“The heart has its reasons which reason knows nothing of…” ~Blaise Pascal
The employee of the nursing home had no explanation. “It belonged to her,” was his best guess.
The cardboard box was empty except for a religious-themed calendar. Someone in the facility had likely made off with his aunt’s possessions (whatever those items may have been) and left a free promotional calendar behind to blunt their brazen thievery. Nothing would be gained by pursuing the matter, so the blood relation grabbed the pointless item and left.
The nursing home visit was a pretext to ride into Wavery Bean on another matter. The denizen had been putting off a visit to the rapid-care clinic. No one was in the waiting room when he arrived, and his name was called before he withdrew to a chair after initialing a sign-in sheet. He was escorted a short distance past a set of French double doors into an examination room where the waiting area was still visible through glass insets. Doubtless Liam, with shirt unbuttoned to his navel, would be seen, too.
The nurse practitioner came on him in a start. The Korean man was of stocky built, with a low center-of-gravity. He set about poking the patient’s chest before his assistant finished with the blood pressure cup.
His object of study glanced around the small, compromised room nervously. Little in its décor suggested medical use. There was not even an obligatory poster about proper disposal of hypodermic needles.
An older woman and child came into the waiting room during this strange interlude, and Liam was understandably self-conscious seated on the examination table. The new arrivals squared themselves with the uncovered windows in the French doors and stared impatiently at him, as though queuing up at a phone booth.
The practitioner did not notice them, or perhaps did. He blew on his stethoscope with pelting, deep-throated breaths, and when the disc was sufficiently heated, it was planted on Liam’s sternum. Leaning in, the probe was turned in the manner of a safecracker listening for clicks. Little of the man’s face was seen from the angle, but he appeared to be mugging the little boy looking in through the window glass.
The child at first laughed, but then began to bawl. The offered face must have been misread as threatening, or as a form of humor that did not translate from Korean into American. Regardless, the child’s guardian showed similar disgust and, taking the boy’s hand in hers, exited the building without signing in or taking a seat.
No mention of this episode was made. The curtains were drawn over the doors, and a retina scope was removed from a lab coat pocket. A line of questioning developed while exploring the patient’s eyes. “Dreams, I believe, plague you.”
Liam thought this a circuitous route to his problem, but answered, “Since coming off withdrawal from benzodiazepines, my dreams have become a thin, unmemorable gruel.“
“Were you prescribed benzodiazepines for sleep?”
“No—for anxiety, but I lost my sleep to them, nonetheless.“
“How would you describe your post-withdrawal sleep?“
“I do not suffer from insomnia, per se, yet my sleep has become a pale copy of its former self. I was put under the doubtful mediation of first amitriptyline and then mirtazapine to manage my discontinuation syndrome and improve my sleep. Mirtazapine has proven to be less merciless, but it is paradoxical. I was later prescribed gabapentin, which improved my sleep perception, although its overall effect on my sleep is less certain.”
“Describe what you mean by ‘sleep perception’?“
“Of all my sleep stages, REM is the most damaged. My dream imagery is less action-like than thought-like, though my role in it remains participatory. I appear, cosmetically, to have copious amounts of REM. Dreams even follow me into waking consciousness, and to and from the bathroom where they restart once my head returns to the pillow. I do not exaggerate in saying it is a continuation of the same dream started hours before.
Early in my recovery, I sometimes felt the course of a dream when I walked around in daylight. I claimed knowledge of it sympathetically, which is to say I experienced vague emotions elicited by the dream but no details of the dream itself. What I felt was an episode, like a tape loop playing in another room that murmurs in the wall. I claim an acquaintance with these vibrations by their reenactment.”
The medical man sought to dissuade despair. “Dreams can leach out of REM and into other sleep stages, with or without paralysis. They can even erupt into full consciousness where there is pressure to do so.” In his consolation, he rose from his chair and reopened the curtains on the French doors. The patient expected to see someone else standing here, or some point of detail, but the waiting room was empty.
A preliminary judgment was circumscribed. “What you describe may be shoved, in board outline, under the umbrella term of a ‘discontinuation syndrome,’ and inevitably wild goose chases ensue in pursuit of whether a given prodrome belongs to the disease as a symptom or to the attempted cure as a side effect. Though you were prescribed benzodiazepines for anxiety, those drugs also target, with less selectivity, hypnotic receptors. Resultantly, this protracted (sub-acute) withdrawal state you suffer may be the result of persisting maladaptations in your brain, where the glutamate that set your brain on fire during benzo withdrawal has become a trigger whenever it occurs naturally in your physiology.”
He went on to explain. “Glutamate rises in the hypothalamus to start the circadian clock at the onset of one’s sleep. It is also involved in the mechanics of REM sleep. Gabapentin lowers your exposure to the pernicious effects of glutamate. Resultantly, it also interferes with glutamate’s role in sleep, which paradoxically leaves you with a higher than normal consciousness during a time when your brain should be desynchronized. Neurological drugs are, admittedly, Paleolithic and imprecise, as are the unthinking prescribing practices of many doctors. However, gabapentin has been a game changer for you.”
(This much was true.)
“Having said this,” he continued, “serotonin, by way of the antidepressants you listed, has been dragged into a fight in which it had no dog. Are you on the autistic spectrum?”
Liam thought this question telepathic. “Well… yes.”
“Autistics have impaired cholesterol pathways in the brain, and cholesterol is vital to its proper function. Your best plan is to eat no less than your daily allowance of saturated fat—I suggest butter, preferably before bedtime. Do not skimp on other forms of fat, especially Omega-6.”
The patient nodded obediently.
The elucidator in these discussions began scribbling in his notepad. “What I describe is a post traumatic stress disorder induced by withdrawal, through which your various drug regiments imperfectly manage your symptoms. In normal sleep, executive brain function is inhibited while emotional and sensory processing are uninhibited. The opposite of this may be regarded as a working definition of autism. When your dreams were normal, I suspect that they contained an inordinate number of nightmarish elements. Nightmares are the natural way your brain deals with executive function inhibition. Their removal signifies an unnatural order.
One may honestly ask: Why should the brain work this way? Why should executive function be on one side and emotive-sensory processing be on the other? Why should the dreaming brain seize on the necessity of inhibition from rational processes?”
Liam was not certain if the practitioner wished him to answer one or all of these questions.
“Your principal complaint lies in a lack of deep Delta sleep,” the gentleman concluded. “Delta sleep is the tide that lifts all boats. These ‘defects’ you perceive in other sleep stages arise in part because deep sleep is not erasing memory of them. Stage Three sleep functions like both retrograde and anterograde amnesia. What is essential is to thrive where the stresses of the brain, under whatever conditions it labors, are engineered around. The goal is to restore a sense of wellbeing and aid recovery. Amnesia in sleep—inhibition of executive brain function—separates the wheat from the chaff, leaving you to remember only those aspects of your dreams that matter most.”
The patient had not followed the course of these elucidations so well as he might. “What do you mean by ‘your dreams that matter most’?” he asked.
“Dream sleep is where the line between this world, and any other, is thinnest, so it is important to preserve this line of communication. Emotions are less affected (or censored) in oneiric, rhapsodic sleep, and one has the innocence of a child in receiving them.”
To this stage, the caliber of the analysis struck Liam as impeccable. This language sounded the first false note. “Communication…?” he probed. “Who wishes to communicate with me?”
The practitioner apprised, “Between three and five in the morning is a time linked in Chinese medicine to spiritual awakenings.”
The patient chose to concentrate on those pronouncements he deemed economical and germane. “I am pleased to receive this information,” said he. On buttoning his shirt, this action elicited a sharp pain, and a reminder for the reason of his visit. “What about my injured wrist?” he asked.
The medical man glanced again at the case file, which mistake placed in his hands. Without hesitation or embarrassment he seized the man’s arm and squeezed the referenced joint, enjoining cheerlessly, “No broken bones that I see, though you appear genuinely bothered by it. How did you come by the injury?”
“I have no idea. I may have slept on it funny… pinched a nerve…”
“It may be Carpal Tunnel Syndrome, and work related.”
First Liam thought of his painting, but he did not pursue this interest so industriously that the activity should be confused with labor. Mildly vexed, he postulated, “I should not think, in my new job, that I’ve worked long enough to acquire a disability.”
“I would like to take a series of x-rays,” announced the other. “My assistant will show you to radiology. Make a followup appointment with the receptionist, and until we next meet, take acetaminophen and do not aggravate the injury.”
The patient was confused by the use of the word ‘series’ where one X-ray would cover the problem. “What did you imagine my complaint to be when you stepped in the room?” he inquired.
Decorum and authority were maintained on rising from his swivel chair. “Does it matter,” came the succinct reply, “where accident may be regarded with the same import as coincidence in bringing one to a desired result?”
With this, the lively consultant was gone through the side door, leaving the patient to exit, with less flair, through the French doors.
Liam was escorted to radiology through a corridor perpendicular to the one seized by the practitioner. It was dark and unwelcoming and did not suggest usual business hours.
“The nurse practitioner is speedy on his feet,“ commented the patient.
“Nurse practitioner…?” mumbled the lab assistant. “You have been meeting with a psychiatrist. One who specializes in regressive memory hypnosis.“
A bewildered Liam was led to an equally dark room, where a rectangular apparatus occupied half its available space. He was not clear on the procedure, yet initialed a release form by the aid of an insufficient penlight. He left the room shortly afterwards, with no x-ray (by his understanding of the concept) being taken.
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