The Slip

Chapter 7

7

THE ON-CALL NURSE AT St. Catherine's directed Susan to therapy room B indicating Carla would be brought there momentarily, as she had just gone through a traumatic episode.

In exchange for helping the hospital to diagnose and treat patients when the facility was overwhelmed or required her expertise, Dr. Susan Reynolds was given access to the patients so she could carry out her own research focused on dissociative identify disorder. Today's visit would be her third research session with Carla. Susan had so far identified two of her alters, Carla and Elizabeth, with Carla appearing to be the host. Carla ranked fairly high on the Dissociative Experiences Scale, so Susan had an expectation that a number of additional alters were yet to be identified.

After a perfunctory knock at the door, an attendee walked Carla into the room and showed her to the couch where she sat down. The attendee then left as silently as he came, closing the door behind him.

“Hello, how are you doing?” Susan asked, careful to not use a name until it was clear who was present.

When Carla looked up Susan saw an instant of surprise recognition in her eyes. Like when you see someone you are not expecting on the street. Carla immediately sat up, locking her eyes onto Susan.

“Dr Reynolds! It is so good to see you again! Something has happened to me. I don't understand any of it.” Carla spoke quickly, clearly under duress. “I'm having strange memories. Sometimes control of my body is taken away. And now…now my body has changed…”

Carla’s voice dropped off, her desperation was palpable.

There was something about Carla's eyes that seemed different but familiar somehow at the same time. And the voice… Susan felt she’d heard that tone before, somewhere else, but shook it off.

“It's okay Carla. You're okay. This is a safe place and everyone is here to help you.” Susan leaned forward and gently touched Carla's hand as she tried to calm her.

“Let's take it step-by-step. Do you remember where we left off the last time we talked?” Susan used this easy and natural way to identify which alter she was speaking with. Her prior session notes indicated where the discussions with each alter had left off.

“I was trying to talk to you. I broke through briefly but the angry man was too strong and pushed me back. Then you left and two other people came in…then I was somewhere else…I don't know where…I don't know anything…what is happening to me?”

Susan had talked to each of the two alters for about an equal amount last session, 20-25 minutes apiece. What Carla described was definitely not their last session. Maybe this was a new alter?

“I remember speaking for a good 20 minutes at our last get together, are you sure you are thinking of your discussions with me and not someone else?” Susan pursued.

“It was you doctor, but I was in a different body…my body. I think?”

Was this a new personality, or was Elizabeth playing some sort of game? In their previous sessions Elizabeth had exhibited a particularly nasty, very aggressive and malevolent personality. Dissociative personality disorder was almost always the result of traumatic childhood experiences. Creating alternate personalities allowed the sufferer’s psyche to withdraw while a newly created, often tougher personality suffered the traumatic episodes. It was still early, but Elizabeth might be the alter that Carla’s subconscious created to deal with some otherwise unbearable events earlier in her life. Commonly such patients had more than one alter, 10-15 was not unheard of and in a few extreme cases over 100, so there was still much work to do.

This type of challenge associated with DPD, and the many unknowns that surrounded it, had captured Susan’s imagination many years ago and had driven her to become a now world renowned specialist in this disorder within her professional circles.

“Well, then I must apologize for my behavior and ask for your forgiveness. You have me at a disadvantage as you know my name and I have yet to learn yours.”

Susan watched as Carla played with the tassels on one of the throw pillows and squirmed awkwardly in her seat. Her other hand moved like a spider along the overstuffed arm of the sofa. She moved her mouth a little but did not seem able to get it to do what she wanted it to, or so it appeared. The placid look in her eyes was at odds with her agitated movements.

With an inaudible click Carla’s body went still and her eyes transformed to an intense glint. If eyes could smile these eyes grinned evilly with vicious intent.

“Is everything okay, you seem a little agitated?” Susan asked already assuming that a transition had just occurred to a different alter.

“Agitated, is certainly one word for how I feel. f*****g angry is another one. Let’s stick you in this place and see how you feel after a couple days. You might feel agitated or maybe you’d be ready to f*****g kill someone!” Carla punctuated with some spittle projectiles. This was the Elizabeth Susan knew.

At the end of their session Elizabeth was displaced briefly by the unknown alter. The desperation returned this time as a controlled urgency.

“Doctor, can you make these other people go away? I’m getting better at taking back control but it’s difficult… it’s tiring… some of them are frightening…”

Each alternate identity a DPD sufferer has, represents different memories and experiences of the overall person’s life. One of the major goals of treatment was to have the alters become aware of each and to have them communicate with each other. This begins the process of stitching the different parts of the patients life back together. It used to be thought the elimination of alters should be the goal of treatment, but often the patient would not react well to what felt like the killing off of parts of themselves. Most professionals, including Susan, now looked to help the alters know each other and learn to coexist. This enabled patients to function in the world and over time sometimes the alters would combine and disappear, but sometimes not.

This might be a breakthrough with Carla. This new alter was aware of the others and seemed interested to learn how to cope with them.

“It’s okay. I understand you’re frightened, and I can help. Can you tell me your name?”

“I… don’t know. I can’t remember anything before the shopping cart… I have strange dreams or maybe memories but they’re so strange they can’t be real…”

“That’s okay, let’s start there. Can you tell me what you remember starting with the shopping cart?” Susan asked gently.

“I was pushing this cart…the smell…there was an awful smell. I think I had been on the streets for a while. I threw up… and then the angry man took over…”

“Okay, what happened then?” Susan encouraged.

“I watched as the man took out a big knife. He was very angry and started yelling and was swinging the knife around. The police came and took us…me… away. I was moved to a couple different places and that’s when we met.”

“That’s when who met?” Susan asked.

“Us… you. That’s when I met you. I was chained to a chair. We were in some kind of cell.”

John Doe!? Angry man… two men came in, the orderlies? Susan’s scientific mind pushed back against the irrational thought that had started to germinate.

“f*****g CELL! What are you talking about? This whole place feels like a CELL!” Elizabeth screamed, taking over yet again.

Before leaving the hospital, Susan sought the on-call nurse who had greeted her when she came in. Her name tag read Lizzie and Susan took her to the side to speak with her privately.

“Dr Reynolds, is everything okay?” Lizzie asked her with a hint of worry in her voice.

“I’m not sure. When I came in earlier, you mentioned a traumatic episode in conjunction with Carla. What were you referring to?” Susan asked.

“Well, one of the newer nurses was escorting Carla from her room to the therapy rooms, where she was to meet with you, Dr Reynolds…” Lizzie’s voice died off, clearly she was uncomfortable about something.

“Yes, and, go on,” Susan said impatiently.

“Well, the nurse forgot to tell the front desk she was moving a patient and unfortunately there was another patient being brought down the hall in the other direction. There was an encounter.”

“What do you mean encounter?” Susan asked.

“Well, the other patient became suddenly very aggressive and lunged at Carla pinning her to the wall momentarily. Carla was understandably quite shaken but wasn’t harmed,” Lizzie said.

“Who was the other patient?” Susan asked.

“It was a John Doe transferred from an arrest a couple of days ago,” Lizzie said biting her lip.

Susan paused in thought for a moment and then directed Lizzie to put Carla in with another patient named Harlon for a few hours before the end of the day. Harlon was a gentle and quiet patient that Susan was also working with.

Susan directed Lizzie to put them in one of the rooms with cameras. She knew the nagging thought in the back of her mind was impossible but she couldn’t help taking it a little further, anyway.