We didn’t talk as we rode up the elevator to Psychiatric Intensive Care on the next floor. Daniel seemed lost in thought, and I was busy counting my heartbeats while focusing on my breathing. I’ve suffered from claustrophobia for years, a fact that would probably shock my patients. Various coping techniques help, from mental imagery to breathing exercises, but when I first heard the elevator seal shut, I had to restrain myself from hitting the panic button.
We were buzzed into the unit. In PIC, the nurses’ station is behind glass, and a security guard is always at hand. One side of the unit is for high-risk patients like Heather, and the other is the step down unit, where they go when they don’t need the same level of monitoring. If they continue to improve, they are moved down to the next floor, where they have more freedom.
The nurse searched the bag Daniel had brought for Heather to make sure there wasn’t anything she could hurt herself with—the frame was removed from their wedding photograph, same with the tie from her robe. When the nurse was finished, I showed Daniel to an alcove in the lounge area, where they could have some privacy but still be in view, then went to get Heather.
As I entered the seclusion room, I gave her a quick visual. She was still curled in a ball, her pale arms wrapped around her torso with both small hands on her shoulders, as if she were trying to hold herself together.
“Heather, do you feel up to a visit with Daniel now?”
Heather twitched at the sound, then slowly rolled over. Her voice was pleading and her eyes flooded with tears as she said, “I need to see him.”
“Okay, but you’ll have to come out with me because we don’t allow visitors in the seclusion rooms. Are you feeling strong enough to stand?”
She was already pulling herself up into a sitting position.
When we entered the lounge area, Daniel jumped to his feet—and froze as he took in the sight of his wife slowly shuffling beside me, the bandages on her wrist, the hospital blue pajamas, the blanket she’d wrapped around her shoulders like an old woman’s shawl.
“Daniel!” she cried out.
“Oh, sweetie,” he said as he gathered her into her arms. “You can’t scare me like that again.”
Once a patient has been in for a few days we leave them alone with their visitors, but I wanted to see how Daniel and Heather interacted—in case Daniel was part of the problem. I sat in one of the chairs a little to the side.
Daniel gently helped Heather lower herself before taking a seat. Heather rested her head against his shoulder, and he wrapped his arm around her back, supporting her.
“I’m sorry, Daniel.” Heather’s voice was raw with emotion. “I hate what I’m doing to you. You shouldn’t have to take care of me all the time.”
A red flag. Suicidal patients try to convince themselves that people would be better off without them.
Daniel said, “Don’t talk like that. I love you. I’m not going anywhere. I’m going to take care of you forever.” As though to prove his point, he pulled the blanket up around her shoulders, tucking it around her neck where the hospital pajamas had drifted down, revealing the hollow of her thin collarbone.
She clearly wasn’t frightened of Daniel, so I decided to leave and finish my rounds. Then Heather, speaking slightly under her breath, said something that caught my attention.
“I told the doctor about how they keep calling.”
“What did you say?” Daniel didn’t sound upset, just a little worried.
“Not much, I don’t think… I’m confused, and my head feels funny. Are you mad at me?”
“I’m not mad, sweetie. But maybe you shouldn’t think about any of that right now, just think about getting better. We can talk about everything else another day.” His face was earnest, making sure she understood.
“Do you think Emily knows… what I did?”
“No, they probably wouldn’t have told her at the center.”
Heather nodded, then glanced up at the camera in the corner. She’d also glanced at it when she first sat down, and I wondered if she’d been at a treatment center where patients were monitored.
“Is there someone you’d like me to contact for you?” I said.
Heather looked at Daniel. He shook his head, just a slight movement, but she nodded back, acquiescing to whatever he’d just silenced.
I said, “It would help my treatment plan for Heather if you told me what program you were attending.”
Heather rested her hand on his Daniel’s leg, her eyes pleading with him. Daniel’s were focused on her bandages, then he turned to me.
“We used to live at a spiritual center. It’s out in Jordan River. We left when Heather got pregnant because she didn’t want to have the baby there. Some of the members have been calling to make sure we’re okay. They’re nice people.”
I’d heard that there was a center out in Jordan River, a spiritual retreat of sorts that was well respected, but I didn’t know much else about them.
Heather had started to cry again, her shoulders shaking.
“They made me feel like it was my fault I lost the baby.”
“They don’t really believe it’s your fault—no one thinks that,” Daniel said. “They’re just trying to help, sweetie. You were doing so well.”
Heather was crying harder now, her face twisted.
“I didn’t like how they’re always telling us what to do. They—”
“Heather, stop— you don’t know what you’re saying.” Daniel’s eyes shot to my face, his voice concerned and his expression helpless. “They have rules, Dr. Lavoie, but they’re so we can stay focused on the workshops.”
Heather and Daniel clearly weren’t on the same page about the center, but she didn’t want to contradict Daniel in front of me. She kept glancing at him. Is it okay that I’m saying this? Do you still love me?
She gazed at him now, her hands gripping her blanket tight around her.
“They wouldn’t let me say good-bye to Emily.”
This was the second time Heather had mentioned Emily.
“Emily didn’t want to leave with us, remember? She loves it at the center. I know you miss her, but you need to worry about yourself and the bab—”
Heather recoiled like he’d hit her.
Daniel said, “Oh, sweetie, I’m sorry. It was just habit.”
Heather’s eyes had gone dark and empty again, her hands dropped by her sides, palms up—defeated.
“It’s my fault I lost the baby. You’re mad at me.”
“It’s not your fault, Heather—and I’m not mad at you.” In a voice so loving and sad it made my heart hurt, he added, “You’re the most important thing in the world to me.”
“They said we should stay. They said it was better for our baby— and maybe they were right. I made you leave, and now the baby’s dead.”
“Heather, stop.” Daniel was rubbing her back. “Don’t say things like that.” He put his face close to hers. “Hey, look at me.” But Heather was just staring at the wall now, her expression blank.
I didn’t want to push things too much, especially with Heather starting to dissociate from the conversation, but I was concerned about why she was blaming herself so much for the loss of her baby.
“Why did you want to leave the center, Heather?”
She began to rock, her arms wrapped around her body.
“They said that all adults are the child’s parents. So everyone helps raise them, and they don’t even stay with you.”
The horror in her face made it clear that this hadn’t sat well with her.
“At the center, they believe it’s better for the baby’s spiritual growth to be loved by many hearts,” Daniel said. “They have highly trained caregivers.”
This center sounded highly controlling. I turned to Heather.
“But you didn’t want to share your child?”
She nodded and glanced at Daniel, who stared down at Heather’s bandages again. She looked like she wanted to explain herself more, but then she reached out and held Daniel’s hand. He gave it a small squeeze.
