*****

Téa held Tom for another thirty minutes. She gently kissed his forehead, and then Frank and Susannah helped her lay him in the bed. They turned him on his side and covered him with a couple of blankets. The ICU staff was relieved that he had calmed down and gone to sleep. Frank asked Susannah if she wanted him to stay with Todd, "unofficially." Susannah patted Frank on the back and told him to go spend the rest of the day with his own kids. Frank nodded. He looked at Tom and gently stroked the hair out of his face. He headed home to hug his boys.

Téa asked Susannah to step outside and talk to her. As they were getting settled in the waiting area outside the ICU, they saw Sam and Viki walking from the elevators. Viki and Sam were surprised to hear that Rocky and come and gone. They were very distressed to hear about Tom.

"What is going on with him?" Sam asked.

"Doctor Hanen, he seemed so moody. One minute he was up and happy the next he was sad and crying. He was that way all through my visit," Téa observed.

"I notice that too. He seems to cry at the drop of a hat these days. Is his depression getting worse?" Viki asked anxiously.

"Yes. I'm afraid it is. He never responded well to Paxil. The only reason I haven't changed it up until now is that Todd was responding to it and Tom was not this depressed."

Sam swallowed hard. It killed him to see Tom feeling so bad. "Why do you think his depression has worsened?"

"I'm not sure," Susannah admitted. "He seems to have lost his way in the system. The purpose he was born for does not exist anymore. He doesn't have to protect Todd from being tortured," Susannah theorized.

"Doctor Hanen, Tom asked me if I were going to beat him for making a mess with the pancakes. He almost seemed upset because I told him I would never hurt him. Is that possible? I thought I must be reading him wrong."

"Yeah, what is with this kick he's on about getting beaten? You can't tell us he wants to be hurt!" Sam could not understand this.

"It's not that he wants to be hurt," Susannah began trying to explain. "Tom was terrified of the physical torture Peter put him through. He is now terrified of the flashbacks he has of being abused and of his father still being alive. You need to understand, Tom came into the system for a purpose. That purpose was to be the one, for the most part, who would take the beatings and some of the other tortures. Tom may also equate the physical torture with his father's love. As many of the alters and even Todd have told us, Peter would tell them he was doing it for their own good. The message being, I wouldn't beat and burn you if I didn't love you. Judging from some of the things he has said, I also believe Miss Perkins gave him the responsibility of helping her care for Timmy. This is what Tom understands and feels familiar and comfortable with. These were his reasons for existing. Now his reasons are gone. He may be feeling lost and useless."

"So he wants to be hit to feel like he's loved and has a purpose? No . . . I . . . Susannah, I'm sorry. I don't think so." Sam could not grasp that Tom could possibly feel that way.

"He kept talking about Kevin. He thought I wanted to go skating with Kevin and not him," Téa informed them.

"He was talking to me about Kevin too, remember," Viki commented. Sam shifted uncomfortably. "Do you think Tom is jealous because Kevin is so close to Timmy?" Viki asked.

"That may be a part of it. Tom may feel displaced in his relationship with Timmy because of Timmy's affection for Kevin or he may feel that Kevin likes Timmy better. I think it's more than that though. Tom seemed to have a problem with Kevin from the minute he came to visit him last time."

Sam knew he had to get Susannah alone and tell her what Tom suspects and that he was not so sure Tom was wrong, as far as Kevin's feelings for Téa were concerned.

"At least he took the news about having epilepsy well. He seems to know how to take care of himself if he feels a seizure coming on," Téa added encouragingly.

"Yes, he did take it well. I'm not sure if he fully understands what we talked about. He was not as frightened as I thought he might be and that's good. I want you all to understand that the odds are not great that he will know when he is about to have a seizure, if he ever has another one. It is not great that any of them will get or understand the warning signs, especially at the beginning. Most likely they will not know what's happening to them. I'm hoping that none of them continue to have seizures. I also hope that if the seizures continue, eventually, they will start recognizing the signs their body is giving them. Usually seizures are very stereotypic. They almost always originate in the same part of the brain and follow the same pattern. If there is an aura, it usually does not change in the same patient. Now, with Todd and the alters I'm not sure. Not much research has been done on epilepsy and DID. It may be different for each alter and it is possible that some of them are not epileptics," Susannah theorized.

"Tom just seemed so unhappy and miserable. He didn't act like himself at all that night Kevin and I came to see him," Téa stated.

"Why are his feelings that his brain is so mixed up stronger now? I mean he always complained of that and had a problem distinguishing between the past and present and understanding some concepts, like telling time. Is it worse for him now?" Sam pressed.

"Sam, he's more depressed now. He's having a harder time keeping his thoughts straight. His thinking is disorganized. His thoughts are all over the place. He's having problems concentrating. Depression can affect his intellect. Also, he may not have responded well to the neuroleptic. In some cases they can worsen depression."

"Timmy's IQ went down. He's not able to remember how to spell words he used to know. We've also seen major personality changes in him. Do you mean it is affecting Tom similarly to the way it's affecting Timmy?" an agitated Sam asked.

"Yes. Worsening depression is likely the cause with both boys. It's only their reactions to it that differ."

Sam threw his hands up in disgust. "So the same medication that may be helping Todd is making Tom worse and possibly Timmy too. That's just great! So whom do we sacrifice? Do we do what's right for Tom or for Timmy or Todd? . . . What about Thomas? He has that restless thing . . . and Scared . . . his vision was affected . . . and his muscles . . . who was the one who had headaches . . . oh yeah, poor little Peep."

"Sam, I know this is upsetting. I don't intend to sacrifice any of them. They have been off the Zyprexa and the Paxil for two days now. Since it was not the drugs that caused the seizures I would like to try another combination with them. There are some different neuroleptics and antidepressants I'm thinking of. I need to go over the side effects of each of them with all of you so we can decide which way to go. I have to warn you, it's not likely, but the phenytoin may be contributing to his depression and may exacerbate the psychotic episodes. I'm not going to lie to you. Now with epilepsy added to his conditions, we may have a problem."

Tears came to Téa's eyes. She believed that if the anticonvulsant were contributing to their depression then she was responsible. She also believed that Todd would not have gotten epilepsy if it weren't for her hitting him. Téa knew her guilt was not going to do Todd or Tom or any of them a damn bit of good. She had to do whatever she could to help them. To do that she needed to understand everything she could about them. "Doctor Hanen, did Rocky come out again because of the seizures or because of any medication changes?" Téa asked.

"No, none of that has anything to do with Rocky coming out again," Susannah replied.

"I don't understand Rocky at all. How can he feel such love and such a strong alliance to that monster who called himself their father?" Téa wondered out loud.

Susannah understood the role Rocky played in Todd's system was a difficult one to understand. "Téa, there are most likely several reasons for Rocky's being. When the abuse against a child is chronic, it becomes part of the child's 'normal' daily life. It is all the child knows. He has no references to anything else. He also knows it hurts. In most cases, as it was with Todd's, the abusing parent and even sometimes the non-abusing parent gives the child the message that he is being hurt because of his own actions . . . that he asked for it. The child believes if he weren't bad in the first place he would not be punished. Peter constantly told whoever was out and being abused, physically, emotionally or sexually, that it was his or her fault. He made them believe that he or she made him do it."

Téa understood, up to a point. She had always blamed herself for her mother leaving. She had thought, 'if only I'd been a good girl my mami would still be here.' What Téa had a hard time with was a child believing they were bad enough to be not just hit, but also horribly tortured. "Todd usually refers to whatever abuse he does remember as 'being disciplined,'" Téa remembered.

"So, Todd and the others actually believed they deserved punishment that severe?" Sam stated more than asked.

"Yes, they believed it. They came to expect it as part of their daily routine. Now, at the same time, there is an instinctual need in children to bond with their parents. They need to feel loved and protected. They need to think that they have a safe place with at least one parent."

"Susannah, I remember you telling us about attachment to the perpetrator. Is that what you're talking about?" Viki asked. Viki understood that in a way neither Téa nor Sam could. She knew that no matter what your only parent did to you, a part of you needed to attach and bond to them, even if you had to shatter in a hundred pieces to do it.

Susannah began to try to explain the complicated reasons for Rocky's existence. "Yes. Todd desperately needed to feel some love and safety from his relationship with Peter. It was natural for him to want to bond with his father. Once Barbara left, and even more so when she sent him away from the summerhouse, Todd lost all hope of being saved by his mother. He had to cling to the hope that he would get what he needed from Peter. Todd only saw himself through the eyes of his father. His whole identity became entangled in the way Peter saw him and in the way Peter treated him. It is perfectly normal for a child to assume that if he's being punished, he must have done something bad. The more severe the punishment, the worse he assumes he is. He believes that if could be good enough the punishment would stop. This self-loathing may have become so intense that Todd wanted to die. He needed to be able to hate himself without becoming self-destructive. He also needed to be able to love his father and get his safety needs met."

"So he created Rocky to hate and blame Todd and all the others for the abuse . . . leaving Peter in the clear," Téa stated. She was beginning to understand.

"Exactly. Todd needs a part of him to believe he had a good dad who wanted to save him and protect him. He needs to have someone to blame for his father's actions so Peter could be that 'good dad.' Rocky can blame Todd, the alters, the women Peter dated and Barbara and everyone but himself and Peter for Peter's actions. He needs to preserve the image of the 'good dad' at all costs."

Téa nodded in agreement with everything Susannah had just explained. "That's why Rocky wants to be so much like Peter and thinks that everything his dad thought is right. I know when I explained about the portrayal of the women in those magazines to him he understood, for a moment. Then he quickly went back to thinking that if his father thought it, it must be true."

"Magazines?" Viki inquired.

"Apparently, Peter used to show Rocky magazines that depicted sexual sadism toward women." Susannah filled her in. Sam and Viki shook their head's in disgust. "He also told Todd that if any woman ever said she loved him, she'd be lying," Susannah continued, "and that if he ever had any money, any woman he met would only pretend to like him for the money."

"That rotten bastard!" Sam seethed. "He knew Todd was going to be very wealthy some day and he had to make sure that he would believe that."

"I don't think Todd ever really completely believed I came to care about just him and not the money. As much as I hate to admit it, Blair also came to love him for who he was and not how much he was worth, but he never believed that either," Téa lamented.

"So Rocky hates all the others because he thinks they are responsible for Peter being the way he is?" Sam posed.

"Yes. It seems that because of Rocky's idolization of Peter, he was able to forge some kind of relationship with him. Most of what few fond father and son memories there are belong to Rocky. Peter played ball with him. He watched T.V. with him. Unfortunately, he also tried to teach him to smoke and drink and he shared his views of women with him. Although he also shared those with Pete and with Todd himself," Susannah added.

"My God, I'm not trying to excuse the rapes and Todd's attitudes, but it is no wonder Todd ended up with such a distorted view of women," Viki shook her head and declared.

"I believe that could have definitely been a contributing factor . . . not to mention some of the alters seeing Peter rape Barbara, possibly several times and Barbara's not saving Todd when he was abused and then abandoning him, twice," Susannah theorized.

"Dear Lord, Susannah, how are you ever going to help Todd? There is not an aspect of his life that wasn't destroyed by Peter and Barbara. It's frightening to know how much she loved that child and still did so much damage to him," Viki lifted a trembling hand to her eyes to wipe away the tears that had formed as she spoke.

"Todd is extremely ill and has a very long, difficult, road ahead of him. I want you to remember he also has a lot going for him. His survival instincts are the strongest I have ever known. He is brilliant and multi-gifted young man, and even though he would never believe it, he has this amazing capacity for love. As hard as Peter tried, he could not torture that out of Todd. For all the horrible things Todd has done, he has an innate goodness in him. Yes, he is one of the sickest patients I have ever worked with. Still, he has more going for him than many, especially when it comes to having a support network around him. The way all of you feel about Todd, the way you treat him and are always there for him and the unconditional love you give him is invaluable. He would not survive without it," Susannah pointed out.

Sam took Viki's right hand and Téa's left. "That's one thing Todd will always have. We love that boy. We love him with all our hearts."

Viki looked at her watch. "Téa, it's two-thirty. Do you still have some time?"

"Yes, it won't take me long to get to the penthouse."

"Susannah, do you think you can go over the side effects of the neuroleptics and the antidepressant you want to give Todd, now, while Téa is here. This way you don't have to go through them again?"

"Sure. First, I want to make sure you understand. As I said, it is not common, but the anticonvulsant and the seizures themselves may contribute to his depression and possibly to psychotic episodes. Hopefully, they will have the opposite effect, which is also a possibility."

"Do you mean the seizures may physically cause these problems or his finding out he's become epileptic?" Viki needed clarity.

"Both," Susannah made clear. "Certainly Todd did not take finding out about his seizure disorder well. Having multiple seizures can cause postictal psychosis. That is usually a short-term psychosis. The problem is, it would be difficult to differentiate between any psychotic episodes he may have as being caused by the psychosis due to his mental illness or by seizure activity." Susannah could see how disheartened they all looked. She hated to have to give them even more negative news. Nevertheless, they had to be able to make an informed decision. "The drugs I have in mind for a neuroleptic are safe, but not quite as safe as Zyprexa, which is why that was my first choice."

"Susannah, maybe Todd doesn't still need to be on a neuroleptic? Can't you let him try without it for a while?" Sam asked.

"Of course we can. I do believe the neuroleptic was facilitating his ability to communicate with us. I also believe it helped to slow down the switching and psychotic episodes, to some extent, but not enough. I'm afraid without the medications we will see some rapid regression," Susannah stated sadly.

"Do you think that is most likely what will happen?" Viki pressed. She was not sure if she really wanted to know.

"Unfortunately, I do think this will lead to a set back. I think we will definitely see some regression, how much I don't know. We may only see it in Todd or in some of the alters. Since the medications were having little positive effect on Tom, Timmy and Thomas we may even see an improvement in them, in some ways. From what Thomas told us, Andy has been experiencing a major depressive episode since his disclosure about the sexual abuse. I'm hoping Andy and the other alters, as well as Todd, will benefit from a different antidepressant and neuroleptic."

"But now the epilepsy plays into your decisions, doesn't it?" Téa stated.

"Yes, that is a major concern to us. I am going over all the options with Doctor Anderson and Doctor Williams. We will be looking for what is safest for his heart and will be least likely to trigger seizures and at the same time be most effective. Unfortunately, many of both the neuroleptics and the antidepressants can cause seizure activity in susceptible patients."

"And now Todd has become a susceptible patient," Sam declared.

"Yes, now he has," Susannah sadly confirmed.

They all sat quietly for a few moments, trying to absorb the situation. "Doctor Hanen, what you are saying is the Dilantin may make his psychiatric problems worse and the psychiatric medications may make his seizures worse. My God! Todd is in trouble no matter which way you go," Téa commented in a strained voice.

"Choosing meds for Todd was always very difficult. It's definitely more complicated now, but it's not impossible. We have to weigh the potential to heal and the potential to harm of each drug. Todd must be on an anticonvulsant. There's no getting around that. If we can eliminate the neuroleptics, and I honestly don't believe we can at this time, we will. I think the possibility of us being able to eliminate an antidepressant right now is nil. Todd and most of the alters are severely depressed and beyond being able to get relief without medication. There are several ways we can go. I would like to stay with the newer atypical antipsychotics and the SSRIs for an antidepressant."

"SSRIs?" Téa asked.

"Serotonin Selective Reuptake Inhibitors. What they do is to inhibit the reuptake of the neurotransmitter, serotonin, by the presynaptic synapse. That is the nerve ending. This forces the serotonin to remain in the spaces surrounding the nerve endings where it works best to control depression. The antidepressant I would like to try with him is called Zoloft," Susannah explained.

They were once again quiet as they absorbed this bit of information. "Wasn't Paxil also an SSRI?" Viki asked.

"Yes, but unfortunately many of the alters were getting no relief from it and Todd wasn't getting enough relief to warrant continuing it. Now, the neuroleptics are more of a problem. There are two that we are thinking of. Both have some side effects that are of concern. One is called clozapine and the other risperidone. While it is not common, risperidone can be more likely to cause EPS. However, it is a less likely to cause seizures. It can cause some heart rhythm disturbances. Clozapine could present even more of a problem to his heart. We are leaning away from clozapine for those reasons and because it has the potential for some very serious blood disorders like agranulocytosis, leukopenia and neutropenia. We would only consider it as a last resort if there is any problem with the risperidone or he doesn't respond to it."

"You and the other doctors said that Dilantin could also cause some of those same blood problems. It is harmful to the white blood cells. You want to give him two medications that can cause those problems!" Sam asked loudly. His voice was shaking.

Susannah was not sure this was the best time for them to make this decision. With all they had been through in the past two days, hearing about these potential but unlikely side effects was terrifying them. "Yes, it could cause a decrease in the number of white blood cells or cause them to behave in an abnormal fashion. These conditions are extremely serious. If Todd were to go on clozapine he would need weekly blood tests. He already has blood tests every other week, so that in itself would not present as much of a problem as the possibility of the conditions themselves. While not life threatening, clozapine can also cause and increase in REM sleep. It can increase it to eighty-five percent of total sleep and because of that there can be an intensification of dreams. It can cause Todd to go into REM sleep as soon as he falls asleep. As with Zyprexa, there is a very rare possibility of neuroleptic malignant syndrome and tardive dyskinesia with either drug. There is much less of a chance of TD and EPS with the clozapine than with the risperidone . . ."

"Wait a minute," Sam cut Susannah off. "You're saying the one that causes the blood and heart problems puts him at more of a risk for seizures, but it has less of a chance of causing tardive dyskinesia and EPS than the, supposedly, safer one! God! I hate this. What are we doing to him!"

"We're trying to help him in every way we know possible," Susannah stated. "We are trying our best not to cause any harm. If he shows any signs of any of the more serious side effects, the medication will be reduced in dosage or discontinued." Susannah's assurances did little to wipe the frightened and worried look off of their faces. She understood what a terrible and terrifying responsibility it was to have to be the one to decide what was done to and for Todd. She knew that Todd having no say in what was done to his body and mind seemed horribly unfair. Sadly, for now, Todd could not make these decisions for himself.

Viki took Sam's hand. Sam was beginning to wonder if, perhaps, Blair's idea of just taking Todd home was such a wild one. "Is the risperidone very likely to cause those extrapyramidal symptoms?" Viki asked anxiously.

"No, but clozapine is much less likely to. That was one of the only reasons we even considered it in the first place. Listen, you don't have to decide anything right now. If you like, you can discuss it with Doctor Anderson and Doctor Williams," Susannah suggested.

"I've been checking out sites on epilepsy on the Internet. Some of them mention a ketogenic diet," Téa announced.

"Really! . . . A diet to help epilepsy? Susannah, have you heard of this?" Sam was grasping at straws.

"Yes. It's a diet rich in lipids. Those are fats and oils. It’s also low in proteins and carbohydrates. The high intake of lipids and oils creates a condition in the body known as ketosis. The metabolic shift that is created by this increases the seizure threshold for some. It is usually only effective in children. There is a possibility it may work with some of the alters, but that is highly unlikely. The diet is calorie and liquid restricted. It must be adhered to strictly. Todd's nutritional needs are too great for such a restricted diet. However, in the future, if he does not respond to anticonvulsants and we can get his weight up, we may consider trying a ketogenic diet . . . although it can put a strain on the kidneys. In all likelihood the anticonvulsant will control Todd's seizures. It just may take some time to get to the best therapeutic dose for him. Most people with epilepsy live out their life fully and with the same quality as anyone else. I have some information pamphlets on the anticonvulsants and the neuroleptics and antidepressant I want to try with Todd. Why don't you stop by my office when you have a chance and pick them up. My secretary knows where they are or I can get them for you. I really do think it would be a good idea for you to meet with Doctors Anderson and Williams and voice your concerns about the drugs. This is a team effort and as Todd's family you are part of that team. Remember that. You have the right to question any of our decisions," Susannah offered. She did not want any one of them to feel guilty for any decision made. They needed to be informed.

Téa looked at her watch. It was three twenty-five. "I think I'd better be heading to the penthouse. I don't want to be late and have Starr think I'm not showing up. If it's Tom who wakes up, please tell him I love him and I will see him later or tomorrow."

"Have a good time with Starr and give her a kiss from us and from her daddy." Viki's eyes filled with tears as she said the last words.

Téa took Viki's hands. "I will. I will let her know how much her daddy and her entire family loves her." Viki hugged Téa to her. Téa gathered her things and headed for the penthouse.

"She loves Todd and the children so much. Téa is the best thing that ever happened to Todd. She always tried to push him to be a part of us instead of pulling him away from us," Viki commented.

"From the day I arrived to help Todd save his marriage to Téa I could see by the look in his eyes that he found something special and I knew I had to do everything within my power to keep it for him," Sam added.

"Is it all right if we go and sit with Tom for a while? We won't wake him?" Viki promised.

"Of course. I'll be in my office. The ICU staff knows to get me immediately if there's any problem or changes in his condition. Susannah headed for her office and Viki and Sam for Todd's bed.

Secrets 89, Page 2