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No more Doctor Nice Guy Part 18 I pat myself down as a reflex. I suppose affirming my conclusion; but it probably looks as if I'm searching myself for a concealed weapon. Although I purposely avoid the one place where something may well be concealed. I don't want to know. Everything about me feels so grotesque and distorted. So wrong. I'm larger, coarser, hairier even. It's such a disorienting unfamiliarity. Did I feel the same complete dissociation the near 18 months ago when I travelled in the opposite direction? I couldn't recall. I remembered the overwhelming sentiment then was fear for my life, followed by a despairing compulsion to end it to escape what I had found myself become. So perhaps I had. I guess now I was a little more familiar with the whole concept and less impulsively shocked, so my adjustment was not quite as dramatic. I do notice that the feel of the day has changed; it's later; my brief glance towards the little window my office has tells me it's dark outside. I wonder if we have in fact travelled back in time to when everything all began. I don't have the opportunity to process it all though, as has seemed to be a universal theme with my transformations, as Mr Black's presence tends to override all other pressing concerns. "Well I can tell by the look on your face this certainly is, as predicted, a surprise," he begins with derision. "You said... I was never going to be Alex Turner again." It wasn't my intent to be so overt, but I wondered if in challenging him on this point I had revealed that I was disappointed to find myself returned to the form of that man. "That's what you're going to quibble over? I would have thought by now it's abundantly clear that part of my torment of you involves the dissemination of disinformation," he states smugly. "You could just say: 'Lying to me.'" I want to call him out for the arrogant prat he is, even if he is other worldly, but my filters still tell me how unwise that would be. "You should be pleased. Grateful. Thankful. Your punishment is over. You're back exactly where you started. Just a year or so of your life passed by. Which will be explained, if you're at all interested, by an extended sabbatical, in the wilds of wherever you choose. Nepal or Tibet is always popular. It could also conveniently account for why you're such a changed man." That answers the time question I guess. I'm not sure how I know, but it's still the same day I, as Alex Ward, was discharged from Wellness, just it's now a few hours later. Time appears lost in the transformation. "So I'm not actually going to 'become' Alex Turner again." I move to clarify. He said I was a 'changed' man. "I mean you're not going to change my personality back to how it was?" I assumed that would defeat the purpose of this whole torrid process somewhat. However it was immediately apparent to me that I was so far removed from the previous Alex Turner that attempting to re-immerse myself in that life would be so fraught with seemingly insurmountable challenges. "What exactly do you mean Dr Turner?" Perhaps he had purposely referred to me as that, for the first time, to unnerve me further. "Surely you can't just thrust me back in my old body after turning me into a completely different person." Which is exactly what he had done. And whilst I was still struggling with coming to terms with what had just happened to me, I didn't want to be anything like I once was. I'm not sure why I was even trying to reason with him, or what I even wanted. "You changed me so much. My personality is no longer compatible with that life." He immediately laughs quite viciously and heartily. "Really?" He emphasizes incredulity. "You think I changed you? This is not the 'forcing you to fall in love' scenario all over again surely?" It's a rhetorical question once more. "As I told you; all I did to you at the very beginning was change the way the world saw you and gave you a backstory consistent with your new appearance. You were still Alex Turner in every other way. So any changes in you were induced by you." He doesn't pause long enough for me to interject. "Sure; maybe they were influenced by your change in status and new environment but you were the one who molded your changed identity." "Furthermore," he continues, "you turned yourself into the woman you thought the world expected you to be. All the while absolving yourself of your own responsibility by saying you were being directed by forces beyond your control. But you weren't." He laughs mockingly again. "So it's quite apparent that In spite of all your former confidence and bluster you really had quite a weak personality to reformat it so completely. I was able to exploit that too when I was your psychiatrist. I had you emphatically denying you were ever anything other than the insipid girl created from the skewed recesses of your mind. So don't blame me for who you are now dear. It's all completely on you." "But..." I'm so utterly bewildered. Flabbergasted even. This can't be true. Surely not? He's blatantly stating that I'm responsible for all my own changes. I can't believe it. "Uh-Ah! Tut-tut and shoosh. I have no desire to engage in lengthy discourse with you. I feel we've done that enough over the past year. Particularly this last month whilst I was your treating psychiatrist. So I'm just a bit over it. And frankly my overriding diagnosis for you is you're boring and you're basic." "Oh." It was surprisingly hurtful. You'd think I would have toughened up by now, with regard to his jibes; but apparently not. "So be quiet and let me spell it all out for you." He does not let up. I feel bound to cooperate, and am indeed speechless. "When I met Dr Alexander Turner last year, at the risk of repeating myself yet again, I found him quite obnoxious. He was living with the four pillars of privilege and quite indulgent in that." "Four pillars of what?" I find a voice. I had to. I simply didn't understand what he was saying. "Affluent, straight, white, male." He emphasizes each one. As if to count to four. "It was a little sickening to see you in action. But all I had to do was take one of those things away from you and sit back and watch all the dominoes come crashing down." "You took more than one." My impression was he was referring to the last one, but he'd taken much more from me than just that. "Don't you dare squabble with me!" He barks. He knows his aggression will subdue me. "It was just one. If you mean, I took away your wealth you are wrong. You may not have been a rich single Doctor anymore but you still had everything you needed. Which is much more than we can say for many. And as to the other variable, I think your former husband would attest just how much of a heterosexual woman you were." He implies it like I should be ashamed of it. If I felt at all like I was Alex Turner maybe I would. But I'm not Alexander Turner. Even if Mr Black is telling the truth and I killed him off myself; the fact remains; I'm Alexandra Ward. Well Alexandra Moore really if I could be. I'm just stuck in Alex Turner's body. "Anyway. Continuing without the interruptions," he warns again. "Alex Turner was sexist; misogynistic even. As well as racist, callous, discriminatory. He even mocked the mentally unwell. The people he was supposed to be helping. So my punishment for you involved being on the receiving end of most of those things. You became a disempowered vulnerable woman who was prejudged on your abilities just because of your background or appearance. You also suffered and experienced the indignance of mental illness, being held and treated against your will." "So now you're back right where you started Dr Turner." He seems to be summing up. "I just hope you learnt something. My belief is that you will now be a better psychiatrist; and a better person too. I wouldn't go so far as to say a better man. I think we'd both agree that's no longer the right fit for you. The good news is that's something you can rectify. With determination, hormones and surgery." "Couldn't... couldn't you just fix that? All else being equal. I'm sure I could be an even better person if I didn't have to be a man again." I guess it was worth a shot. "I told you at the very beginning Dr Turner. I'm not here to magically transform the transgendered. Especially not you. If you want what you want, you have to do it the hard way, just like everybody else." Oh God. The thought of how much work required to transfigure this body into the semblance of a form I can live with was too ginormous to entertain. "Anyway," he concludes. "I really must leave you to it. There is only one remaining caveat. Which I'm sure you know." I could guess, but I wanted to hear it from him. "Do not attempt to find 'Kevin'. Or try and disrupt her life in any way. Happiness is attainable for you Dr Turner. It just may seem a long way off right now. But she has her happiness. Any interference from you could undermine that. And trust me; she will resent you greatly if you come into her life in any way." He responds to the look on my face. "If I offer you some consolation maybe you'll leave this alone. I did downplay her thoughts and feelings in our previous discussions. She does think of you on odd occasion. With fond indifference. As far as she knows you're still an Emergency department nurse named Alexandra Ward. She did ask me once to pass on her regards and best wishes." It was the most I would ever get from her I guess. Mediocre platitudes. I had so foolishly got my hopes up, as an incarcerated mental patient, that she was trying to reach me. But it was just more of Mr Black's trickery. I'm probably just an ugly reminder of a time of her life she'd much rather forget. I couldn't imagine, even after an indefinite lengthy stint as Alex Turner, I could ever feel such disregard to the woman who was once my husband. I guess we are just very different people. I'm sure my countenance clearly expresses my sentiments. Mr Black has never found me difficult to read anyway. I assume that's because of his Godly powers. Of course he could be right in that I'm boringly predictable. However there is still one thing I'm itching to know. "Can I just ask?" I begin, and don't wait for permission. "Why me? Of all the people in the world? It seems like you're fairly selective. Was it truly just because I ran into you?" "You want me to tell you it was with a far greater purpose that I selected you? That I paired you with Kevin with grand intent? In spite of me specifically telling you it wasn't that way," Mr Black states to clarify. "I guess so." "Well, even if that were true, do you really think I'd give you that satisfaction?" He smiles. But it's perhaps not as full as maleficence as his usual smiles were. Were I to clutch at straws I could make myself believe that this was a concession of sorts. That the person I was, Alex Turner, was a bitter man but not a bad one. Burnt out with compassion fatigue and a hardened heart. And now after being run through the mill a few times I had a chance to start over. And this was the design of Mr Black all along. To remind me of what was important and where my priorities should be. I guess I wanted this to be about morality rather than simple demonic pleasure. I suppose I'd never really know. Perhaps I could just make of it what I wanted. "So goodbye and Good luck Dr Turner," Mr Black intrudes on my thoughts. "Our business is concluded. I trust you won't give me cause to visit you again." That was a decree I would wholeheartedly abide. I watched him vanish, then quickly checked myself for any parting changes. I had hoped to be Alex Ward again but I knew it was fanciful. I was still Alex Turner. I felt I was the same as I remembered him to be. Physically I mean. I would have to look in a mirror to concretely verify that. I wondered if he would appear attractive to my feminine eye. How absurd would that feel? I looked around my office. Also unchanged by the 16 month absence. I was free though, for the first time in a month. I told myself it was far better to be a free man than an imprisoned woman. I'm not sure I believed it though. I would have languished in my thoughts indefinitely for sure but a knock on my door made me look up at Mike Richards. "You are back!" He grinned. "I was beginning to think it was never happening. How was it?" "How was what?" I'm still not up to objective thinking. "Your time away. In the Buddhist monastery or wherever the hell you were. So remote that no one could reach you. Seeking enlightenment. Have you come back with Super powers like Dr Strange?" "Someone's delusional? Do I need to fill out an A.O?" I avoid his initial question. "Like you'd remember how! Anyway. How are you?" "Honestly." I sigh. "I probably have come back quite different. I guess you'll be in the best position to judge that, moving forward." "Well. That's probably just as well. The Emergency Department were baying for your blood when you left. Complaints from the Deputy Director as well as one of the ANUMs. I gotta say, as your friend, you were being a bit of a prick. And you were sucking at your job." Funny what you can say when you deliver it with a caveat like: 'as your friend'. But of course he was right. I felt suddenly sick though, as a result of that assessment. That's the version of me Kristi remembers. Someone she passionately hates. Bad enough that I lost my best friend, but to become her most loathsome foe was such an additional unnecessary cruelty. The thought of now being in a position where I could run to her just to see her was tempting, but the look of contempt she would be saving for me would be more than I could bear. "I'll behave from now on." I'm earnest. "Just as well. Coz liaison say they are backed up in the Emergency Department and are asking for help. I don't want to pull rank, but I'm a psychiatrist now and you've still got over twelve months to go, so I'm delegating." "Fine," I reply. I mean it. I need to get out of this office before it swallows me whole. And curiosity does draw me back to my old 'home.' The Emergency Department. Chances are Kristi won't be there, so I won't have to deal with her scorn. I couldn't right now. She'd been trying to cut back on evenings and nights before I disappeared. She must be about 13 weeks pregnant now. When I had the miscarriage she was 9 weeks. I'd been in Wellness House for a month. Even if she was on, I would just stay well away from her specifically, no matter how hard that seemed. It would be just better for everyone. "I'm glad you're back," he adds as he departs my room. "Well that makes one of us," I mumble near inaudibly, and if Mike heard it he chose to ignore it and walked out anyway. Alone again it feels like I have no choice other than to hit the ground running, and hope that the skills I once possessed, even though I'd spent the past month denying them, still resided deep in me. *** I found the liaison psych nurse in their little side office before I'd even entered the ED. The moment I realized it was Ros I gave a shudder. She had been so cruel to me when I was trapped in Wellness House. I guess on the plus side she was one of very few in the world who might like Alex Turner better than Alex Ward. "How can I help?" I ask. "Well there's not much you can do right now. There's an overdose waiting for medical clearance but ED seemed to be short staffed. Generally, but particularly of Doctors. No-one's even gone near him yet. So we'll have to wait." "Okay," I reply half heartedly. "I'll be back in a sec," Ros remarks. "I got a lippy teen with a bad attitude and an eating disorder who really just needs a hard slap." "Ros!" I scold. "Sorry." She's meek. But disappears all the same. I stay put for only a few moments before I venture into the Emergency Department. Not specifically after Ros, but sitting idle in the little annex office felt wrong. Looking around, I'm mostly relieved there is no Kristi, but plenty of faces I do recognize. Not just faces. But names. And stories. My friends. Was it truly only 4 weeks since I was last among them? When I was one of them? How long ago it seemed; and how it still felt like something I'd dreamt up. But the mere presence of them was a reminder that all that I had been through really happened. I found myself unconsciously staring at the ground at the exact spot where I had my miscarriage. How the floor had stained red with my blood. Not that there was evidence of that now. Whether it had ever been there or not - cleaning sterility would have removed all trace of it long ago. That was the last time I was here. The last moment I was Alexandra Ward, working Registered Nurse. Of course this timeline now dictates that never ever happened. My memories indeed had a surreal, ethereal quality about them. I know what happened to me though. I remember exactly how it felt. Both physically, but more drastically emotionally. It may have been parts of a fetus, or products of conception if we are to be technical, that fell away from me onto the floor, but for all intents and purposes it felt like my heart. Wandering around I have my ID badge on, so people can see I'm staff and not some random, but nobody expects me to have much purpose. I feel like a bit of a ghost in a way. People rushing by me but not actually seeing me. One old man asks me for a urine bottle, and another old lady needs a lot of help getting on and off the commode chair and back into bed. They are both in Tracey's area. She seems busy. Afterwards I tell her what I have done, thinking nothing of it. It's what I would have done as Alex Moore back in the day, helping a colleague, but Tracey's reaction is not what I was accustomed too. She expresses no gratitude and instead forms a face that looks like she's sucking hard on a lemon. I slink away and decide I'll see 'the overdose' that Ros mentioned. It's like 'hide and seek' I decide. Coming, ready or not. I flick on the EMR (electronic medical record) at a computer terminal and find him in the unassigned column. He's in a cubicle at least but there is no documentation beyond the triage, which is over an hour ago now. I introduce myself. It was the first big test of remembering who I am. He's drowsy but he can engage. Better than that, he even seems willing to. We exchange pleasantries and I establish the nature and the amount of drugs he's taken. It's a potentially dangerous cocktail including some possible cardiotoxins. I run a set of obs, hook him up to the Phillips monitor and stick an Iv in, sending off some bloods to path. I'm studying the 12 lead ECG when the curtains fling open, and an accusing yet familiar voice barks at me. "What the hell do you think you're doing?" She growls. My impulse overtakes any assessment of the situation. "Oh hey Kristi!" I say with warmth I cannot contain. My fears for this encounter are outweighed by my enthusiasm in seeing her. She must have just come on, which means she's working overnight. She, like Tracey, looks taken aback by my overfamiliarity. But she recovers. "I remember you!" She hisses. And I know that's bad. But I try. "I'm Alex." "I'll ask you again." She ignores my attempts. "What the hell do you think you are doing?" "A psych consult," I reply. But not with any attitude. "Mr Jensen took an overdose. We're just going to chat about it." "But he's not ready." "He's able to talk. We've been conversing already." Which we had in steps as I was working him up. I hadn't really had time to reflect on the whole litmus test nature of it. Would the vast extent of my differences one year on and the psychological torture of the past month leave me incapable of being a competent psychiatrist anymore? I felt I hadn't got far enough to tell. "He needs medical clearance." Kristi seems to purposely use my former words against me. "Our Doctors haven't been near him yet." "Nor have your nurses. But that's okay." I don't mean to be antagonistic. "Well you're wrong about that," she refutes tartly. "He's in a gown, had a set of obs documented and is on the monitor." "He did all that," Mr Jensen leaps to my defense. Hooray for him. Kristi pauses from her attack for a moment to regroup. She can't hide her surprise. "Well you're the one who insists on medical clearance. If I remember rightly. He's taken some drugs that could affect his heart." "Yep. But it's been a few hours and his ECG looks fine. His QT interval's not prolonged, even correcting for heart rate." Kristi looks at me like I'd farted in her face. "Of course I'm just a psychiatry registrar," I back pedal. "You might want to get one of your ED seniors to sign off on it." "I will," she affirms feistily. She pauses for a moment before relaunching at me yet again. "Also. One of my nurses told me you put Mrs Kapidis on the commode...." "And took her off. I didn't just leave her there..." "Why are you interfering?" "I wouldn't call it interfering. It's supposed to be helping. Clearly you're undermanned. I'm an available resource." For a moment there is a flicker of uncertainty from her. She's desperate to hate me. But I'm making it hard for her to do so. Whilst it's not my primary intent, I don't mind that it's a side effect. "It's just that I've never seen a Doctor put a patient on a commode in my life. Not an ED Doctor. And certainly not a psychiatry one." "Maybe you just know the wrong Doctors," I joke. "Or perhaps I was a nurse in a former life." I worry I'm being too cute, even though it's a truism. "I don't know what you're up to but I'll be watching you," she threatens as she leaves. "I'm just trying to be collegiate." I smile. But it's forced. Truthfully I'm now unnerved and I feel myself trembling from the encounter. Relaxing only slightly when she'd gone. My demeanor was not particularly because Kristi had attacked me; although that in itself could be ferocious; it was more complex than that. I thought fondly of her ferocity. I liked it much more when I wasn't on the receiving end of it. She had tried to teach me back in the day, what she called RBF. It stood for 'Resting Bitch face'. She told me it was an essential facial contortion for working at triage. "So you're saying you've had a ten out of ten headache for 24 hours now and you haven't taken any analgesia in all that time?" She would say it in such a way, with an expression set so, that if the recipient had any insight at all they would realize how stupid they were, and how belittled they should feel. Surprisingly though, insight seemed to be in such short supply as to be critically endangered by and large. I must admit though, after a triage shift, if one more person said to me, "I didn't want to mask the pain." It was hard to sometimes resist the urge to punch them in the face. Nonetheless I was a much sweeter triage nurse than Kristi could be. We used to laugh about that fact. No; my current physical reaction was more to do with my huge feeling of loss. It just became all the more apparent when it was shoved down my throat. Mr Jensen and I came to the mutual agreement that a short stop in would be better for his safety and mental health. I was mindful of how hideous a prolonged stay in that place had been for me. So as soon as he was even at a semblance of getting back on track I'd have him out with community psych. After writing him up and checking his biochem and levels I took a deep breath as I prepared to face Kristi again, to tell her I was taking him over with me to Wellness House. As I approached her the feeling of d?j? vu was so intense, for there with her was Dr Meg. They were together just as they had been that fateful night such a seemingly long time ago. They did not acknowledge my approach though, and as I sidled up it was evident they were arguing heatedly. "You can't stay another night Meg. How long since you've slept?" Kristi was polite but emphatic. "I don't see what choice I have. This place can't run overnight with just one Registrar and an intern. That's so undermanned as to be dangerous." "I'll be here," Kristi counters. "We'll get by. But you can't stay. It's too dangerous. You haven't slept in nearly 48 hours." It was apparent her earlier question was in fact rhetorical. "I don't know...." Meg starts to reply, but stops when she sees Kristi's attention has now been drawn to me. "What do you want?" Kristi barks. Her default tone with me tends to generally be variations on a theme of disdain. "Sorry to interrupt," I begin with humility. "I just wanted to say I've cleared Mr Jensen medically and I'm taking him with me over to Wellness House." "You medically cleared him?' Meg mocks. But I was prepared for that. I show her the ECG and lab results, and explain my rationale. Meg looks at Kristi, who nods a small affirmation. "Well I never!" Meg begins. "A Psychiatry Fellow who's not completely useless. Fine! Take him," she says of Mr Jensen, and dismisses me. I step away and they start at each other again. I choose to linger in earshot, apparently quickly forgotten. "Look Kristi, I know Javed's come a long way, but to leave him on his own with just an intern it's too much. We need at least one more decent resident just to have the bare bones. Just to be safe. Maybe we should end Stanley's suspension. He's desperate to come back," Meg suggests. "Javed's a lot better than you realize Meg," Kristi replies. "And as for Stanley, I don't think that would go down at all well with the nursing staff. After what he did. Most of them think he got off way to lightly. You can't bring him back prematurely. No matter how dire the circumstances." That piques my curiosity of course. What did Stanley do? But that is something for another time. For my brain is currently doing cartwheels over something else. I'm momentarily frozen by my indecision. I conclude I much prefer the 'method in madness' hypothesis to the 'random acts of malice' one. There's a reason Mr Black has thrust me back here tonight. A reason why it only feels like I woke up a couple of hours ago. A reason I've missed a whole day. "I can work," I blurt out before I can filter myself. "What?" They reply in unison. Only now once again being awoken of my presence. Likely too stunned by my interruption perhaps to chastise me. "It's after 10," I quickly continue. "I've finished my psychiatry shift. If you need a Doctor for overnight I can do it." "In what universe would you ever think we'd either want or need you?" Meg attacks. I look at Kristi. I suppose I would have liked to have thought that even through two alterations of reality some residual trace of our friendship still remained deep inside her and she would sense it. But I feel like I'm just being fanciful. She says nothing. I answer on my own. "You said yourself all you need is resident level. Someone who can take a history and exam, formulate a plan and run it past Javed. I'm not so far removed from my intern days I can't remember things." That in itself would have been a lie. Internship was so long ago that I had deskilled. But I had become a pretty good ED nurse since then. One who happened to have a medical degree in her past, which had been reignited when she had studied for her critical care certificate. Combining Alex Moore with Alex Turner, the best of both of me, was a surefire way for my current self to be exactly what I claimed to be. To be able to do what I truly believed I could right now. "He can do it you know," Kristi weighs in. "He was all over the overdose man. He's not as stupid as you think." Thanks bestie; I think. Well sort of, I guess. "But you and I both know what he's like. I mean behavior wise. He's effectively another Stanley." Pretty brutal when I was right there. I suppose they assumed I didn't know who Stanley was. Or more particularly, what Stanley was. "I don't think he is. Not any more." Kristi is still batting for me. "I saw him with Mr Jensen. He actually seems to give a fuck. I mean he actually cares." "I still don't know Kristi. This is my department. The buck stops with me." "And I'm here all night," Kristi points out. "I'll make sure nothing bad happens. If he's more liability than asset I'll turf him straight away." Meg doesn't respond to Kristi, instead returning her attention to me. "Why?" She begins. "Why do you even want to? What's in it for you?" "Is it so hard to believe that what Kristi says is true? That I do want to help?" I try and explain. "And human beings aren't designed to go that long without sleep. My professional opinion is that if you stay any longer a psychotic break is likely. You always tell your residents to listen to the senior nurses. Maybe you should take your own advice." Kristi grins at that. A response that warms me greatly. There is a prolonged pause, a silent stand off. Then a loud sigh. "Okay fine!" Meg finally relents and concedes. It's happening. After transporting and settling Mr Jensen in to Wellness house I return to the Emergency Department to find Meg gone and Javed present. Kristi introduces us, and I'm a little heartened that she remembers my name. But she probably does so because of my former infamy and the complaint she made about me a year or so earlier, not because of any impression I've made on her today. I'm nervous about what I'd signed myself up for, but it's really no harder than being nurse in charge on nights. To be honest it's probably easier. ******* It was a typical rough night. It had only been a bit over a month since my last night in charge so I didn't actually feel that disconnected. Both my body and my role were clearly different now; although part of the joy of being run off my feet was I didn't have to think too much about the former change. I think in an ideal world I was hoping for a scenario where I would rise up and save the day; much like Javed had done the night of the tricyclic overdose; and would re-earn Kristi's admiration and respect. But such an opportunity never arose; and I had serious doubts about whether I could even seize it if it did. Still, I worked hard, providing both support to Javed, and even occasional flashes of wisdom to Emily the intern. (Who once upon a time was so sure I was going to die in front of her. Which technically I suppose I did.) There were times when I felt Kristi watching me, judging me, but I tried my best just to ignore it, challenging as that proved to be. Finally, as the new day began and 8am approached, Kristi, shift finished and ready to leave, fixed her stare on me one last time. It was so protracted I was compelled to acknowledge it. "Going home?" I turn and ask her. "Yes." She's curt. "Sleep well." Not that she ever really did. On nights. I imagine even less so now pregnant. But it seemed like a thing to say. My courtesy is met with silence for a long time and it's becoming awkward just looking at each other. She's clearly thinking about what she wants to say. I'm just not sure if it's going to be scathing or kind. "Thank you Doctor." And I know her tone well enough to know she's not being sarcastic. "You surprised me tonight. Pleasantly I must say." Not the resounding vote of confidence I'd hoped for. But better than nothing I guess. "Be sure to tell Meg I didn't kill anyone," I joke. "I will." She moves to turn away. I don't want her to go. But there is no reason for her to stay. I'm nothing to her now. "I hope your pregnancy's going okay." I had been wondering a lot all night long about how she was. Of course I wanted to know. I couldn't broach the subject though. Even now I regretted doing so. She looks a little startled and looks down at herself. "Oh no." I begin to retract. "You're not showing." She's only 13 weeks for god sake. But then I have an awful feeling. What if the fact that there was no pregnant Alex Ward meant that Kristi never rushed to get pregnant? And I've just basically called a non pregnant woman fat. (Which she wasn't, pregnant or no.) "I'm sorry." Too late to dig out of this hole. "Someone said. Maybe I got it wrong." "Who said?" Oh shit. This is so bad. I've fucked up majorly. "I forget. I don't know everyone's name. I didn't mean to offend you." "I haven't told anyone yet," she states, eyeing me with suspicion. "But you're through the first trimester." It came out without thought. "I decided to wait till I was 16 weeks. Just to be sure." There was no doubt in my mind, that her hesitance to announce her pregnancy was somehow because of me. On some level she was well aware that miscarriages still happen at 16 weeks, having lived through that with me. "Oh! Just forget I said anything. I won't mention it again." "You're a strange one Alex Turner. That's for sure. I don't know how you knew. But I know no-one told you. Must be your psychiatry super powers." She laughs. "I'll see you around I guess." This time she does turn and walk away. "Bye," I say after her. Feeling stupid. But I have to admit to myself, even in spite of my best efforts, she's clearly warming to me. Be thankful for small mercy's Alex, I tell myself. Start with civility. Work your way up from there. *** 4 months later I'd like to have said I eventually readjusted. But I didn't. Or hadn't yet. Considering how much I had changed in the first 3 or 4 months when I had transformed the other way, it really didn't bode well for future progress. There seemed to be an element of the damage I'd done to myself was irreversible. I wondered how much mating with Kevin had impacted on those changes. Had I been cemented in that role because I had a male life partner? Now I was single. And very alone. Were I forcibly paired with a female currently would that draw the male back out of me? I didn't know. And I had no real intent to find out. I missed being me. Alexandra I mean. I had returned to my old flat in Hawfield. With my fancy Beamer in the garage that really didn't appeal to me any more. (It seemed a little ludicrous that I actually missed my little Mazda.) I was returned to all the male trappings of a male life. My body still felt awful and awkward. It probably wasn't very feminist of me but I found hair in my armpits gross. Hair everywhere on my body frankly disgusted me. I missed my soft smooth skin. I missed my smallness and slenderness. I hated what I had become. Which was simply what I had been. It just wasn't right for me now. I could heed Mr Black's words. I could fix it. I'd thought about it. In fact at times it seemed like all I could think about. It would be easy enough to prescribe myself hormones, and I was fortunate enough to be able to afford the surgery. But no matter what I did I could never truly be Alex Moore again. And that was really what I wanted. I wanted to go back to my happy life that was now beyond my reach. I had waited I guess. To see if I would grow to accept being Alex Turner again. Some sort of equilibrium restored. But how much longer should I wait? **** I continued to do casual shifts in the ED. Meg built up a tolerable acceptance of me. She was never overly friendly to me when I was Alex Moore so it wasn't a major slight. She had saved my life and she was an inspiring clinician, so I would forever be in admiration of her. As perhaps the strongest endorsement I would get from her she'd asked if I wanted to join the Emergency training program. I was within 12 months of finishing my psychiatry training. I could not envisage starting at the bottom in another specialty and slaving away for 6 more years. Besides, these guys, like Javed and his colleagues, were pretty hard core. I'm not sure I was made of the right stuff. So I graciously declined. The ice continued to thaw with Kristi. We had reached polite courteous conversation. But as she entered her third trimester of pregnancy I knew it wasn't long before she disappeared on maternity leave. And she may never return. Many didn't. Emergency nursing was a tough occupation on new mums. The shift hours weren't great and the ever present danger caused a lot of re evaluation. I wasn't going to return when I had my child. But that wasn't by choice I guess. Regardless, Kristi would soon vanish from my life. There was nothing I could do. We could never be close again. More than anything my gender precluded that. Marty, or anyone, would never believe the purity of my intent. Even if I overtly advertised my lack of sexual interest in women. Not that males seemed to particularly float my boat anymore either. I seemed to have drifted into an asexual indifference. I wonder what old Sigmund would think of that. Of my other friends, from before, specifically my critical care study buddies, namely Shaan, Jenna and Dane, the best I could really cultivate was a healthy professional working relationship. Shaan was still with Zac. I was heartened to discover. I still gave myself credit for that. Even if in this regeneration their meeting was coincidental rather than engineered. I eventually got the low down on Stanley. The moron completely ignored the idioms about how 'one should never shit where you eat' (which is how I may once have put it) or 'don't screw the crew.' (The terminology the current, slightly more refined me preferred.) After cheating on Julie for the umpteenth time, with an impressionable grad nurse no less, Julie finally dumped his arse and got him suspended for sexual misconduct. If I wanted to gloat I restrained myself. Partly because I wanted to be better than that. The disrespect he held for women seemed to trouble me more now than when I was one. I wonder if that was because it was so commonplace and I encountered it so frequently I just put up with it back then. Righteousness by association perhaps now? Rage appropriation? I didn't really know. Mostly though, there was no joy to be indulged in from his downfall. He ruined many more lives than his own. Julie was a mess. Fully evident when my innocent collegiate inquiries to Julie as to her welfare elicited sexual advances from her. Poor needy girl looking for anyone to latch onto. I'd be lying if I said I wasn't tempted. There were no real stirrings of lust but the desire to stave off the seeping pervasive feelings of loneliness, if only but for a moment, held a great deal of allure to me. But Julie didn't want me any more than just a convenient substitute to Stanley. It chilled me a bit that she still saw similarities. Indirectly affirming what Meg had said. She was at least receptive to a discussion about her behavior, and I found myself doing some corridor counseling. Self esteem issues at the root of it not surprisingly. I guess I really was a psychiatry fellow again. In that sphere of my world the rhythm seemed to have worked its way back. Even though Mike was my friend in spite of what an asinine ass I'd been, the divide between Consultant and Registrar actually made our relationship worse. He was my boss primarily now. How could it be that I had fewer friends now than the old Alex Turner had? It didn't seem fair. It wasn't true I suppose. I just felt my solitude a lot more. The old Alex Turner didn't need anyone but his own self adoration. I on the other hand needed people. And I had them. Then lost them. All I could do was miss them. My life was so otherwise empty my work, whether as an Emergency department sessional, or psychiatry trainee was all I had. So I threw myself into it. As well as my psychiatry ward work I was doing community and outpatient work; part training requirement; part optional extra. Outpatient clinic was perhaps the closest representation of what I envisaged the future has once held for Alex Turner. When my priorities were very different I'd wanted set up my rooms to deal with those afflicted by what I called "the poverty of affluence." Upper middle class neuroses. First world problems. Call them what you will. I'm sure I could still help people doing that, but I wasn't sure it would give me the fulfillment I now knew I needed. As I sat in my clinic office one meaningless Thursday I suspected the next new referral I was soon to see was somewhat the embodiment of all those fears. I read the General practitioner's (GP) introductory letter. A woman near my age. Thirty one. From a nice suburb. Suitably vague about what her mental health concerns were. Just that she had issues to discuss. I guess that was good not to shape any preconceptions. Although it seemed I already had. However as I fetched her from my waiting room and lead her into my interview room those assumptions were perhaps thrown out the window. The cornerstone of every psychiatry assessment is what we call the mental state exam. It breaks down our analysis into sections. For example: Mood and affect. (Two different things - mood is more like your 'climate' whereas affect is your current 'weather') Speech - pattern and style. Thought content. Perceptions. Hallucinations and delusions. Insight and judgment. And so on. The first thing we assess in a 'MSE' though is Appearance and behavior. Are they groomed or unkempt? Is personal hygiene attended? Do they make eye contact? Are they calm? What is their body language like? I could glean a lot from her in that first instant. "Louisa?" Even though I know that it has to be. She was the only one there. My question draws the attention of the psychedelic splash sitting before me. So much color. Even the shoes. Floral stilettos that remind me of the style Galliano would have designed for Dior back in the day. (Still so much Alexandra Moore in me. As much blessing as curse I figure) She's well put together though. She's not a bag lady. It probably all is designer. It's just in combination totality, a bit.....much. It does start to formulate diagnostic possibilities in my mind. She pauses for a moment before meeting my gaze. There is apprehension. Louisa also takes a quick anxious glance around the room. Which she had already been sitting in for at least some minutes before I called her. This action hints of paranoia. Or even hallucinations. Like she can see, or is expecting to see someone who is not really there. She seems to regain her composure, returning her focus to me, looking at me as she rises from her chair. Another momentary pause as she seems to study me, before speaking. She flushes for a moment and her respiratory rate visibly increases. I'm self aware enough to realize that it's not because she finds me dashingly handsome that she does this. This is anxiety manifest. "Hello," she replies. "Thank you for seeing me." In spite of her bodily betrayal her speech is not unsteady or even pressured. Nor does it suggest her mood elevated or flattened. But all this is just initial impression stuff. I still suspect mania. Her clothing screamed of it. Bipolar disease, also called manic depression is a troubling insidious condition. The depressive symptoms are not dissimilar to conditions of the same ilk but the manic phases, which can at times be spectacular and entertaining, are even more devastating. As I lead Louisa Clark to my office I considered the conundrum. She was dressed like a manic person. Exhibited mannerisms of paranoia, but spoke with level headed neutrality. I was none the wiser as to why she was here and what she wanted. Of course it was part of my job to work out that very thing. Once seated my first step was to establish rapport. Unlike other medical interactions - where you don't have to like each other to effectively treat them - psychiatry is different. When I was Alex Moore I learnt to look for the good in people; but reflecting about it now I dealt with some detestable human beings. It never influenced my treatment of them though. Here though; for me to help Louisa Clark as best I could, whatever she may need, she had to like me. And equally, I had to like her. Formerly I had used a degree of deceit to achieve that end - especially if I had a secondary (sexual) agenda. Now it just seemed easier to be genuine. We exchanged the usual pleasantries and I continued to gauge her. She was almost brunette. Her hair the darkest brown, down to her shoulders. She wore it out to this appointment. She was slim, but not petite or waifish. She seemed well proportioned. I was suddenly conscious of what I was doing. I wasn't just analyzing her physical appearance as part of my diagnostic work up. I was appraising it. I was behaving like a male. I was feeling attraction. Were my old traits resurfacing? That Alex Turner who took advantage of his patients. It was too early to say but this woman could well be the stereotypical hot mess that I once would have preyed on for my own sexual gratification. She was looking at me with intent and my unprofessional thoughts made it hard for me to return her gaze. Her rich green eyes held a sparkle that sung loudly of sophisticated intelligence. I tried to rationalise. Whilst I could appreciate attractiveness in both genders now, this was the first human being I had felt physical, even sexual attraction to since being male again. But it didn't mean I was going to act on it. On the contrary I was going to analyse it in context as all good psychiatrists should. What sort of transference was going on here? I figured that as long as I was conscious of this dynamic I could control it. I suppose, on a personal note it was a good thing that finally after 4 months back as Alex Turner I was feeling something. Unexpected I guess, that it was for a woman. But they say perhaps that not something one has any control over. Furthermore it was unfortunately awkward that it was a patient. But I'm a professional and it shouldn't be a factor. If I ever thought it would become one I would recuse myself and hand her care over to Mike. Perhaps she could sense my slight leanings of desire for now she looked away. I decided the best form of denial was inquisition. "Is everything alright Louisa?" "Yes. I was just a little worried I'd be struck down or smited just by being here." "By whom. By God?" Religious delusions. It was rare in mania. This suggested psychosis. Which would put her more into the schizophrenia or schizoaffective disorder category. "Well.. 'A' God." "Do you think there's more than one?" "I don't know what to think exactly. But I know there's things far beyond our comprehension." Well I guess that was true. Given what I'd been through. But she doesn't know that. She's just making stuff up. "Do you talk to God? Does he talk to you?" I go for the jugular I guess. "You're trying to establish if I have a thought disorder?" It seems she's on to me. "Well I don't. I'm here because I'm depressed. Not because I'm mad." "Oh Okay. It's just you brought up the whole struck down thing. It's just unusual." "It was a figure of speech. Just forget I said anything please." She's dismissive. "Okay then." If she was psychotic, it would reveal itself fully with time. I would draw it out in due course. "Well tell me about your mood. Why do you say you're depressed? What are you feeling?" I let her talk. Using active listening and asking pertinent questions where relevant she did much of the work for me. She was having relationship problems with her boyfriend. An all too common trigger for depression but one not to be underestimated. It was only a six month long relationship, although that was amongst the longest she'd ever had. A sad indictment of today I suppose. It didn't matter so much about the length I guess, more about the depth. And her coping mechanisms for appropriate or inappropriate grieving over a relationship potentially ending. She mentioned in passing she was a carer for the disabled. Whilst she didn't dwell I knew this too could be an additional stressor. It's very hard work at times. Physically and emotionally. I made a note to extrapolate further in future. Our sessions only go for an hour and this was my first with this woman so it was more about establishing her issues and getting to know her rather than initiating any treatment goals. Yet as she told me her story I was already formulating a plan for such treatment. Psychotherapy would work a treat. I still had to explore her eclectic dress sense. It could be that she was just quirky, or eccentric. Regardless she was intelligent, charming and completely disarming. I had to wrestle with my professionalism. Not even because of any carnal need. For someone who felt somewhat friendless and alone, I just found her company enjoyable. I realized that when the hour had flown by without me being at all conscious of it. At one point, as we approached the end, trying to be subtle I did broach the inconsistency and asked her what her colorful dress was trying to express. She laughed it off and told me that her mother accused her once of looking like she'd lost a wrestling match on the floor of a charity shop. This made me laugh. But I felt like I heard this somewhere before. At the end of the session we made a booking for the following week and I gave her some suggestions about how to talk to her boyfriend Sam about the state of their relationship. She left slowly, almost reluctantly; I knew there were many more issues she wanted to explore. But these things can't be rushed. All in good time. I remained intrigued. I could not work this woman out at all. Something was not quite right. I couldn't specifically put my finger on it, but my gut was telling that maybe things weren't as simple as they seemed. Was I being deceived? Was this possibly some sort of trap? God Alex, I quickly redirected. Wasn't a month locked up in psych ward 4 months ago enough for you? Still unnerved and distracted by such an unusual initial interaction I answered my suddenly ringing mobile phone like an automaton. "Alex!" More of an officious statement than enquiry. "Yes." I was formulating a rapid short list of who the woman on the phone could be. "Any chance of an overnight tonight?" Clearly it was Meg. And this was a request for work rather than sexual congress. At least I was fairly certain. "Tonight?" The reclarification was because of my incredulousness. She doesn't answer though. She knows I understood. "I'm doing clinics at Wellness today. I can't really." "Even if you came at midnight. Could you sleep for a bit before?" "You're assuming I have no plans this evening. Or work tomorrow." "Well do you?" "No." On both counts. "Look we're out of other options. We really need you." "So I'm the last choice?" I bait. "Well yes." Good thing about Meg I suppose. She doesn't mince her words. "But you were a choice." "Okay fine!" What am I doing? It's not like she fed my ego or anything. "I'm pretty much done in clinics. I'll go home for a sleep." It was my irresistible compulsion to help I guess. Bloody Alexandra. How did you make me lose the ability to ever say no?!! ***** So I found myself foolishly walking through the Emergency Department door at a few minutes to midnight. Meg was there. Looking haggard. No sign of any Kristi to police her and send her home. I guess that made it my job. "So," I began after we exchanged greetings, "who's the senior on tonight?" I actually hoped it would be Javed. I definitely liked working with him the best. "I thought I had made myself clear on the phone." Meg bristles slightly. "You are." Well no. She hadn't made herself clear on the phone at all. Oh shit. I felt my knees weaken. "I told you we were desperate." I guess my expression gave her cause for justification. She was still not filling me with confidence mind. It felt like another bout of Deja vu. (Did I really just say it felt like d?j? vu all over again? Oh God. I'm king of the oxymorons.) I had been through this before. Albeit slightly differently. Once upon a time I had faced my first night as nurse in charge when I was Alex Moore. But I had warning then. And I also had people in my corner. Kevin and Kristi particularly. Pumping me up and believing in me. Now I had no one. And the contrast was blatant. Perhaps I should have seen this as an inevitability; even if I couldn't believe it was an endorsement. Chronic staff shortages meant rapid promotions through the ranks. It wasn't so much that I was good enough. More like that I'd just have to do. But could I do this? For a psychiatrist I guess I made a reasonable emergency Doctor. I was definitely caught between 2 worlds though. Medical fields that were like oil and water. They didn't really mix. Still Meg was wrecked. She had to go sleep. I plastered my face with false bravado and assured her all was well. All I could do was hope for the best and pray no one decided they wanted to die tonight. ****** I suppose I got half way. At about 3am and elderly gent called Mr Larkin, on a medication called warfarin, which is used to 'thin' the blood, and prevent blood clots, came in with epistaxis. This is a fancy way of saying blood nose. But this was just not any old blood nose. It was pouring from him. Whilst I waited for his Prothrombin Time (or INR) to see if his blood was too 'thin' I tried to stem the tide. I was soon nose deep in nasal specula and suction catheters whilst I tried to identify the bleeding point and cauterize it. The blood was flowing faster than I could suck it away. Which made it hard (impossible) to see the bleeding spot. If I could find it, it was sometimes as simple as dabbing it with silver nitrate. But I couldn't. He coughed and spluttered as blood trickled backwards down his pharynx and into his throat. The occasional bloodied sneeze sprayed my face mask and hospital gown with a mixture of blood and snot. It was not for the weak hearted. I could see the look of angst in Mr Larkin's eyes. "It's okay," I told him. "It always looks a lot worse than it is. We'll stop it soon." I hoped! As I battled on I was so lost in focus that Jenna's voice beside me startled me a little. "Alex! We need you in the other Resus room now," she urged. I turn towards her, I'm incredulous but I don't show it. Things were clearly not under control here. Which I'm sure she could see. "Is it an arrest?" I ask attentively. I meant cardiac arrest. I guess that would shift my priorities. "No," she asserts. "Pending arrest?" Were they circling the drain, so to speak. "Well no." She hesitates. She knew what I meant. She was describing a stable patient. My current one wasn't. I had to finish here first. "Grab one of the residents Jenna. Let them make a start. I just have to stop this bleeding. Then I'll be right there. I promise." My tone is suggestive rather than dictatorial. "I can't really grab another resident." Jenna looks really worried now. Which unsettles me. "They need you!" "Why?" I'm getting a little anxious. Jenna looks at Mr Larkin, then at me. She clearly wants to say something, but not in front of him. "Because the patient....." she begins. "You know her!" The air is still. And full of omen. "She asked for you," Jenna adds. "She needs you." Oh God. I have a feeling in my bones. The same one that had made it very hard to sleep in preparation for this night after I left outpatient clinics yesterday afternoon. That something was unfinished. That filled me with such uncertainty. Some flashing beacon or shrieking alarm bell that I had simply failed to heed. There was no doubt in my mind that the patient in the next Resus room was Louisa Clark. After spending a session with me she had tried to kill herself. How successful she had been in that endeavor I was about to find out. But that was still a few minutes away. I had to save my current patient first. I process for a mere moment whilst I consider my options. "Okay Mr Larkin. Change of plan." I try to sound upbeat. "I can't find your bleeding spot right at the moment. But I can stop the bleeding for now. Then when I've reversed your warfarin a little bit we'll have another look in a few hours." Acting swiftly I re-spray his nostril with co-phenylcaine. This is a vasoconstricting anaesthetic, which, as the name implies, is actually not that dissimilar to cocaine. From my experience with that, the last time I was Alex Turner, it was effective. Cocaine made my whole face numb! Once feeling was reduced I shoved what for all intents was a fancy blow up tampon fair up his hooter. It's called a 'Rapid Rhino' and it uses pressure to stop the bleeding. It wasn't particularly pleasant for either of us but it had to be done. The bleeding was now ceased, so I leave Mr Larkin with his nurse and repetitive promises to return. I make my way with haste towards Louisa. Is she still conscious I wonder? She must be to have asked for me by name. But then how would she even know I was here? Nothing made sense. I reach the cubicle and I pull back the curtain to see Jenna fussing with angst. And the patient, who was clearly unwell. But I was wrong. It is not Louisa Clark. Yet this knowledge brings me no joy. It is another woman. Pale. Writhing in pain. Holding her abdomen with both her hands as if this forlorn gesture will help. Yes. This is in fact so much worse than and scenario I had concocted in my head. The patient is Kristi. My former best friend. And she's in premature labour. TBC