Chapter Twenty

Dr. Alfred Billingsley

Att: Head Nurse McAdams

Please give this sealed envelope to Dr. Chantelle Bichon at 8AM on Monday morning 11/12/2012.

Dear Dr. Bichon, Welcome to Potomac Fields. Please once again accept my apology for not greeting you personally and leaving this rather unprofessional note in my absence. As I mentioned on the phone, I will be presenting an abstract at the 65th annual meeting of the American Psychiatric Association over the next few days in Boston. However, if there is anything that needs my immediate attention, I will be carrying my pager and my staff can contact me. You come highly recommended by my colleagues at Georgetown University and I’m sure you will do fine without me for a few days. I’m pleased you decided to do a rotation here at Potomac Fields.

I will be out for the group session on Monday and the one on one sessions on Tuesday, but will be returning for the group session on Wednesday. I look forward to getting better acquainted with you, Dr. Bichon, and especially hearing your first impressions of the four primary patients I’ve assigned to your care. I have tried to prepare the patients for you. It may be a little awkward, getting them to feel comfortable enough to talk to you and trust you, but your Chief Attending at Georgetown tells me you are one of the most promising Psychiatric Residents he’s ever encountered. I’m sure you’ll be able to handle everything here. Plus I believe it is a positive step in their recovery to adapt to a new person in the clinical environment.

In this brief note, I just wanted to convey basic info regarding the patients in your care- first name, age, and the length and reason for their admission. Forgive the brevity. I’ve got to catch a flight in two hours and I’m not packed! I will be leaving the thick case files of each patient with their medical histories on my desk. Please feel free to use my office until my return. I would suggest that you spend Monday morning reviewing the files to better familiarize yourself with the four patients, to prepare for your group and individual sessions. All four patients are on meds and are non-violent. Three of the four patients are communicating well to the staff and have made great strides in the recovery process. One patient though has been silent for four weeks since being admitted to Potomac Fields, and is a bit of an enigma to me. He doesn’t appear to have a mental defect like autism. I believe he has the ability to talk, but just chooses not to. Perhaps a pair of fresh eyes on the puzzle of Jeremy will help us break through to him too, one hopes. Here are your four patients:

Sara, age 24. Admitted 5 weeks ago with COC (Co-Occurring Disorders) after a crack cocaine overdose and manic depressive behavior. Seeks sexual attention from other male patients and staff.

Carolyn, age 26. Admitted 6 weeks ago with DID (Dissociative Identity Disorder) after an emotional break up with a boyfriend. Suffers from body image problems and weight related issues.

Eloise, age 27. Admitted 7 weeks ago with BD (Bipolar Disorder) after an attempted suicide following her first sexual experience. Is the product of a strict Christian household with associated guilt complexes and shame about her sexuality.

Jeremy, age 34. Admitted 4 weeks ago with… Depression? Diagnosis yet to be determined. Admitted after a self-inflicted wound on the day of his Father’s funeral. Left hand observed to be constantly clenched during the day and relaxed at night. Consulted Neurologist on call, tested for clenched fist or psycho-flexed hand syndrome, all tests proved inconclusive for a neurological disorder. Considering Electroconvulsive Therapy, please advise whether you agree with this plan of treatment after you’ve evaluated the patient.

So that’s it. I will see you on Wednesday, Dr. Bichon.

Best regards,

Dr. Alfred Billingsley