Kevin wanted to make things right with Tom. He wanted to be able to care for him as he did for Timmy. Thinking of Tom broke his heart. He could not believe his relationship with Todd had become so important to him. He was obsessed with it. Kevin knew there was nothing he could do about it right now. Right now there were just two things Kevin wanted . . . to have a drink and to see Téa. "I just like talking to her, that all!" he whispered to himself. He tried to fight the desire to do either of the things he desired. Kevin sat in the lounge struggling with those desires for another half-hour. Things were calm in the ICU. Kevin lost the fight. Disgusted with himself, he headed out to get a drink. He knew he would then try to find Téa.

*****

Susannah and her staff, current and new, sat in her office. Susannah had worked with some of the new techs and nurses before and was familiar with their work. She knew four of them from the hospital she was with in Chicago. She had called and asked them if they would be interested in becoming part of Todd's treatment team here in Llanview. It seemed like a hundred years, to Susannah, since she had asked some of the current team if they wanted to work with a young patient in Llanview Pennsylvania. When Susannah first realized that Todd would have to be transferred to the psychiatric unit, she had contacted Frank, Dave, Connie and Terry and asked them if they would be interested in coming to Llanview. The other two new members of the current new team had come highly recommended. Susannah would never hire someone she wasn't 100 percent sure about to work with Todd.

"I want to speak with you alone, before I introduce you to Todd and his family." Susannah's words were directed to the newcomers. "I know you have all read the history and progress notes. As you've read, although we were not able to successfully complete either the DES or the SCID-D with Todd or the alters because most of the questions were too triggering for them, from what we did get, Todd has tested off the wall on all criteria for DID. Even without the diagnostic eval, I have to say that I was reasonably sure of the DID diagnosis from the moment I met Todd."

Both the new and the current staff knew diagnostic tools like the Dissociative Experiences Scale and Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised dealt with questions that might set Todd and the alters off.

"I know this is a lot to absorb and will take a few more readings before you are really familiar with this case. That's why I want to go over some of the specific details of treatment. We are dealing with a young man who has many co-occurring physical and mental illnesses. Unfortunately, we are in a situation where his physiological problems exacerbate the mental ones and the mental ones do the same to his physical health. We walk a very fine line with Todd. We also have to take his family into consideration, always. They are to be treated with the utmost respect at all times. Whenever possible, Todd's treatment is to be thoroughly explained to them before anything new is done to him. His family has been through more than anyone should have to bear. They are all starting to show signs of anxiety and depression themselves. They all have their own issues to deal with in addition to being scared to death for Todd. So, please, always take this into consideration when dealing with them."

"I see that at least one family member stays with him overnight," Mark, one of the newly hired nurses, commented.

"Yes. Sam, Viki or sometimes both spend the night with him. They have pretty much moved themselves into the private family lounge. It is necessary for the time being. Todd and the alters' dependency needs are extraordinary. In turn, since he almost died of pneumonia last winter, his family has become obsessively fearful of not being with him. Usually the first thing Todd does when he surfaces is reach out and call for his sister. If she is not around he quickly escalates . . . sometimes to a restraint and heavy sedation."

"He's regressed considerably since his blindness," Don, one of the newly hired techs, looked at his notes and commented.

"The blindness may allow Todd the excuse, but it's much more do to his unmet dependency needs and his physical and emotional illness," Susannah explained.

"I see he and some of the alters suffer from major depression in addition to DID, Post Traumatic Stress Disorder and psychosis," Eileen, another of the recently hired nurses observed.

"Some of the alters' cognitive and motor skills have been effected as well. Tom and Timmy's thinking is becoming more disorganized," Susannah informed them. Then she added, "Before I forget to mention it, please do not refer to the various personalities as alters, to their face. Some of them find it insulting."

"Has he been successfully engaging and bonding with you and the staff?" Steve, another of the recently hired techs, asked.

"Many of the alters have developed a good level of trust with me and the staff. Todd still has a long way to go. His ability to trust was stolen from him long ago. Todd tends to push away the very people whom he wants most in his life. He pushes them away before they can reject and abandon him."

"Has any work with coping skills been done with him?" Janet, the last of the three newly hired nurses, inquired.

"Some, to help with anxiety attacks. He has been able to calm without meds on occasion. Other times he is unable to utilize them." Susannah filled them in.

"Do you already have a pretty good idea about how his system is set up?" Steve asked.

"The alters have been asked to do mapping . . . again, they became anxious when they realized they were divulging information about their system. I do try it periodically with them and each time their anxiety has escalated. To my knowledge, there has been no fusion or disintegration of any alters since Todd's been my patient. Only more and more alters coming forward. Mike is the alter whom I believe to be the gatekeeper. Other alters have reported that he seems to decide who comes and goes in the system. I believe it is Mike who chooses who is allowed, who's kept inside, who's sent away, who's put to sleep and who becomes dormant. I don't think he does this in the day-to-day operations of the system. I'm reasonably sure he acts only in times of crisis. I believe for the most part he allows the alters autonomy. Nevertheless, some of them fear being sent away by Mike."

"Was he the one who caused Andy to become dormant for so many years?" Janet guessed.

"I'm quite sure it he was. Mike has been mentioned by two of the alters as having been the one to send Andy away. Mike has yet to show himself. If there is a memory trace personality or an administrator personality, they have not yet shown up either. I suspect there is one because Todd was an excellent businessman. At times he seemed completely consumed and focused with the operations of his newspaper. If there is an administrator, he or she may also be responsible for organizing the system. There are alters who are not aware of each other. The antagonists, Rocky and Saber, whom I believe at this time to be the primary internal persecutor, have surfaced. There are three caregivers that we know of . . . Miss Perkins . . . Carol and Goodone. Some children are known to all of them and some to only Miss Perkins or to Carol and Goodone, who act jointly as parents . . ."

"Excuse me. Do Carol and Goodone consider themselves to be husband and wife?" Don asked.

"No. Carol is convinced that all husbands abuse their wives. Goodone may also believe that, so they do not consider themselves married. Goodone plays a very important role in Todd's system. He is the one Todd runs to when he goes inside. Goodone is the only one, whom we know of, who knows where Todd's hiding place in the system is. He also has the power to allow Todd to hear us or keep him from hearing us when he's inside. Goodone knows when Todd is overwhelmed and comforts him. If necessary, Goodone puts Todd to sleep. He wakes him when he feels the time is right. He seems to be able to judge just how much Todd is strong enough to endure. Goodone has also been instrumental in helping me bring Todd to the front and has agreed to work with me," Susannah informed them.

"That's a huge step," Eileen commented.

"Yes, very huge. I waited months for that connection. I'm not sure, yet, how much control Goodone has in the entire system. He seems to have good control of Todd. I believe he may be the primary internal self-helper," Susannah told them.

"Has he given you any information on the workings of the system?" Mark asked.

"Not much. I don't push him for information too much. His trust is slow in coming. He has already been sorry he helped me bring Todd out when Rocky hurt the body on our watch. I do believe that Goodone has valuable information on the inner system. When I feel the time is right I will pursue that with him," Susannah explained.

"Does Todd consider Goodone to be his father?" Eileen inquired.

"When he is inside, yes. He calls him Papa. Todd has only recently begun to have memories of being inside with Goodone."

"Is there co-consciousness between Todd and Goodone or between Todd and any of the alters?" Janet asked.

"When Todd was very young . . . mmmm . . . I'd say younger than six . . . he had a good co-consciousness with the alters who were around at that time. Then he started to fear them and assumed hearing their voices meant he was crazy. There is communication even now, but it is usually alters who want to terrorize him. I do believe Todd has always been able to hear some of the alters communicating with each other because he has complained of headaches and his head being loud and noisy all his life. We are having a lot of trouble with the internal persecutor."

"He doesn't want to align with the system?" Angelo, one of the other newly hired techs, asked.

With a frustrated smile on her lips, Susannah shook her head. "We are very far from that. I consider Saber, one of the internal persecutors, a much greater threat than Pete. Pete sometimes terrorizes Todd and claims to hate him and not care if he dies, but Pete is really a helper alter."

Looking at her notes, Eileen stated, "Pete is fourteen."

"Yes. He's full of rage and he can be very violent. Pete is proud of his violence and survives by intimidation. He usually stays to himself. He ridicules some of the younger alters, particularly Tom. Miss Perkins considers him one of hers. Unfortunately she has very little control, if any, over what he does within the system or in the world. Yet, I have seen vulnerability in Pete. I have seen him afraid. He can be reasoned with, at times. Pete claims to have no parents. It is very important to him that Peter and Barbara Manning are not to be considered his parents. It is also very important to him that we do not think that he was ever abused in any way. I'm reasonably sure he was. Escape and assault precautions have to be very strictly adhered to when Pete is out. Pete is also an impostor alter and likes to pretend to be some of the others, especially Todd and Tom." Susannah smiled. "Pete usually ends up giving himself away. Saber has shown no signs of fear. He has intense hatred of Todd and contempt for all the alters and for Todd's family and for the staff here."

The newly hired staff was becoming fully cognizant of how very ill Todd was.

"Is Saber the reason he's still on suicide precautions?" Don asked.

"Saber is one of the reasons. Todd is very depressed. So are some of the child alters. Suicidal ideation is still a problem. Todd has made statements wishing he were dead almost every time he surfaces. The Paxil was giving Todd some relief and his thoughts were becoming a little more organized. Unfortunately, Timmy, Tom and Andy all have worsening depression. I'm going to switch him to Zoloft. I also want to try risperidone with him. His family is having a hard time deciding if they should allow any more neuroleptics to be used on him. They are also very concerned about the Dilantin. His sister lost a daughter to lupus and when she was told that it could be caused by Dilantin she really freaked."

"It would be so rare for that to happen," Janet remarked.

"I know," Susannah agreed. "Viki was traumatized by Megan's, that was her daughter, death. Viki is more a mother than a sister to Todd. Both she and Sam Rappaport consider Todd to be their child and he thinks of them as his parents. Both of them have serious guilt issues where Todd is concerned. Todd's sister carries the guilt of their father giving Todd to abusive parents. Sam feels guilty because he was there when Todd was a child and teenager and he didn't recognize the signs of abuse, or at least not the extent of the abuse and he didn't rescue Todd."

They all shook their heads. "They must all be suffering greatly." Eileen verbalized what everyone was thinking.

"Yes, they are." The staff heard the sadness in Susannah's voice, as she continued. "There is also a problem with Todd's ex-wife and current wife being in competition with each other. Each hopes Todd will come back to them when he is well."

"I see he has a young daughter. Does she visit?" Don asked.

"No. Starr is too young and Todd doesn't want her to see him like this. He doesn't want his current wife, Téa, to see him like this either. I think he is starting to come around on that. He has given permission for her to visit two of the three alters that he knows about . . . Timmy a four year old . . . and Tom, a seven year old. Both of these alters love Téa very much. Tom has a huge crush on her that is complicated by his awareness that Kevin Buchanan, Todd's adult nephew, may have feelings for her as well."

Susannah passed out a page to each of them. "Here is the list of approved visitors. You can see an asterisk next to Kevin's name. He is allowed to visit with all of the alters, except Pete. He is also not allowed to visit with Todd when Todd is awake, at this point, but I plan on speaking to Todd. I believe Kevin is very important to Todd, for reasons I don't yet know. Their relationship has been extremely volatile over the years. Todd also has some very strong feelings for Bo Buchanan, the police commissioner. I hope to explore that with both of them at some time in the future, when Todd is more stable. Timmy idolizes Kevin and is very dependent on him. Timmy has been having extreme separation anxiety the last few times he was out. As I said, there is a problem with the two Mrs. Mannings and Kevin. I have warned all of them that I do not want them to visit Todd at the same time. Their anger escalates quickly and their words can have disastrous affects on Todd. You will also see an asterisk next to the name Dorian Lord Hayes. She is Blair Manning's aunt and is allowed to visit. There are times when Blair needs Dorian's moral support. However, she was caught looking at Todd's chart, without permission. If she comes to visit, I would appreciate it if a very close eye were kept on her. She and Todd's sister have a long and complicated history of problems with each other. Mrs. Hayes has been known to go out of her way to cause problems for both Viki and Todd. The visitors list is also posted in the staff lounge," Susannah informed them all.

"My goodness, things must get very complicated around here," Eileen declared.

"You cannot imagine," Susannah confirmed and then warned them, "Of all the cases I have worked on, Todd and his family are by far the most complicated. Todd is also the most seriously ill patient I have ever worked with. His abuse was very severe and chronic. He and most of the alters have great abandonment issues and unresolved grief. You can see in the history that the mother left when he was nine. He ran away to the house she and her second husband shared. She sent him back to his abusive father after six days. Then Jimmy, a fourteen year old alter, saw her again the day before she died. He saw her beg the father for permission to see him. He saw her being verbally and physically abused by the father this one last time. He immediately attempted suicide."

"His history reads like a horror story," Angelo proclaimed sadly.

"Todd is a testament to survival, that's for sure," Don added.

"Yes, he is. He has one of the strongest survival instincts I have ever known anyone to have. Yet he is very self-destructive. Self-mutilation and self injurious behavior are a big problem with Todd and many of the alters. Some of them feel no physical pain and self-mutilate to prove that. Some do it to hurt Todd or each other, some to punish themselves because of anger turned inward. Some of them may be trying to show us how much they're hurting or may be trying to feel. I believe they all experience psychic numbing at times. Pain may be the only way they feel that they are real and that they exist. At this point there is very little cooperation within the system. It is in chaos. Todd switches left and right, almost always spontaneously, sometimes even in his sleep. He has no control over it."

Susannah sighed deeply and continued. "Some of the alters are not aware of the others and there is very little therapeutic alliance between them. Timmy and Andy are very close and Tom has always been a caregiver to Timmy. Much of Tom's job has now been taken over by the family and Tom is feeling lost, in and out of the system. There are three psychotic alters whom we know of and Todd experiences psychotic episodes. He just had one this morning, after being taunted by Saber. Todd is also having a difficult time accepting the epilepsy diagnosis and is still in denial over the DID and depression diagnosis. He is despondent and hopeless. He begs for us to kill him or help him die. There are some fragment alters. There are two sets of twins that we know of. Each set of twins is never to be separated. They function together, as a unit," Susannah directed.

"Is he at risk for further dissociation?" Steve asked.

"I'm afraid so. There is a strong possibility that new personalities are still coming forward."

Susannah could see that the new staff members were already feeling great compassion for Todd and his family.

Janet flipped through some pages of the history. "Do you still believe his decompensation began when he found the body of that young girl who was killed last spring?" she inquired.

"Yes." Susannah nodded. "Todd was a high functioning multiple for most of his life. Once he found Georgie Phillips' body at Asa Buchanan's lodge he began to decompensate rapidly."

"Is that when his sleep disorder started?" Angelo asked. "No. According to Sam, Blair and Téa, Todd always had trouble sleeping. He was always plagued by nightmares."

"Do you think they were of past traumas?" Mark posed.

"Yes, I do. After Georgie, his sleeping disorder became extreme. He functioned on almost no sleep and both Sam Rappaport and Téa noticed a marked decrease in his appetite. His behavior became erratic. He was terrified of losing his wife and yet isolated from her. He became secretive. He had extreme mood swings. His nightmares increased. His paranoia increased and he became suspicious of everyone. Unfortunately, some of his suspicions were true. Bo, Asa and Kevin Buchanan were trying to pin Georgie's murder on him."

"Does he have any memory at all of the connection in circumstances between Georgie Phillips' murder and the murder he witnessed as a child?" Eileen asked.

"No, none at all. He can't face it. I believe that the reemergence of the repressed trauma, even to the other Todd, is why he developed a conversion disorder. His blindness is one way not to look at things, and more, a way to punish himself for what he believes to be his fault. He may also be suffering from survivor's guilt. I don't think he can forgive himself for remaining alive while Michelle died," Susannah theorized.

Eileen shook her head. She realized what a tortured soul Todd was.

"Have you done any therapeutic abreaction with him?" Mark asked.

"Some, to the limited degree of his tolerance and stability. Hypnosis was used. Some traumas were disclosed, but they were not successful abreactions. Todd was not able to handle the traumas these times either. He got no relief from the memories. The trauma was not digested and was forced back into its compartment immediately. Todd has not been stabilized enough, yet, to try any more therapeutic abreactions. He and the alters have many spontaneous ones, but again, they do not really help any of them in digesting the trauma and lead to little progress. Most of them suffer from intrusive flashbacks and thoughts."

"Has the trust level increased at all since he's been here?" Janet inquired.

"It has. Not nearly enough though. The child alters are engaging some. Todd has an extremely high level of resistance, not only to therapy with me, but also to some therapy to help him with the blindness. He has voiced beliefs that some of the town's people, especially the Buchanan's, are conspiring against him and paying me to keep him here. Being mentally ill is one of Todd's greatest fears. Control has always been a big issue with Todd. He is terrified of not being in control. He believes the drugs are making him feel crazy. He refuses all meds, even painkillers. All oral meds are administered through the NG tube. Unless they ask, we do not tell the alters or Todd that they are receiving medication. Most of the alters have a great fear of meds and of all medical procedures. Eventually, we will have to try to get Todd to take his medication willingly. Right now, he is not in a mindframe to decide for himself or to benefit from medication sessions. Most of them are terrified of even the most basic medical procedures. They will freak out completely when a doctor, other than myself, has to examine them."

"Do any of them eat willingly?" Angelo asked.

"Some of the alters do eat voluntarily," Connie spoke up, "unfortunately not enough to sustain them."

"As you read, the NG tube has been in for about six weeks now. I have to approach the family about putting in a PEG tube. I don't want to hit them with that on top of all they have just endured. I will talk to them about it in a few days," Susannah informed them.

"His weight seems to have stabilized in the past few weeks. He's only gained a couple of pounds though and he is still extremely underweight," Frank added.

"In addition to the chart at the nurses station, the alters' dietary preferences are also posted in the staff lounge," Susannah reminded them.

Dave chuckled. "We keep a wider selection of food in the pantry on our unit than anywhere else in the hospital. We are known to have a huge variety of goodies here and you will notice staff from other units coming around when they get the munchies."

"If any of them, especially Todd, use their fingers to eat with, no attention is to be called to it," Susannah instructed.

"Do most of the children like to be held and cuddled?" Eileen inquired.

"Yes. Most of them do, Timmy especially." Susannah smiled. "You will find he will almost always snuggle up to you, if you sit next to him. It's fine to hold him and hug him as long as you keep therapeutic boundaries. Thomas does not like to be held, especially by women. He may think it is some kind of betrayal to his mother. He is very protective of her. Don, Angelo, Steve, Mark, you have to be very cautious about any physical contact with Andy, should he come out. Touch from an adult male is very confusing to him. At this point, we believe he was the alter who was shown affection during molestation. He also holds feelings of pleasure that may have been experienced during sexual abuse. Andy does usually accept and even crave physical affection from Sam. He is, at times, terrified of male physical contact and at other times he thinks he has to allow it to be loved and may initiate it." Susannah made sure to let them know.

"Have there been any problems with Andy touching staff inappropriately?" Janet inquired.

"No, not as yet," Susannah responded. "Recently Andy has disclosed information about the sexual abuse. He is not prone to flashbacks but he did re-experience some of the trauma this time to the point that he started to go into shock. Since then some of the other alters have told us that Andy seems to be experiencing signs of a major depressive episode."

Eileen and Angelo sighed. They all remembered reading about the disclosure Andy made the last time he was out.

"Does Todd like physical affection?" Eileen asked.

"Todd used to shun any form of physical affection like the plague, except from his daughter. However, since his blindness, he not only accepts it he seems to be in desperate need of it from his sister. He also accepts it from Sam. Todd will sometimes accept it from me. He's still not comfortable with physical contact from the staff," Susannah clarified.

"Oh, there's an alter named Jimmy who experiences tremendous pain when touched," Terry spoke up.

"Yes, thank you Terry. I'm very glad you brought him up," Susannah praised. "Jimmy is profoundly depressed and suicidal. He doesn't come out very often. Unless touch is needed for treatment, or if things change and he initiates it, there is to be no physical contact with this alter."

"Do you or the staff use any pet names or terms of endearment for any of them?" Eileen asked.

"At various times we use honey or hon, sweetie or sweetheart with most of the children and sometimes with Todd. They seem to take comfort in it. Thomas becomes very upset and feels rejected if I . . . and sometimes the staff . . . do not call him honey or if Sam doesn't call him Boomer, a pet name he has had for Todd since he was a child. Viki usually calls them sweetheart or baby and Téa and Blair also use terms of endearment with most of the children and Todd. They do not seem to have a problem with it triggering any traumas. Most of the children thrive on affection and are desperate to be mothered. As I said, their dependency needs are great. If some of the little ones forget and call you mommy," Susannah directed at the three women, "please correct them and then assure them and let them know that even though you are not their mother, you are there for them and they are very safe here."

"Do any of them have trouble staying in the present, when not experiencing a flashback?" Steve asked.

Susannah nodded. "Most of them have, at times, only much less than they used to. Most of them are oriented to person and place, but not date. Tom experiences a lot of confusion. He has a talking watch that gives the time and date and that helps him a lot. He becomes very upset when he comes out and discovers he is not wearing it. It is kept in the top drawer of the night stand when he's not around." With a big smile on her face, Susannah continued. "Tom wants to learn to rollerblade and, hopefully, soon you will be seeing him skating up and down the hallways."

"Do they have a problem sharing their things?" Angelo asked.

Carl answered. "Thomas does, but just slightly and only with some of his things. Mostly, he is resentful for the time Goodone spends with Todd. Many times Thomas comes out when the system can't handle the anger, resentment and frustration he's feeling because Todd is taking up so much of his papa's time. For the most part they are giving and generous, to each other and to us." They heard the admiration in Carl's voice.

"Do they all realize their parents are deceased?" Don asked.

"No. Most of them do not realize the mother is dead. They fully expect her to come back to them, especially Timmy. He has been told his mother is very far away and that she is safe from the father. Jimmy, Pete and the adult alters understand that the parents are dead. Todd knows. At times he becomes delusional and thinks his mother is alive. He very often confuses Viki with his mother. He believes he did something horrible to make the mother leave and he sometimes begs her to tell him what he did so he won't cause her to leave him by doing it again. I have to warn you . . . when that happens it is very hard to watch. It will rip your heart out. If that should occur and you feel you need a break and it is appropriate to leave for a few minutes, please feel free to do so. A staff debriefing after such incidents is also helpful," Susannah made sure to inform them.

"What about the father? Do they realize he is deceased?" Janet pressed.

"Todd usually remembers, but he has flashbacks and nightmares that cause him to believe the father is still alive, so does Tom. Only Tom is more confused and needs to be reminded that the father is dead and can't hurt him. Most of the other children do not realize it. Rocky is the one I worry about the most as far as that goes. He idolizes the father and fully expects him to come here and save him. He believes that the father will 'get us' for speaking against him. Rocky will be devastated when he eventually learns the truth. If he starts coming out more often I will not be able to keep it from him because it will impossible work with him if he's expecting his father to charge in here and beat up the staff and save him. Rocky is one of the only alters we know of, so far, who got along with the father. The father showed him some affection, in a sick and perverse way. Rocky soaked it up like a sponge. The father has twisted many of his perceptions about sex and woman. Actually, he did that to all of them," Susannah added, disgustedly.

Angelo thought of the Activities of Daily Living. "I see that they all need assistance with personal hygiene. Are there any special bathing or bathroom considerations?"

Susannah turned to Frank. "Would you like to answer that?"

Secrets 91, Page 2