Therapy Progress Note 1

Monday, March 27th, 2017 – 5:40 am

Therapy Progress Note

Records selectively reviewed, 30 minutes spent in phone session counseling with Pat.
Session #: 7

3/21/2017 7:00 PM

Assessment and Plan

Diagnosis
CONVERSION DISORDER (primary encounter diagnosis) as evidenced by tremors, dissociation, trigger response, unstable gait which is not explained by neurological findings.

Patrick seems to be slightly improved since last visit. He states he is feeling much more energetic and optimistic, however, he continues to experience an increase in tremors in recent weeks. He reports his arms and hands have started spasming and flapping, even without his awareness, though sometimes he is aware and is shaking his hand to release tension.

He has been keeping copious notes on his diet, is trying to eat more often, but has only gained a few lbs.

We discuss long term goals for therapy (walk without a walker and return to driving) and developing skills for his PTSD and tolerating distressing emotions without withdrawing or suppressing.

Therapist encourages him to continue with check in of his body, to decrease numbness. Patient states that “I used to have severe pain for twenty years, but now I have been completely numb for the last year since I got sick and needed the canes. Now, every once in a while I feel something like pain for a few seconds, and am actually glad because I feel something again.”

He believes he needs to decrease some of his myopic focus on others, and focus on improving his relationship with his body to decrease dissociation.

He does not remember if he has eaten today (it is 7pm) but states he went out to dinner with his wife last night, and will be going out again tonight to eat.

Follow up in three weeks. Plan will involve intensive individual treatment.

Final Wish

Saturday, March 25th, 2017 – 7:02 pm

“Final Wish”
 
You finally accept yourself again
As you pass, many hold your hand
Your name is cherished
You dream of passion in her arms
Love that salves and saves, never in time
You will know greater pain than mine
You just want to feel as though you belong
You just want these others to accept you
Give it time
I already love you
You can do this, kid
Let go

Act Your Age

Tuesday, March 21st, 2017 – 4:58 am

“Act Your Age”

I am one and already me
I am two and always running
I am three and believe in laughter and violence
I am four and believe in nature and magics
I am five and believe in love
I am six and believe in hell
I am seven and I hurl my first curses skyward
I am eight and violence unleashes a new monster in me
I am nine and violence is fine as weed and wine
I am ten and just want drugs and sex
I am eleven and death keeps touching us
I am twelve and I just want to have fun
I am thirteen and the blood keeps chasing me
I am fourteen and I curse God openly and swear there is no such thing as love
I am fifteen and He changes my mind
I am sixteen and I believe in God and only want to love everyone
I am seventeen and the ghosts are still chasing
I am eighteen and a girl gets me to believe in true love
I am nineteen and my calling to pastor or preach was put on pause
I am twenty and I start to feel hidden pain, trauma larger than worlds
I am twenty one and a baby girl makes me believe in magic again
I am twenty five and my body begins to break
I am thirty five and the poppy vanished a decade
I am forty and hope for healing
I am forty five and begin the final break inside
I am forty six and sick with addiction
I am forty seven and believe I am almost done on this side of the light
I am forty eight and the world begins to spin in other directions while family and friends and foes gather around to gawk or lift my spirit. I am at my most broken and least able and most terrified and least worried. I have plumbed depths of dark and peaks of peace that sicken and still me. I oversee a dizzying haunted house ride with such grace from above and impossibly deep loves.
I believe in God. I believe in miracles. I believe I will run again.
I am this age and have always been.
 

Words and Numbers

Monday, March 20th, 2017 – 12:55 am

Children’s books author Paula Louise Shene received eighty dollars a week in 1970 and after paying bills, she had twenty remaining for groceries and luxury items.

A dollar fifty went to priceless Golden Books. Based on size, it made cents that each primer was thirty, forty, fifty, sixty or seventy nine. We would precisely pick only unique ones each time. What does the word thrift mean, mom? Twice the number of books if they’re used, honey.

My two years older brother Paul sat me down when I was almost two and began to read to me from one of his favorites. He could not discern the letters, but remembered every story with frightening precision. He became frustrated when baby brother feet followed my flagging attention and so he smacked the book on top of my head and yelled that I sit down and listen. At all his future readings, I was notably absent.

My MP father grinned as he told four year old Patrick and his brother torrid tales of broken sailors, crying in their cell, forced to hold up broom handles and briefcases and beaten if their arms and the floor didn’t remain parallel. He promised his boys he could break the will of any man, but was looking only at me as he spoke.

Two of my favorite reads by five were dad’s Playboys and horror comics. Asses and demons. Still American family favorites after all these years. I began to track mother’s schedule downstairs each day to stretch my secret reading times. I could read and write before four, so I knew instinctively that every truth and answer and the way to God must lie hidden in a book somewhere. I just didn’t realize I would prefer the pictures.

My  brother slapped his seven year old hands on several centerfolds that our bad dad had thoughtfully tacked on the wall. Paul yelled “mommy!”

Mom laughed. But then dad said, “I wish.”

I could see that made my mom sad. “You know how you are different from all those other girls, mom?” I asked. “You are sweet and prettier and you have brown hair, not yellow.”

I loved the pictures and looked at them after I finished my homework. Every day for ten years. But after a while, mostly the faces look different. Especially the eyes.

When this breaker of men told me he would spank me if I kept looking at his Playboys, without blinking I promised him that I would still sneak in every day to look at zombies and boobies until I am a hundred.

In his heart, that little boy already knew he was able to withstand anything that anyone had to throw at him. I had already divined father and I were the same size on the inside. The already shattering five year old swore to be the first to break the mold. Thus epic hammer and anvil crashed in vain for decades.

An early attempt at perfect justice, discipline and order, our father once spanked us with the belt and then stood us brothers in opposite corners. I glared over at Paul and dared that he not fall to the pressure. But within minutes he wailed and our wanton warden released the coward as reward.

Then I saw my smug father smiling and I pictured sailors crying and lifting trembling broom handles for hours or maybe days.

I swore to the quiet above and the burning below to break this brutal bastard in two, if it took me eighteen years.

Silent and staid, we wondered why we could see tears rolling down the cheeks of the little boy in the corner, but there were no heard cries or any light in his eyes. Then I wondered how I could see Patrick from the outside. In my story, I am the master of muse, musics and magics and only I decide what to ban or abide.

Over four hours later, my father caught me falling as my two eyes rolled backward and my five year old knees buckled. He yelled and spanked me again and sent me to bed without supper.

But I won.

Didn’t I?

Broken Table

Sunday, March 19th, 2017 – 4:10 am

“Broken Table”

Each night a vandal and captain of my destiny, I sneak into the hall of my fathers.

The dusty burlwood table stretches in perfect parallel, married to the end of this impossibly long chamber. In the loving cover of Luna’s light, I return here to run my fingers down the wood grain, messy in symmetry, each year of growth a loving fold and wrinkle in flesh.

Close to the beginning of the marbled surface, still flicker the fading letters painted in earnest and fear with the trembling hands of our first love:

If children live with hostility, they learn to fight.

I see where the decades old flake of gold peels and flees in pieces, but this long hand is the shortcut to our mother’s heart and will outlive the table itself.

At the head of the table, my chair lies overturned by the broken remains of my father’s throne. I follow the first line from my birth to death, second birth to second death. Will of the Phoenix. I drag my rusty bowie knife down the stage of the final supper to carve a new chapter, but my hand slips at the broken edge of history.

The rest of table is gone.
It was here just the night before and almost everything is lost.
All the papers with all the truth with all the meaning with all the hope and faith and love and God and they’ve fallen into the black hole beneath the remains of the table and beneath the floor.
I had a paper for each one of you.
I had so much room for your scrawls and scrolls, tombs and tomes.

The moon no longer sings to me. It turns each time. It hides its face in shame and the cool blue fingers are cut short and refuse to crawl into the hole under the shattered wood and bone.

I’m no longer looking to rescue the papers or the table to put them on. Each distressed page with your face and traits clearly listed. All gone, but the most precious few. So, I write them from memory anew, that I am best able.

I edge up to the abyss, hugging my hastily scribbled memories, cobbled close to my chest and I venture a guess of the miles of depth to this trench. I think back to the final urgent words of mother on the missing half of my battered desk:

Fold your arms
find the faith
close your eyes
and fall

Ghost Ship

Friday, March 17th, 2017 – 10:01 pm

“Ghost Ship”

No man recalls the season our controls were severed. I just refueled bare hours before and must do it four times a cycle to keep afloat. The black oil and sometimes weaker brown and green that move our broken airship are bitter and costly in evil ways.

The brush and bump below is followed by cost and complaint. I hide my panic at the hull shredding from sudden boulders bruising our portside. Avoiding such meteors in years prior would have been child’s play. Now I look down at the red hydrogen oozing out of our jagged pink fabric. I weep silently at the state of our once revered, invincible vessel. I regret the times I casually cursed her and wonder if she can even get us home again.

At one time, I would whim and whisper and the wheel would respond smooth and with purpose. The bloom of grace commanded a love and invited the hubris and mistakes of youth. Now worlds torn, the top half halfheartedly halters while the lower decks scream protest, a blackened bowel of forgotten blasphemies.

The growl and drone ever grows and we tune anew to the year long wails of the doomed engineers below. Every twist and turn and cry and prayer yields zero response from the singing of tendon and blood. The primitive reactors scream and spew hot acid with tears and their dying despair haunts me each sunrise. Just as they destroyed the captains before me that broke their vows. They flew like ghosts.

The ship lurches into a primitive dance of ecstasy and agony, merging hate and love with chaos and order, black and white, sensual and violent. The endless echos of the larger dark space lusting for a worship that we usually reserve for stars and flaming suns and daughters.

I reach out the cabin window to break the chain and lower the boom and cane. My rancor burrows deep into sand and caresses mock marble with a loving thud. My innocent crew is saved once more from the cliffs of time and cold fires of space.

Our physical connection to the globe is long lost. Now it is flawed and forced and barely felt. I honor their memory with my few remaining red rotations. I have not set foot to holy ground for more months than I chose to count. I ripped up the angry orders of my past and simply point north each dawn toward my father and the sun and my unruly ghosts. Together we daily lace scarred hands and lower sunken eyes to purchase our uneasy peace.

The begging below cuts deeper each night and I pray for souls to the God of land and air. I ask for those buried in this self inflicted tomb. I plead for a final chance to ferry these few tortured stories back to their birthplace.

Sad and under, the sighs surrender, wave and fade to a sweet silence. I pull into the port of their parents with a blackened bow carved from years of battle and trade. Fighting tears and near collapse, I kept only one vow, to bring their souls to the place closest to the illusion of their home.

Dreams of other worlds and the caprice of gods and chance decide whether these lost ones will be longed with kisses and song or the curse and cold of bone and gold.

Final Race

Tuesday, March 14th, 2017 – 11:20 pm

In Fairview Arms, I flail to free myself from a fevered dream. I run with brilliant torches down God’s chosen path. I yell warnings, begging you follow me to safety. But my bright race cuts back to black. I wake up with my first seizure. I’m eighteen.

My head was nodding wildly and uncontrollably and I reached up with trembling hands and I pushed against my cheeks to stop the shaking. The tears on my palms announced I was sobbing. Night terrors.

Now I cry every day. One or two or ten or twenty times a day. Sometimes for as little as half a second, gasping and choking it back. Often it is while engaged in the mundane, such as making coffee. Little things.

My conversion disorder agitates and aggravates seizures in unpredictable ways. When I cross thresholds like painted lines in parking lots, my brain locks up and the body likewise in basic lockstep. Then I must one, two, three baby steps and one day at a time to push through the seizure to cross the finish line. Each time.

This is typically paired with panic attacks, sharp stabs to the chest and gasps so fast now, I have to be careful not to pass out. Once done hyperventilating and adrenaline abates, I go into seizures again. And then crying. And then.

I cycle through each and all – panic, gasps, seizures and sobs – three or four times each in a twenty minute span of trying to fall asleep. I wake up in the middle of some of the symptoms at random times. Every night.

Every time I push my walker or cane into a new room, it is all I can do to not sob uncontrollably.  All day.

Every transition every input every color every sound every noise every fear and hate and love and empathy and fuck and why and God and too much please stop at once oh no seriously I think we’re gonna crash. Help us.

I struggle every day with the fear the doctors have missed something. Whilst my spirit often soars and I am pushing myself more than before, my physical improvements seem negligible to nonexistent. I’m impatient.

My body is so numb, I barely make it to the bathroom in time, several times a day. We have to schedule reminders to eat, because my brain most often cannot hear hunger. I must also watch that I do not overeat, as I cannot feel fullness. Total disconnect.

Around 2000, seeking God, I fasted many times over a few year span. It was usually days or weeks. I had three fasts that were forty days each. Too long.

Mapping my near demise and demolition is tedious and daunting. From 2000 to 2010, I was on almost maximum doses of Fentanyl. Or Oxycontin. Or Morphine. Or Methadone. Because those are the medicines that good people do. And die.

In 2009, my father was rapidly declining. After my first opiate detox in 2010, I began to drink much more. Two shots of whisky a night became four became ten became twenty became thirty blurry nights in other homes and foreign couches. For years.

After my second opiate detox in 2013, something brain based broke loose and floated downstream and down ptsdream. I hurt so much then and now and later. I ache inside so deeply, it cannot be named. Seeing others suffering now causes me such physical pain. Not helping others is rare to resist. I’m compelled.

October twenty eighth, two thousand fifteen, twenty, thirty blurry hurried shots and my last hurrah. It was the final night I drank alcohol. For life. I had between twenty and thirty dirty drinks in a dangerously small window. Three hours.

My PTSD evolving or succumbing to conversion disorder may have turned the track when I quit drinking. There was no longer enough aqua vitae on the globe to drown a living lake of fire. If I could do it all over again, I would do it the same. Still burning.

October twenty ninth, two thousand and fifteen and fate and faith falter and freeze. I am standing again at the final crossroad and see my end coming soon. I am telling God we are damn well done drowning everything and deluging everyone in my fucked up story Ark.  He is telling me of final fires and floods. He is warning of burning torches to win loved ones lost in slumber. He is reminding me of thirty year visions and a final race to draw witnesses. He is saying it is the brightest I will ever burn. Personal best.

I will never stop burning. I will never stop running. I swear.