Losing a client nosleep

One of the passions I have in life was psychology. I took an intro to psychology class in high school, mainly for the college credit, and I was hooked. I loved ever thing about it. That spark grew into a flame that led to me becoming a therapist. I wanted to help people and I was fascinated by mental illness. I had a particular liking to the processes behind schizophrenia. Or rather the lack of understanding behind the processes. I wanted to work with them mainly doing individual therapy despite it being somewhat ineffective at times. Hearing the delusions and hallucinations only grabbed my attention the more I worked with these individuals. But the farther I got in my career the more I thought would grow in my head. What if someone suffering from schizophrenia was telling the truth and no one was listening because “they just have schizophrenia.” I have to admit at times it was difficult to tell what was true and fiction.

An example of this would be a client of mine would had schizophrenia and was not very med compliant. He never wanted to take his medications which can be common. Once during my weekly home visit he stated that his nurse visited and told him he didn’t need to take these medications anymore as he gestured towards two medications bottles on his counter. We’ll say my clients name is Steve. “Steve you know you can’t just go off your medications. Do you remember what happened last time, how bad you felt? And your delusions grew in intensity pretty quick.” He was persistent that they his nurse had visited and told him he didn’t need to take them anymore. Steve came from a very remote part of Russian and was trying to start his new life. I wanted him to succeed in that goal. Get a job, hell maybe even a family. Frustrated with him I called his doctor to double check, like I said some of the delusions were actually true and it is always good to confirm what a client tells you. His doctor told me that he had sent the nurse practitioner over for a home visit and there were indeed medications that he did not need to take anymore. This was actually good news since he was already on a cocktail of antipsychotics and other meds. I hung up the phone and apologized. “I’m sorry I didn’t believe you Steve.”

We would meet for weekly sessions. Most of the time it is difficult to get someone in active phases of schizophrenia to engage in any sort of reality based conversation depending on their condition. With Steve this was no different. He only wanted to talk about superficial things. His voice is often raspy and deep due to years of cigarette smoking. “Did you watch the football game?”

“I’ve told you quite often that I don’t watch football. How are you feeling since the discontinuation of the meds?”

“I feel fine. I always feel fine. Nobody ever believes me.”

“We’re are all just trying to help you, Steve. We want you to get better so you can see and be the best person you can.”

Despite multiple attempt to get him to gain insight into his mental illness he never would. I would try to discuss his past history of auditory hallucinations that he suffered from when he was in Russia. He would insist that they were not voices and that people would talk to him. “At night when the base was closed. They come out of woods and we sometimes talk till sunrise.” Steve always told people he lived in a cabin alone way out in the woods. He would never say what town it was near because he insisted it was secret since he worked for the government in Russia. All he would say is his cabin was near a military base and he would live near it as full time perimeter security.

“But when you moved here the medications you started helped. The voices stopped remember?”

“The voices stop because I move away from where they were. They know I live here. They gunna come someday.”

A driving factor in Steve moving the US was that his friend was murdered. The authorities thought Steve had done it. When they arrived all they found was a blood trail in the snow leading from his cabin steps out into the woods surrounding the military base. Steve had actually been the one to call the authorities. Upon their arrival he just kept screaming that “they” had taken him. There was an investigation but the body nor any evidence was ever found to convict Steve. During that investigation a full psych workup was completed and due to the people’s voices he kept discussing he was diagnosis with schizophrenia. The investigation was enough to get him fired and he wanted to move to the US so he left. In psychology if someone has two separate auditory hallucinations, such as separate voices talking to them, that warrants a Paranoid Schizophrenia diagnosis automatically. Steve reported hearing 5 voices.

“Steve I want to talk more about these voices you heard on the day your friend was murdered. Do you think you can do that?”

“No.”

I sat in silence hoping the pressure might make him say something more.

“We can’t talk about them. They come find me if we talk about them that is why I moved here.”

“Steve I just want to get a better understanding of what they are like and how they speak to you.”

He just sat and smiled. “They were friendly. They keep me company during the long shifts at the base. During my training I was warned about stuff coming from the woods. But they were so nice why hurt something nice. I had my friend come over that evening so he meet them. They were angry will me. ‘why your bring an outsider!’ They would scream. ‘You have betrayed us’ another say. Then they took him. Killed in front of me and ate him.” Steve was now crying and shaking.

I had a week’s vacation and when I came back Steve took a turn for the worse. He would call my work phone at least three times a day. I don’t answer after work hours unless I know it was an emergency. Steve never called my phone before so I thought I should answer. “Good evening Steve. How are you?”

He was just breathing heavily into the phone. “Steve are you alright?”

“I told you they gunna come. They’re here. Upstairs I can hear them moving around.”

In the past when Steve has become more psychotic he stops eating and taking his medications. I decided I should go over despite it being 9 o’clock. When I knocked on his door he swung it open quickly and I came in. His pill container was on the stand by the couch and it hadn’t been touched for at least 3 weeks. “Steve why haven’t you” “Quiet! They are up there. They found where I live. I told you they gunna find me.”

Something reflective caught my eye. I looked down to see Steve holding a 8 inch kitchen knife. His hands were shaking and he was white knuckle gripping the knife. When you think a client might be dangerous always keep an exit close and a plan to get out. Steve was standing in front of my only exit.

“There is no one upstairs. No one lives there I check myself the other day.”

His eyes were so wide I could see his whole iris. It have him a daunting look. “They up there and they gunna come down here and kill me.”

“Steve I need you to try to breath and relax.” I took out my phone to call 9-1-1. Steve needed to go to the hospital and they knife made it to where he was a danger to himself and to me if I said the wrong thing. As I took my phone out Steve smacked it out of my hand. He didn’t say anything he just stared at me.

“Steve you can’t…”

I heard something upstairs. It sounded like someone dragging a tall lamp with a heavy base across the floor. A metal on wood scraping sound.

Steve smiled, “I gunna get them first.”

Steve turned around and flung open the door. He ran out and I could hear him going up the steps at the rear of the building to the door of the upstairs apartment. I reached down and picked up my phone and hit send on the emergency call. “9-1-1 what’s your emergency?”

“Yea hi I need an ambulance at 632….”

I heard Steve screaming upstairs. It was the loudest I’ve ever heard a man scream. I completely forgot about the call I just ran outside and up the stairs. The door was kicked open and it was dark inside. Steve had stopped screaming but I could hear a gurgling sound. I turned on the flashlight mode on my phone and could hear the operator talking.

“Hello sir? Are you there? Can you speak to me? Sir, I need your address.”

I couldn’t talk. All I could do is walk slowly into the apartment. In the middle of the empty living room I could see a dark shape. When I moved my light to it I could see it was Steve, or rather it should be Steve. He was in a fetal position on his right side facing me. His face was completely cut off. From his chin to the top of his forehead it was just gone. There were his eye holes and his throat which was gurgling blood and air. The knife he had was sticking out of his gut which he was trying to pull out but his hands were covered in too much blood.

I dropped my phone and when I went to grab it I kicked it under the refrigerator. I had to grasp my ears because they were ringing. I slowly began to realize that it was screeching. I was screaming too. I could feel my voice box vibrating but I couldn’t hear my voice over the sound. Just then something ran by me and out the door. It looked furry and hunched over but it was as tall as I am. The sound stopped.

I ran over to Steve. He was no longer breathing. I called to him but there was no movement. I grabbed his phone from his pocket and dialed 9-1-1 again. They came and the cops had to come too. I told them who I was and that I was doing a house call because my client was in crisis. The released the report and his death was ruled a suicide because of the knife. But what about his face. That knife was not sharp enough to just cut his face clean off. I told the police I had arrived and heard him screaming upstairs. I didn’t tell them I saw anything out of fear of them thinking I am mentally ill too.

Sometimes a client can be right. A delusion can only be a delusion if it is false Steve was telling the truth and no one would listen.

Submitted December 31, 2015 at 01:57AM by Letsdiscover http://ift.tt/1OlbN60 nosleep