Slim Novel 14 - http://adventuresofkimi.blogspot.com - See Homepage
6, Sunday Morning
As Stan walks into the emergency room entrance on the way to his neurology ward, a nurse, calls him excitedly, "Dr Pelc, can you ride the ambulance right now? We got a call from a woman who overdosed. Our intern is out and no other doctor." Stan runs to the ambulance and hops in.
It is in the housing project across Mosholu Parkway, a ground floor apartment, the door unlocked and a crowd outside. Stan and the ambulance attendant with a rolling stretcher enter and he sees a woman lying across the bed, fully clothed in high fashion red dress. She is well made up and Stan thinks: A beautiful woman! Black skin like shined ebony; pure African! Her lips are very full and lipsticked cherry red setting them off from the dark skin. She is well nourished and her breasts through the dress are perfect for the body.
The woman appears to be sleeping. By her bed is an open pill bottle half empty. Stan reads the label - Phenobarbital 30 mg. He shakes her shoulder, "Ma'am Wake up! Wake up! Wake up!" He puts a hand on her neck to check her carotid pulses. The skin is warm and the pulses strong - he estimates 60 beats a minute. He notes her breathing - slow at 8 a minute and not deep. With the attendant, he lifts her onto the stretcher, throws a cover over her, and they roll it back to the ambulance through the crowd. He sits with her in the back as the ambulance speeds toward hospital, siren wailing.
Sitting beside her, he is alerted by her taking a deep sighing breath. Then .... no breath and seconds are passing. Respiratory arrest, he thinks, immediately putting his thumb and 2nd finger of right hand in a wide V under the jawbones, his finger tips extending to the jaw angles, and he raises her head, while his left hand sweeps inside her mouth and throat with probing fingers to be sure no airway obstruction. Then, taking a deep breath, holding it and pinching closed her nostrils, he applies his mouth over hers and blows into her mouth, noting her chest rise. He continues making her chest rise by his breathing at 12 per minute and, as he does it, he thinks, irrelevantly and irreverently, It's the only chance I'll get to soul kiss this black beauty. Her mouth tastes good and he can imagine what it might be like. For many minutes, in the ambulance racing through traffic, he keeps the woman alive by his breathing.
As is typical with a barbiturate suicide try, the respiratory urge cuts out while the rest of the victim's body is still strong, with a good heart. So nassisted breathing is crucial for saving a body whose heart & brain are too good to die.
Next day, the psychiatric social worker tells Stan it was the woman's 6th suicide try. The story is: A beautiful, well-educated woman who worked as a Park Avenue doctor's receptionist and fell in love with her boss and gave him her body only to find herself fired when his wife discovered the affair. Then she went into a devastating depression and now the several suicide tries. "It's a case for your psychoanalysis, doctor," the social worker concludes.
7. Stan's Psychoanalysis and Ethical Lapse
The woman's name is Xenia Green. Stan learns to pronounce it Sane-ya and guesses its Greek classical origin came from her black bourgeoisie parents' desire to promote an upper class persona.
Miss Green recovers from the overdose overnight and Stan starts a short-term psychoanalysis, meeting in his office in comfortable chairs facing each other:
"Miss Green, here is my take on your case based on our cooperation in analysis. I see you as basically healthy, and with every reason to live a long life and enjoy it and accomplish what you wish. But now six times you have tried to end your life. And unless things change, you will probably end it next time. Do you want me to help you?"
"Doctor, the first day, I wouldn't have been truthful with you. But now I see you really care whether I live or die. So I have confidence in you." She pauses a moment, takes a deep breath, "I shall be honest! You can analyze me, but when I come home and lie on my bed at night, those memories of what that man did to me, how he handled me with his hot hands and then threw me out on the garbage - they won't go away. Then the impulse takes over. Next time maybe I'll be brave and jump."
Stan is hoping for this moment. Here is the ideal case to test an idea about the use of morphine, the possibility it could be a treatment to block the suicide urge that typically takes over in severely depressed patients. A drug that can make one feel so good is incompatible with wanting to leave life. But he realizes his risk in trying an experiment with an actual patient. And here it is - Miss Xenia Green. Six suicide tries in such a short time! Thus, the background to what he now says. "Miss Green, you have what I shall call a two memory, can't forget problem. We all have memories of events but when an event has an emotional meaning for a person, the memory splits into two streams - the straight fact and, parallel but separate, its emotional affect. Normally, the memory of the emotion quickly fades and we are left with an unemotional memory of the event. An example is death of a loved one like mother or father. It's an event to remember but, also, for the loving person whose parent died, a cause of grief. As almost everyone knows, we quickly lose the emotional memory of the sad loss and we stop grieving and go on with our lives. But when the emotion runs very deep - a loving person like you, badly abused and discarded, - we can't forget the emotion even after weeks, months, years. And that memory destroys our lives by depression and suicide."
Xenia Green smiles sadly. "Doctor, you explain it so clearly even a dumb black girl like me understands. All I know is the feeling of worthlessness and inner pain that wants out. OK. So now I understand. But I still feel lousy. How does it help me? What do I do?"
Stan grabs the analytic moment. "You want to stay alive but you keep getting hit by this overwhelming feeling of failure and then you get the impulse - Am I correct?"
"Yes. At night is when it hits."
"Psychoanalysis will help you forget the emotional memory. But it may take months of weekly sessions. Will you try it?"
"Yes. But what happens when I get my terrible urge? It only takes minutes to go up to my apartment roof and jump."
"I am going to supply you with a medicine" Stan goes to his desk and picks up a hand-size medicine bottle of red syrup. He takes off the bottle cap and pours syrup into the cap filling it up. You may test it right now by holding it in your mouth for two minutes to allow direct absorption into your brain. Then we wait two minutes and see how you start to feel. The idea is you take the medicine as soon as you see you are getting your terrible urge. It should give you at least an hour of good feeling and head off your urge to leave living. By the time it wears off, the urge will have passed but, if you worry it will come back, you call me at once; here is my private number. Will you try? And just to give you confidence, I'll take a dose first, now." Stan lifts the filled bottle cap to his lips and takes the dose in his mouth. Then he cleans the cap with an alcohol tissue.
"Doctor, I have confidence in you like my father. I'll try anything you say if you think it will help my problem. Pour away."
He pours another dose, and she takes it and holds it in her mouth, as he has done, for a timed 2 minutes. Then he tells her to wait and they will discuss how it feels and he gets up and leaves her alone in the room.
The dose in the filled bottle cap is 1 milligram of Morphine that Stan had ordered the hospital pharmacist to prepare as the honey-flavored syrup. It is a small dose but enough to give a good feeling that will, for at least a short time, prevent a suicide try. Now he will see what Miss Green experiences and how her thinking changes.
8. How Does It Feel to Be Sane?
Stan returns to his office where he left Xenia Green after taking the syrup. He purposely returns 10 minutes after he left because he wants to be sure the drug has had time to get absorbed through the small arteries that go direct to brain after being held in mouth. He purposely did not tell her what the drug is. That is unethical but he feels if she knows it is morphine it may affect her response. And she, having supreme confidence, asks no questions.
She is sitting, gazing at his diploma on the wall. At the sound of his return, she turns her head. "Doctor! I'm all a tingle - my skin. Like little bubbles - good-feeling bubbles. And my knees and ankles and wrists - it's like they're glowing. Nice!"
"Tell me, Miss Green: feeling like you feel now, could you imagine attempting suicide?"
"Ha!" she exclaims in a single sharp, happy laugh. "Are you kidding? I never knew I could feel so good. Even if it ain't permanent, just the idea I can get the feeling again is enough to make me want to stick around in this good old world."
"Good. But you should not get the idea the medicine is solving your problem. It is just preventing you from carrying out an urge from an impulse. It will give you time to get your mind together. But, if you need to, please call me for advice."
"Kind of heading bad stuff off at the pass, is that it? Yes, I understand."
"Then I will write for your discharge tomorrow and you see me here once a week. You will be given just enough medicine for seven doses a week."
"OK, Doctor. And thank you."
He opens the door for her to leave. "Thank you, Miss Green, for understanding. We have six months. Keep in mind: psychoanalysis is basically You curing yourself. I'll cooperate with you. I am very optimistic."
"Me too, Doctor." She smiles. "But right now I'm feeling so good it seems impossible for me to not be optimistic."
For next, click 14.(9-10) Stan's Ideal Psychoanalysis & Psychothe...
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