Today’s meeting was in regard to the information in Dr. Fairfield’s report. Dr. Carly Brown eased herself into the chair beside Emily. Squeezing Emily’s free hand, she whispered, “Don’t worry. Dr. Fairfield wouldn’t be addressing this entire crowd if he didn’t have some valuable theories.”
Tired of theories, Emily feigned a smile. Fighting the emotion building in her chest, she managed, “Thanks, Carly, I’m just afraid to get my hopes up.”
Dr. Brown smiled. “Hope is all we have. Don’t give up on your sister.”
Breathing deeply, Emily blinked back the tears. “It’s one thing for me to be disappointed—I’m used to it, but I keep thinking about Nichol having to deal with this one day.”
John leaned over, keeping his voice low as the rest of the room continued to murmur, “Let’s concentrate on Claire. Nichol’s young; we can keep her uninformed as long as possible.”
Emily nodded as she swallowed her tears. Everyone was taking a seat—some around the table and many in chairs at the perimeter. The overflowing room quieted as Dr. Fairfield began his presentation.
“Thank you all for joining me here today. I’ve spoken to many of you in the last few weeks; many over the phone. It’s nice to meet you in person. Let me begin by explaining my role as a neuropsychologist...”
Emily listened as Dr. Fairfield reviewed Claire’s condition. At first, it wasn’t anything she hadn’t heard before—
“It’s well documented that psychosis like what Ms. Nichols is experiencing can be the result of traumatic brain injury. Recent studies have supported the theory of delayed psychosis. This has been well documented in veterans as well as NFL players. It’s characterized by slowly developing psychosis or delayed rapid onset. There are case studies which have documented rapid onset occurring as long as fifty-four months post injury.”
Emily liked to think that Claire’s psychosis was slowly developing. Although previously undiagnosed, that theory justified Claire’s decisions over the last years. As Claire’s sister, it made it easier for Emily to accept some of Claire’s actions and decisions—especially regarding Anthony Rawlings. Emily mentally reviewed the timeline: Claire’s initial concussion resulting in prolonged unconsciousness—hell, a coma—although, when she was capable, Claire refused to use that word—was in September of 2010. Though not a concussion, her second brain injury was in June of 2013, when she was attacked by Patrick Chester. Claire’s break with reality occurred in March of 2014...
“There have even been suggestions that a hormonal imbalance as well as weight gain, like that associated with pregnancy, could have exacerbated previous injuries...”
To Emily, it seemed very cut and dry—and the timeline worked.
Dr. Fairfield continued, “...Although Ms. Nichols’ brain scans support a history of traumatic brain injury, I do not share the theory that this has led to her psychosis...”
Emily’s neck straightened, and she turned to her husband. What was he saying? Of course TBI was the cause of Claire’s psychosis! It was all Anthony’s fault! He injured her. If it weren’t for him, she never would have been Patrick Chester’s target. Emily’s internal monologue drowned out the doctor’s words. She needed to listen.
“...The studies are less conclusive on the rate of recovery, from non-TBI induced psychosis. It’s true; this patient’s current scans indicate previous damage to the right hemisphere of her brain.” He projected various scanned images on the screen and utilized a small blue arrow to point to Doppler generated specifics. “You’ll note, as is consistent with TBI, the damage is most pronounced in the temporal and parietal lobes. What’s of specific significance with Ms. Nichols is the reduction in gray matter. As that reduction occurs, patients tend to feel pain. Ms. Nichols’ history does suggest problems with headaches. Now, if we compare the MRI of 2013 with the one taken two weeks ago, you can see...”
Emily listened, trying to remember the previous evidence. Everyone had said it was the TBI which indeed had caused Claire’s psychotic break. She recalled discussion of injury—evidence of concussion, yet as she tried to focus, Emily realized, Dr. Fairfield wasn’t nullifying that evidence. He had acknowledged that the injuries occurred, but he was also stating that he didn’t feel that the injuries were the cause of her psychosis.
Turning to Dr. Brown, Emily whispered, “Is he saying the head injuries aren’t the cause of her psychosis?”
Dr. Brown’s eyes opened wide as she turned to Emily, nodded, and shrugged.
Dr. Fairfield continued, “If the injuries prove to be the cause of the patient’s current state of mind, then in that case I’d have to agree with the conclusion of others that no further recovery will occur.”
Emily’s mind spun. Who said that? No one had voiced that opinion to her.
Dr. Fairfield went on, “I have based my current prognosis on the patient’s most recent DTI, or Diffusion Tensor Imaging. This is relatively new imaging and wasn’t commonly available at the time of Ms. Nichols’ break. As many of you know, I’ve worked with the NFL on this subject and have been personally involved with many of the more public cases. Accurately monitoring and measuring brain activity is essential in any prognosis. Let me show you this segment of consecutive DTI.” Again, everyone’s attention was brought to the screen. The image before them moved, or—more accurately—it pulsated. The defined areas of color moved, reminding Emily of an intense area of thunderstorm activity on a weather map. “Note the increased activity in this area of gray matter. What’s significant is that this image was recorded during one of the patient’s hallucinatory episodes. Let me also show you the increased stimulation in this patient’s auditory cortex. For those of you less versed in the medical terminology”—Emily knew he was specifically rephrasing for her benefit—“I’m saying that even though we may not hear what Ms. Nichols hears, or sense what she senses, she is indeed hearing and sensing. More importantly, her brain is active. Yes, there are areas of damage, but the human brain is very powerful and is quite capable of regeneration and compensation. I conclude that with the right antipsychotics and a significant change in therapy, progress can be made to bring Ms. Nichols back from her current state.”
As everyone discussed this new prognosis, the room buzzed with whispers. John leaned over Emily in an attempt to speak with Dr. Brown. Emily remained silent, contemplating the possibility that Dr. Fairfield’s assessment could possibly be true. Her mind fluctuated between hopeful optimism at the possibility of recovery and less than guarded indignation at the possibility that Anthony’s guilt could be more indirect than direct.
When the room began to quiet, Emily stood. Slowly, silence prevailed. Clearing her throat, she utilized the voice she’d reserved years ago for addressing students. “Dr. Fairfield, if brain injury wasn’t the cause of my sister’s condition, please enlighten us on what was the cause?”
Everyone turned toward the good doctor, watching as he shifted his footing. “Mrs. Vandersol, psychotic breaks can occur for a number of reasons. Let me emphasize that I’m not insinuating that your sister isn’t truly in the throes of such a break.”
Defensively, Emily stood taller. Pressing her lips together, she refrained from speaking as she waited for the doctor to continue.
“The most common causes of psychotic breaks include brain injury and drug use; however, it’s also well documented that a significant life event can precipitate such a break.” For all of his large words and doctor attitude, Emily saw a sudden shift in countenance as he asked, “Your sister had a significant life experience, wouldn’t you agree, Mrs. Vandersol?”
“Yes, Doctor, I do; however, the length of my sister’s break has—in the past—been reason to believe that there was more than a significant life experience to blame.”