Susannah looked around the room. The full impact of this patient's illness on his family was obvious to everyone. The devastation was apparent. Susannah had to make sure to explain to all of them that Todd feeling a seizure coming on was a good thing and so was Brina and Angel coming out. Susannah hoped it meant that Todd was getting closer to dealing with the sexual issues that so greatly contributed to his illness and to his not being able to be the kind of husband to Téa that he so desperately wanted to be. She wanted to tell them all, especially Téa, that they should feel encouraged. Right now all they could do was wait for Todd's latest seizure to stop.
*****
Todd seized for three minutes and twenty seconds and then it was over. The bite to his tongue wasn't serious. "It will be sore for a couple of days. No real damage was done," Susannah assured them. Susannah gave them orders to clean him up and put him in a gown.
They did a defusing on the physical restraint. Everyone knew it was necessary. Angel had escalated quickly. She was in danger of hurting herself and beyond being helped by de-escalation techniques.
Susannah addressed Todd's family. "I know you are all very upset by what just happened here."
"Yeah, Susannah. We are! What the Hell is going on with Angel? I mean I know she thinks she's a girl, but does her coming on mean that Todd is . . . I-I mean . . . damn it! You know what I mean. He was all over Sam and me." Kevin was so upset he could hardly get these words out.
Susannah knew it would be difficult for them to understand. She realized that Sam and Kevin felt violated. "If you're asking do I believe this incident means that Todd has homosexual feelings for you and Sam, no I don't." Susannah could see that both Kevin and Sam looked visibly relieved.
"Doctor Hanen, what does it mean? Angel seemed to be trying to make Sam jealous." Téa gave them her take on the situation.
"Yes, she was," Susannah agreed. She explained. "Angel felt completely rejected by Sam. She sees him as a father figure. She was relating to him in the only way she knows how to relate to a father, sexually."
"Oh God," Sam mumbled.
"Honey, I understand how you felt," Viki rubbed Sam's arm.
"No. I don't think you do." Sam quietly stated. He looked away from Viki. "I failed Todd, again! He knew how I was feeling toward him. He had no idea why. He didn't do anything, as he said, but he was the one I didn't want to touch."
"Sam, Kevin," Susannah began. "I understand Todd touching you both, sexually, made you very uncomfortable. If you like, I can meet with each of you individually and we can talk about it. Right now I you need to understand that Angel did not really want to have sex with either of you. She wanted love. To her that is how you get someone to love you. You heard what she said."
"You mean about knowing how to make her daddy happy? Oh God, I know what that feels like." They all heard the pain in Viki's voice. She totally and completely identified with this young girl.
"Yes," Susannah confirmed. "She also said 'I'm a girl. It's okay for a girl.' I suspect Todd may have had a dream that made him feel the same disgust Sam and Kevin felt. It made him feel confused about his body's reaction to being sexually abused by his father. Angel may have come about when Todd felt this same confusion as an adolescent. The older he got the more confused he became about his sexuality and sex. Any abuse that caused him to experience pleasure, and perhaps even orgasm, also caused extreme feelings of shame, disgust, guilt, self-hatred, and fear. He not only felt fear of his father, but also immense fear of his own body. He most likely felt his body was betraying him by reacting to being stimulated by Peter. This was not only because Peter was his parent, but also because he was a man. Todd may have confused his body's natural reaction to being stimulated with having a sexual preference."
Both Kevin and Sam felt guilt for what they had thought. If they wondered about Todd having homosexual feelings for them after this one incident, they could only imagine how Todd must have felt after years of mixed and confused sexual feelings.
Susannah continued. "Todd's father forced sexual acts on him when he was little more than a baby. It is possible that there is an alter even younger than Timmy who was sexually abused. Todd's sexual development was never allowed to progress at a normal pace. He also witnessed sexual acts that were completely inappropriate for his age. When Todd was very little he may have thought all fathers did this to their children and to their wives. He had no reference to tell him otherwise. As he matured, there was a part of him that realized this didn't happen to everyone. Now keep in mind there was also the part of him that wanted his father's affection and love, at any price. He needed Angel because he may have thought that it was all right for a girl to feel these things with a man, even if that man is her father. He needed her to be a seductress, not of sex, but of love, love in the only way Peter ever showed it. In some ways, Angel is very much like Andy."
"She thinks she has to offer herself to the father figures in her life to make them love her," Téa interjected.
"Yes. She feels like her body is only there to be used for her father's pleasure. She believes it belongs to him and not her," Viki stated. She sounded more like she was talking to herself.
Sam took her hand. "I'm sorry. Viki, I'm so sorry. Oh, God." Sam's voice broke. A tear slipped down his cheek.
Kevin's heart broke for his mother. He hated his grandfather and Peter Manning with every cell in his body.
"I'm afraid Angel feels exactly as Viki stated. I suspect she believes that her body is not her own to do with as she pleases. She feels it is there to gratify Peter or anyone she sees as a father figure. She feels that it is her job to give them pleasure. Then, if she does her job well, she deserves love. She may also feel some control over her body when she does do a good job. Peter took all control over their bodies away from them. That she can use her body to make her father feel good, may give her some sense of control."
Viki's fingernails dug into her palms. She remembered confessing to Susannah that she too may have felt some control in her father wanting her. "Umm," Viki, made a small sound and then said, "Angel may have felt she had one thing that her father wanted and that was the one and only thing she was good for . . . her body."
"Viki, maybe this is too hard for you?" Sam asked. He was worried that too many memories were flooding Viki.
"Maybe Sam's right, Mom? Maybe we should stop talking about this right now?" Kevin was worried about his mom.
"No! I won't turn my back on what was done to Todd. I'm able to face what happened to me. It will never be easy to discuss. It will never be easy for Todd. I can cope with it now and someday so will my brother." Viki turned to Téa. "He will. I know it doesn't seem possible now, but he will. Todd is stronger than all of us put together. I know it, Téa. I know it." Viki started to cry.
Téa rushed over to Viki. She put her arms around her. She hugged her tightly for a few seconds. Téa knelt in front of Viki and held her hands. "Viki, don't you know that you are so much of the reason I do have faith and believe that I can have my husband back? I see so much of you in Todd. I think a part of him knows it too. I think your strength is his encouragement. Your father may not have done many good things in his life, but being responsible, even if only in the biological sense, for bringing you and your brother together is one of them. I think you and Todd give each other strength when you both need it the most. I know someday Todd will understand that."
Viki looked into Téa's eyes. She stroked her cheek. "Todd has been there for me and given me strength and in some ways he and the alters are still doing it. I think my brother has done the same for you and that's why you can understand this."
Téa nodded. "He has, Viki. I just hope I can get him to realize that, too, someday."
"Did I ever tell you how lucky Todd is to have you in his life?" Viki asked. She smiled at the young woman who knelt in front of her.
"In many, many ways," Téa smiled back. She stood up and rubbed Viki's arm and returned to her seat.
The things Téa said were not lost on Kevin. He had no doubts or misconceptions about Téa's love for Todd. It was all encompassing. He remembered what he had said to Todd as he slept. I was right, Todd. You have a lot to get well for, Kevin thought. Kevin realized he felt no jealousy for Todd when he thought this. He was happy for him. If anyone deserved to be loved that way, it was Todd. He knew that both Todd and Téa were broken, as children, and somehow they fixed each other. That was something he could never share with her. Kevin also realized that he should consider himself lucky that no one had ever abused or abandon him.
"How do we react if Angel comes out and acts the same way again?" Kevin asked.
"You try to stay calm and let her know, clearly and firmly, that it is not okay to touch you, sexually, in any way," Susannah instructed.
"What if she just wants to kiss us the way some of the younger children do?" Sam asked.
"That's fine. We don't want her to become afraid to show affection to family. Just make sure you let her know that any sexual behavior directed toward you makes you uncomfortable and is inappropriate behavior. Tell her it's not okay. You set the limits on expected behavior. Reiterate your role in her life. You are her friend. You can encourage her to talk about what she is feeling when she wants to touch you in a sexual way." Susannah anticipated their response to the last thing she said.
"Susannah, I don't know if I feel comfortable talking to her about that?" Kevin spoke up first.
"I feel that way too. What if I react badly or say the wrong thing? Todd and all of them are so messed up sexually," Sam added.
"Yes, they are. However, if you're honest and try to remember the reasons for the behavior you will do all right." Susannah did not want them to start becoming uncomfortable around Todd or any of the alters because of this. "Just make sure you set boundaries. Don't be afraid to be honest with Angel and tell her how you are feeling. Angel may be testing you to see if you can love her without sexually abusing her, or she may want to be the one who is in control of any sexual behavior that she thinks will be demanded of her. I have to have more sessions with her before I can make a definitive diagnosis or know the answers to those questions."
Sam and Kevin seemed to accept that for now.
"Why do you think it took until now for Brina and Angel to come out?" Téa asked.
"Thoughts of sex and sexuality may be coming closer to the surface for Todd. Angel and Brina did not come forward randomly," Susannah continued to explain.
"Brina is the complete opposite of her sister. She seemed so timid. Why is she so obsessed with washing her hands and with germs?" Sam inquired.
Susannah sighed. She knew that OCD could be difficult to treat. "Brina seems to have an obsessive-compulsive disorder. Most likely she is having persistent and recurring intrusive thoughts and images that she has no control over. In order to gain some relief from these, she is engaging in these repetitive behaviors. The hand washing and preoccupation with germs helps to reduce the anxiety these thoughts and impulses cause," Susannah informed them.
"Do you believe these are sexual thoughts?" Viki asked Susannah.
"Yes, I do. I believe both Brina and Angel were created to deal with the growing awareness and confusion Todd had of sexual issues as he went into adolescence. Anxiety-producing, unacceptable thoughts or feelings Brina may have are kept out of awareness by the opposite feelings or ideas."
"Then Brina may be replacing thoughts that she considers dirty with obsessive thoughts of being clean," Téa stated.
"Yes, exactly," Susannah confirmed.
"And all the steps she takes to prevent germs, dirt and filth, as she calls it, help her to cancel out these unacceptable thoughts that she considers dirty?" Sam tried to understand. He wanted to get a clear picture of what was going on with this young girl.
"Yes, they do, temporarily," Susannah replied.
"How do you treat this? How can you get these thoughts out of her head?" Kevin inquired.
"We don't. We get her to talk about them. Right now she may not be aware of any sexual thoughts. They've been replaced with fears of dying and contamination. It is possible Brina also suffers from hypochondriasis or somatization disorder. Either of those could cause her preoccupation with illness and fear that she is dying or has contracted a disease. Again, these disorders can be caused by any number of things . . . emotional conflict . . . unmet dependency needs . . . ineffective individual coping . . . self-esteem disturbance . . . altered sexuality patterns . . . powerlessness. It is possible that when Todd became physically ill . . . colds . . . flu . . . childhood illnesses and such, Peter left him alone for a few days and became the caregiver instead of the sexual abuser, although I honestly don't imagine he was much of a caregiver. Perhaps Peter feared illness and didn't come near Todd as much when he was sick. Who knows?" Susannah speculated.
"Is there a specific treatment plan for OCD?" Viki asked.
Susannah nodded. "Yes there is. Actually, in some cases SSRIs, like Zoloft, have been found to be beneficial with OCD. I will be starting Todd on that day after tomorrow. Also cognitive-behavioral therapy, CBT, may be up to eighty to ninety percent effective in treating obsessive-compulsive disorder. There are basically two parts to it. Exposure, which is exposing Brina to the things she is afraid of. In her case it would be touching something she considers contaminated or allowing herself to be touched. Then there is Response or Ritual Prevention. That would be keeping her from washing her hands and other compulsive behaviors."
"You say these usually help?" Sam was looking for some hope and reassurance.
"Yes, but it doesn't happen overnight and there is often recurrence. Some patients are what we call Treatment-Refractory Patients. No matter what we try it doesn't reduce the behaviors. That doesn't usually happen. I need you to be aware of the possibility. We also have to keep in mind that Brina is much more fragile than the average child with OCD is. The issues she has to deal with are very traumatic. We have to take things slowly." Susannah didn't want to seem pessimistic. Still, she knew she had to level with them.
Susannah continued, "Brina also seems to have poor insight into her obsessions and compulsions. Often, adults, and even some children with OCD, know their behavior isn't normal. They realize their fears are irrational, even if they can't stop them and need to act on them. They understand the ritualistic behaviors are also abnormal but can't stop them. Brina doesn't seem to have that insight. She seems to believe the world will contaminate her and sees her behavior as a rational response to what she believes. She is more delusional in her thinking. We don't know how often she or Angel will be out. Whenever they next come out, I would like to try CBT with Brina. I will have to have some sessions with Angel and help her to understand that it is not okay to touch anyone, sexually, who doesn't want to be touched. I have to find out what her perceptions of sex are. For Angel, and all of them, sex is confused with violence, love, rage, being cared for, revenge, attention . . . all of their perceptions became distorted. Most of the alters, and Todd, have their own perceptions, mostly negative, when it comes to issues with sex. Those all have to be worked through. They all have to go through some of the normal sexual developmental stages that were stolen from them the first time around. We have to reeducate them. Unlearning what Peter and Barbara's actions taught them will be the most difficult part for them."
Téa sighed, "Poor Todd. He never had a chance, not from the day those people got a hold of him. How could Barbara Manning have brought another child into that house? She knew what Peter was. She saw how he treated the baby girl they adopted. How could Irene have let Todd go, no matter what Victor did or threatened her with? Damn them! Damn all of them!"
Sam put his arm around Téa's shoulders. He felt exactly the same way. Viki was about to tell Téa she felt the same way when she felt perspiration break out on her forehead and spread throughout her body. Her clothes started to cling to her damp skin. Her heart started to pound rapidly. She felt as if she couldn't get a deep breath. Her chest was tight and painful. Her hands began to tingle. She felt lightheaded. Viki had enough panic attacks in her life to recognize one. They all began to notice her condition.
"Viki, come on. Let's sit over here," Susannah pointed to the lounge and walked Viki to it. "Slow down your breathing," Susannah instructed slowly and calmly.
"I know, I'm trying," Viki managed to get out. Viki tried to utilize every coping skill she had ever learned. She applied every relaxation technique as well. Finally she began to breathe more evenly. Her sweating eased, as did the tightness in her chest. The feeling began to come back to her fingers. She became aware of all the frightened and worried faces around her. "I'm fine. I had an anxiety attack. I've had them before. I'm fine!" she repeated. She was feeling intensely embarrassed.
"Viki, I'm sorry. I shouldn't have gone on like that about Todd's birth mother," Téa apologized. She felt responsible for what had just happened.
"Téa, don't! I agree 100 percent with every word you said and you can damn my father right along with the rest of them. No matter how you look at it, it always boils down to him! He's the one who started the chain reaction that led to Todd being in this condition. He condemned Todd to this." What Viki didn't say was that she felt just as responsible and she had no idea why.
Susannah had asked Steve to get Viki some orange juice. She handed it to her. "Viki, I'd like you to drink this." Viki took it. Her hand still trembled slightly. "I would also like you, in fact all of you, to go get something to eat and to rest for a while." As Susannah had anticipated, they all protested. They wanted to wait for Todd to wake up. "All right. Then I want all of you out of here for a while. If Todd is up to it, I want to talk to him about what he felt when the seizure came on."
Téa sighed. Susannah realized how discouraged they all seemed. "I know it seems hopeless at times. I don't want you to lose sight of the fact that Todd is making progress. He's getting stronger, physically and emotionally. Just a few weeks ago, could you have imagined Todd's body being able to rush to the doors and bang away at them the way Angel just did?" Susannah pointed out.
They all smiled. They did realize that, in a way, this was a good thing.
"He was strong enough to want to hear about having epilepsy," Viki stated hopefully.
"Yes, he was," Susannah confirmed. "Todd seemed to feel the seizure coming on and he tried to tell me. That's very good. This time he was already very frightened and confused when it started. Hopefully, if he is calmer when a seizure starts, if another one does, he will have a little more time to get himself safe," Susannah declared.
Sam felt guilt wash over him. He knew he was the reason Todd was so upset and frightened. Todd had sensed Sam's reluctance to touch him. Funny, Sam thought. Because all I want to do right now is hug him and never let him go.
Susannah insisted everyone take a break. They knew by now Todd would be postictal for a while. Téa and Kevin both called their offices. Sam and Viki went to get some coffee. Téa and Kevin said they would join them as soon as they took care of business. Susannah headed for her office to call Bill.
*****
Susannah was walking toward Todd's room just as Todd's family came back to the unit. "Hi," Susannah greeted them. "He's starting to wake up. I was just heading in there. Téa, Kevin, will you both wait in the lounge, please, in case it's Todd who wakes up."
"Sure." "Of course." Téa and Kevin answered, respectively.
Téa hated that Todd still became upset to find her near him. She would give anything to have him ask to see her the way some of the children did.
Kevin still felt anxious about the day he and Todd would confront each other. In some ways he felt more anxious this way.
Susannah, Viki and Sam headed into Todd's room. Carl, Connie and Mark were in the room with Todd when they entered. He was moaning loudly and his breathing was becoming erratic.
"He's coming out of it, but he's very agitated," Mark stated.
"Todd, Todd," Susannah called out.
"It hurts," Todd mumbled. His words were very slightly slurred.
"What hurts, sweetheart?" Viki asked.
"My head and my mouth," Todd answered. He reached up and rubbed his hand along his jaw, on the side where he bit his tongue.
"Todd, it's Doctor Hanen. You had a seizure. You bit your tongue. It's just a small bite and it will heal in a couple of days. I can give you some Tylenol for it."
"No drugs!" Todd muttered.
"Do you remember feeling the seizure coming on?" Susannah asked.
"It's far away." Todd's voice was flat and emotionless.
"What's far away, baby?" Viki asked.
"The earth . . . the whole world. I don't know how to get back. I don't like the woods. Make the trees go away."
"Tell us where you are." Susannah gently led him to talk about his hallucination.
"Far away. Where's Doctor Hanen?"
"Todd, I'm right here." Susannah held his hand.
"No. You're only pretending." Todd started to whisper to someone only he could hear or possibly see. "I know. I know. I'm not letting them fool me. Please! Be quiet. Shut up! Please be quiet. Okay! I can feel it. Stop! I can feel it! "
Sam and Viki exchanged looks with Susannah. She didn't have to tell them that Todd was still exhibiting signs of psychosis. They recognized them.
"Todd, is a voice telling you that I'm not real?" Susannah pressed.
Todd started to laugh. "I'm not real either, so the joke's on you."
Susannah motioned for Sam and Viki to speak to him.
"Sweetheart, it's Viki. Sam and I are here for you."
Todd looked startled. "If you hurt the real Sam and Viki I'll kill you," he threatened.
"Todd, please. We are real." Sam stroked his Todd's cheek.
Todd pulled it away sharply. "No! Sam hates me. Sam hates me!"
Sam was devastated. He knew Todd was remembering the way he reacted to him when he surfaced, right before the last seizure. "Todd, I love you. I love you with all my heart. I'm sorry if I let you think that I didn't." Sam tried to stroke Todd's head.
Todd jerked his head away. He seemed frightened of Sam's touch. Todd's breathing was becoming very erratic. He felt the bed under him. "Oh God! I'll drown! I'll drown!" He started to gasp for breath. Todd frantically tried to get out of the bed. He was apparently hallucinating he was in water instead of his bed. He felt dizzy. Susannah caught him before he almost fell off the bed. Marcia, Jeff and Nancy stepped into the room.
"Todd you need to calm down and listen to me," Susannah stated clearly. "You are safe in your bed at the hospital. Are you hearing more than one voice?"
Todd started to gasp for breath. "Everything is spinning around," Todd moaned. "STOP! MAKE IT STOP! I DON'T FEEL GOOD. MAKE IT STOOOOP! I HATE YOU! GET ME OUT OF HERE. I HATE THE WATER! GET AWAY! GET AWAY!" Todd tried to get off the bed again.
Sam held onto Todd on one side while Susannah held onto the other side of her weak, but struggling patient. She motioned for the staff to keep their distance for now.
Susannah knew he would fall if he tried to stand up. "Todd you need to calm down and stay in bed. Tell us what we can do to help you feel calmer and safer?"
"Get Sam and Viki and Doctor Hanen. Get me out of the water!"
Susannah saw where this was heading. Nevertheless, she tried again. "I know it must be very frightening to hear voices. Tell me what the voice or voices are saying to you." Susannah spoke softly and calmly as she encouraged him to describe his perception.
"Everyone I love and care about is going to be hurt. They've got them all and you're pretending to be them. You want to kill me so I can't find them and help them. You took my body away so I can't find me. You're making the woods too dark so I can't see. No! NO! YOU TOOK MY ARMS SO I CAN'T SWIM!" Todd's temporary calm was quickly fading. He felt the bed again. "YOU'RE LYING TO ME! I'M NOT THAT STUPID! YOU'RE LYING TO ME! YOU WANNA KILL ME! YOU TOOK THEM!"
Susannah was afraid he was beyond being talked down. "Todd, you need to take some slow deep breaths."
"I CAN'T BREATHE IN THE WATER! YOU'RE TRYING TO TRICK ME! I HATE YOU! I HATE YOU!"
Susannah gave de-escalating one more attempt. "Todd, if you can't calm down on your own we are going to have to hold you until you do."
"I WANT DOCTOR HANEN! YOU GET AWAY FROM ME!" Todd shrieked. He continued to gasp for breath. "MAKE IT STOP SPINNING. OH GOD! I'M IN A WHIRLPOOL. VIKIIII! HELP ME! MAMA! NO! DON'T DROWN ME! MAMAAAA!"
"Todd, you need to take some medication to help you calm down. Will you take it by mouth?" Susannah gave him that chance even though she knew what his reaction would be.
"NOOOO! GET AWAY! YOU'RE TRYING TO POISON ME! YOU WANT ME OUT OF THE WAY SO I WON'T TELL ANYONE YOU TOOK THE REAL DOCTOR HANEN. YOU TOOK HER AWAY FROM ME TOO. YOU TOOK SAM AND VIKI AND NOW MY DOCTOR HANEN. YOU WANT TO DROWN ME. THERE'S TOO MUCH WATER! I HATE YOU! GET AWAY! NOOOOO! YOU'RE DROWING ME. I CAN'T BREATH! I HATE YOU! I WANT DOCTOR HANEN! I WANT SAM AND VIKI! SAM HATES ME! HE HATES ME! HE SENT THE FAKE SAM HERE. YOU'RE ALL FAKES. YOU CAN'T FOOL ME! LIARS! YOU'RE ALL LIARS! MAMA! HELP ME! TAKE ME WITH YOU! MAMA! PLEASE TAKE ME WITH YOU! DON'T LEAVE ME WITH THEM. MAAAAMAAAA!" Todd tried to get off the bed once more.
Susannah quickly assigned positions. Todd's arms, legs and head were stabilized. Todd fought the hands that held him with all his might, which wasn't much due to his weakened condition.
"Hey, buddy. It's Carl. Connie, Jeff, Marcia and a nurse named Mark are here, too. Take it easy. We're gonna help you calm down and keep you safe."
"YOU'RE TRYING TO KILL ME! I KNOW THE TRUTH AND NOW YOU'RE TRYING TO KILL ME! YOU'RE GONNA DROWN ME!" Todd shrieked.
"Todd, it's Connie. You're back in your own room. You're safe. Try to relax, hon. No one is going to hurt you," Connie assured him as she held his left leg down.
"LIAR! YOU'RE TRYING TO KILL ME. HE TOLD YOU TO. YOU STOLE EVERYONE . . . SAM . . . VIKI . . . DOCTOR HANEN . . . TÉA, . . . STARR. YOU WANT ME TO BE LEFT WITH NO ONE! YOU EVEN STOLE MY BODY! I HATE YOU! I HATE YOU! LET ME GO! DON'T DROWN ME. PLEEEEASE!"
Todd was completely out of control. His screaming was causing him to become extremely short of breath. Susannah also feared he would have another seizure. She gave Janet an order for a sedative. She did not want to have to use mechanical restraints on him. Todd had no IV or hep lock in and an oral dose administered via the NG tube would take too long to take effect when he was escalating this quickly. The sedative had to be given intramuscularly as Todd was held in a side hold.
"THEY WANT YOU TO MAKE ME CRAZY SO I WON'T TELL. I KNOW. THEY CAN'T FOOL ME. I KNOW!" Todd shrieked. Then he started to whisper to himself again. "I'm gonna cut the trees down and then you'll be sorry."
Susannah wondered if his hallucinations about the woods and trees had something to do with the night he was forced to help bury Michelle. She also thought it might be related to the time he spent in the woods looking for his mother's summer home.
"LET GO OF ME!" he screamed. Todd continued to fight the hands that held him.
Whispering to Sam and Viki, Susannah informed them, "I have to give him an injection to calm him down. He's still psychotic." She knew Todd would need a stronger dose than the one she would have preferred to give him.
