of ADHD by Dr. Carlson in question.

Hospitalizations and Interventions:
Patient suffered head trauma as a result of a social altercation in 2012. Previous hospitalizations before in my care are noted in Dr. Carlson’s file (see attached).

Medications:
(see full history and side effects attached)

Lithium; 2004-2008.

Seroquel 2008-present.

Lorazepam 2008-present.

Jackson walked in and apologized for his tardiness just as Jesse was throwing his file back on the desk.

“Shall we begin?” Jackson said.

“Sure.”

“So, last week we were talking about your bipolar and how it’s affecting your job. How did your week go?”

“It was fine. I made it to all my shifts, late only once,” Jesse said.

“Good. Have you been taking your medication?”

“Yeah, I think so. I might have missed a day, I can’t remember.”

“Okay then. Let’s get to the next subject. When you initially spoke with Shelly on the phone, you mentioned that your depression is affecting your personal life. Tell me about that.”

Jesse shrugged and slung his ankle over his knee. Jackson waited patiently as Jesse found his words.

“There’s a girl. Her name is Bree. She knows about my…everything; my illness. She hates it, she doesn’t handle it well. But she keeps coming back.”

“How does that make you feel?” Jackson asked.

Can I just go home and sleep now? Really, Doc? Could you be any more of a cliché?
Jesse rolled his eyes and Jackson smirked.

“How long were the two of you together?” Jackson asked.

“We were off and on for about two years. We broke up about five years ago.”

“And how is your depression affecting this situation?”

“I’m just, tired. I can’t focus on anything long enough to figure it all out.” Jesse took a long pause. “I just want everyone to stay the fuck away from me.” Jesse could feel
emotion
. His blood began to simmer as he considered his responsibilities, the decisions he should be making, the flood of people counting on him: Lily, Charlie, Ben, Lawrence, Jake, and Bree. “I usually just walk away from it all, but this shit keeps coming back. I want to make it go away for good.”

“So then you’ve considered allowing her back in your life?” Jackson asked.

“Yeah, I’ve considered it.”

“And, do you feel that would be a good decision for you?”

“No.”

“Why not?” Jackson probed.

“Because she’s…she’s…” Jesse stopped to think. “She sucks up all my energy when I have none to spare. When I’m with her, she’s all I think about, I ignore work and friends. I become weak and obsessed.”

“Tell me more about the relationship you had with her,” Jackson said.

“I was really young, and she was even younger. It was wrong in so many ways, but I couldn’t resist her. She was so sweet,” Jesse said, recalling their early relationship. “But she was
really
young, and I wouldn’t have sex with her, despite her wanting to. So, I cheated on her, a few times. She found out about them and we broke up. End of story.”

“And you say she’s been back to see you since then?”

“Yeah, a few years ago she found me. We didn’t start dating exactly, we just began the kind of relationship we couldn’t have when she was underage. I became jealous, obsessive, controlling. I demanded to know where she was constantly and didn’t trust her,” Jesse said, looking down.

“Why didn’t you trust her?”

“Probably because I didn’t trust myself. But she
was
having sex with other guys, so I guess my instincts were right.”

“And now?” Jackson asked.

“She came to see me a few weeks ago. She wants me back. I hadn’t thought about her for a while. And there’s another girl now, too. We’re just friends, but she makes me want to be… she makes me feel hopeful. Like…almost like I could be good again. Maybe, someday.”

“So then the question you should ask yourself is: In comparing the two, which one do you think is better for you and your future?”

Jesse’s eyes shot up and stared through Jackson. He didn’t think this simple question would have such an obvious answer.

Waking the next morning, he felt refreshed – not like the previous weeks of sleeping that had left him only wanting more. He rode his bike that day; two miles. He was starting to notice a break in the depression, a dim arrival of a light in the distance.

He showered. Shaved. He even spent an hour enjoying a video game. He stretched. He yawned. He prepared himself lunch. It felt incredible being
able
to remember accomplishing all these things.

*

“Hey Ma, what time is the thing tonight?” Jess asked, when his mother answered the phone.

“How many times do I have to tell you?
” She laughed. “Eight o’clock. It’s at the boat house at your Uncle Al’s. He’s set up the canopies and lights out back. Do you remember how to get there?” she asked.

“Yeah, I remember. Do I have to dress up for this?”

“Nah, jeans and a nice shirt. They’ll just be happy you’re coming. Will you be bringing Jake?” she asked.

“No, I’m bringing my friend, Charlie. We probably won’t stay long.”

“Great! I look forward to meeting him. We’ll see you at eight – gotta run! Love you!”

Him?
He laughed
. I guess I didn’t clarify.
Jess hung up the phone and walked over to his closet.
Jeans and a nice shirt. Hmmm. I wonder what Charlie is gonna wear. I should call her.

“Hey.”

“Hey there. We still on for tonight?” Charlie asked.

“Yeah, I just talked to Ma, it starts at eight. I can pick you up around seven thirty. It’s pretty casual, but feel free to wear thigh highs, a garter, and a matching bra.” He smiled.

“Oh, a joke! You must be feeling a little better. You know Jess, your sexual innuendoes are getting old.” She laughed.

“So are your rejections.” He bit his lip. “I’ll see you in a bit.” He heard her laughter through the phone as he hung up. He instantly felt lighter,
almost
happy.