It's three o'clock in the morning, but I can't sleep. I've decided that I might as well try to get all my thoughts down about the whole Courtney Styles mess, see where I went wrong and...alright, I'll admit it, I know exactly where I went wrong. But I'm hoping that when I recount it all, something will occur to me that didn't at the time.
Obviously, this isn't an official case file. That's already on record at the hospital. No, I'm dictating this for my own personal use. Still protected by therapist/patient privilege, though, so if you're listening to this, you probably shouldn't be. Unless I give it to you. If I've given this to you, I probably did so for a very good reason. So fuck therapist/client privilege and give it a listen.
*****
Courtney's parents checked her into St. Mary's about four days ago, claiming that she'd become irrational and paranoid after a trip to Greece. They'd gotten back a week before we admitted her to the hospital, and at first, she'd seemed fine. Perhaps a little more jet-lagged than usual, seemed to be practically dragging herself out of bed every morning, but everyone feels like that the first few days back from Europe, and anyway, she's seventeen. When I was that age, I felt like I had to drag myself out of bed every morning. (yawn) Excuse me. Just the word "bed" is kind of a taboo subject right now.
Anyhow, her mom said that after about five days, the problem hadn't cleared up, and she'd begun to worry about her daughter. Courtney looked more tired than ever--dark circles under the eyes, the whole package. That evening, she decided to look in on her daughter to see how she was sleeping. She found out that, well, she wasn't. Courtney was sitting up in her room with a pot of black coffee and her headphones on, blasting music as loud as she possibly could while surfing the web. Mom tried to get her to go to sleep. Courtney got snappish, then moved to panicky, and finally to near-violent. She kept insisting that she mustn't sleep, that "he'd get her" if she went to sleep.
Yeah, I know. You can start singing, "One, two, Freddy's coming for you," any time now. But the thing is, that was based on a real case. Not the knives or the child killer or anything, that was all just Hollywood slasher-movie crap. But I looked it up last night, and there really was a bunch of kids, refugees from Cambodia, who were having nightmares so bad they were convinced they'd die if they went back to sleep. Well-meaning psychiatrists convinced them that they were just paranoid, that there was no way that sleeping could kill them no matter how bad the dreams were.
So the kids went to sleep. And they all died.
That's kind of haunting me right now. I mean, I'm a psychiatrist, I know just how real psychosomatic illnesses can be. But when a case is staring you in the face, when it's so outside of your normal experience that you just can't imagine it to be anything other than crazy, well...sometimes you make the wrong decisions. Nobody can make a medical judgment based on a horror movie they saw when they were a kid.
But making a bad decision in our profession has serious consequences. Those people who were working with those Cambodian kids, they were just trying to help. I was just trying to help Courtney. Fuck. Fuck fuck fuck!
*****
OK, I'm back now. I put down the tape recorder for a bit to collect my thoughts. I'm not at my best right now, sorry. Anyhow, Courtney's parents spent a couple of days trying to get their daughter to go to sleep, doing things like hiding the coffee, giving her warm milk--they tried to slip a couple of Unisom pills into it, but that just backfired, she started refusing any food or drink she didn't make herself. When they found her at three AM standing under a cold shower to keep from falling asleep, they decided to seek professional help. That's where I came in.
I got to work that morning to find Courtney's mom and dad, looking like they hadn't gotten very much sleep themselves. They tried to tell me what a bright, bubbly young girl Courtney was, how she was an honors student as well as a cheerleader, how she volunteered down at the homeless shelter, all sorts of things about how well-adjusted and likeable she was...and how, in the span of a week, she'd become a burned-out paranoid wreck.
I played the good doctor with them for a few minutes, reassured them that all kids went through rough patches, but inside I was wondering what the hell I'd stepped into. They didn't have a clue as to why Courtney was freaking out so bad. All they could tell me was that she was worried "he'd get her". I figured maybe she'd seen one too many horror movies, had a few nightmares and built it up into something worse than it was, but I knew I needed to see Courtney to find out.
I walked into her room, and she was pacing back and forth next to her bed. I remembered my reading on sleep deprivation, back in school. The parents had said she'd slept a little, just in short stretches, but Courtney still hadn't had significant sleep in seven days. By this point, her demand for sleep would have gone beyond simply 'insistent' into 'compulsive'. She'd be suffering paranoia, hallucinations, and more importantly, she wouldn't be able to relax without falling asleep. That was why she was walking. She must have done the same reading I had, probably looked it up on the Web, and known that the only way to keep awake was to keep active and moving.
"Hello, Courtney," I said. "I'm Doctor Christine Linders." I used my usual tone, the soft, friendly 'I'm on your side' voice. That voice works wonders. Ninety percent of people I see just need someone sympathetic to talk to.
She turned and looked at me. Her face was...I've never seen anything like it, that wary, exhausted, terrified look. "Hi," she said. "I'm Courtney. Bring a needle anywhere near me and I'll scratch your fucking eyes out."
Courtney was one of the other ten percent.
"It's alright, Courtney," I said. "I don't have a needle. But you're right in thinking that we have sedatives here. We've also got orderlies that can make sure you get them, even if you don't want them. So if you don't want me to sedate you, you're going to need to give me a good reason to let you keep staying up." It was a risk, but only a small one. Courtney had threatened to get violent with anyone suggesting sedation, but she was also a teenage girl who'd been pretty much normal until a week ago. She probably wanted someone to talk to. I just hoped she'd want to talk to me.
"I..." She looked uncertain, even more scared than before. "You won't believe me. I know you won't believe me, nobody will believe me, oh, God, he's going to take me into the dream forever and there's nothing I can do!" She dug her fingernails into her arm, hard. I wasn't sure if she was really trying to hurt herself, or if she was just trying to stay awake.
"Courtney," I said, "I can't promise I'll believe you. But I can promise that I'll listen. You're right, I might not believe you. But if you don't say anything, I'm going to have to sedate you. So you might as well tell me about it, and see what I say."
