Under Her Care(13)
“Ah, shoot, I was hoping you’d be able to do it this morning. Any chance you could move things around?” he asks in a pleading, sweet voice. A dramatic difference from after I insulted him about the investigation last night.
“I’ll see what I can do, but I have to go,” I say and end the call as Harper’s sounds beckon me to the kitchen.
I’m having to reschedule clients left and right, but I guess that’s what happens when you’re part of a murder investigation. I’m still trying to wrap my brain around what Detective Layne told me last night. Annabelle was brutally murdered, and if Mason didn’t do it, then someone else did. That’s why Detective Layne is pushing so hard for it to be Mason to the exclusion of everyone else. If Mason killed Annabelle, then it was likely an accident or he didn’t realize what he was doing, which isn’t any less tragic, but it is less scary. If he’s the guilty party, then there’s no monster lurking in the woods waiting to attack their next victim. I understand his reasoning, but what if he’s wrong?
The PDF from Detective Layne takes forever to load on my computer screen. I waited to open it until after I dropped Harper at school so that I could give the report my undivided attention. I watch as the screen finally fills. There are hundreds of pages from multiple reports. Mason’s had numerous evaluations from psychologists, doctors, and specialists over the years. I dive in immediately.
He’s had all the gold-standard tests—Autism Diagnostic Observation Schedule, Childhood Autism Rating Scale, and the DDD interview—and received the matching autism spectrum diagnosis to go along with them. He has the usual deficits in social communication and social interaction, as well as restricted interests. His interests center around trains and listing the United States in alphabetical order. He’s also obsessed with the color red. He doesn’t recognize people’s emotions or facial expressions and has unusual or no reaction to social cues.
He has a hard time coping when he’s upset and reacts by biting his forearm, smacking his forehead, or slapping his thighs, which he did numerous times throughout his testing sessions. These descriptions remind me of Harper and how she reacts to stressful emotions by pinching herself or anyone else who dares get near her when she’s that upset. The first time she was evaluated, she pinched the evaluator so hard she left bruises, and staff had to come pry her off him. He refused to test her again.
Mason is a lot like Harper in other ways too. They both have hypermobility issues, so they share the awkward gait and problems with large-muscle control. Her issues are much more pronounced than his, though, and he doesn’t have the insensitivity to pain that she does. Physical therapy was recommended because of it, but it doesn’t look like he receives those services. That’s weird. Why wouldn’t Genevieve hire the best for him? I would for Harper if I could, but some of those specialized aides charge hundreds of dollars per hour. We get by on the PT covered by my insurance.
Unlike Harper, Mason has significant intellectual impairment. My heart aches for Genevieve for the additional challenge on top of an already difficult diagnosis. Mason has an IQ of 38 on most of his assessments and a mental age of around four in most things. All three of his functional skills are way below average, daily living skills being the lowest. He can’t do much by himself.
None of this is as unexpected or alarming as his multiple psychiatric hospitalizations. From what I can tell, he’s been locked in the inpatient psychiatric unit at White Memorial twice, but I only have one or two pieces of the progress notes from the hospitalizations. The rest of the reports are missing. There’s a single sheet that has to be from a psychiatric report there because of the letterhead of the hospital at the top and then the following:
PURPOSE OF CONSULTATION (include diagnosis at time of admit): psychosis
12 yo h/o seizures brought in by mother. Numbness on L side. Lower quadrant. Labile mood. Inappropriate affect. Agitated. Pt given Ativan prior ER. Mother administered. 3 34 qt/1
A history of seizures? There’s no mention of seizures anywhere else in the reports. Did I miss it? I wouldn’t have overlooked something that important. I quickly scroll through the earlier reports just to make sure, but it’s not there. That’s a really important piece of medical history to be missing. Why is it missing?
One of the doctors from what I’m assuming is the same hospitalization goes on to paint a very disturbing picture at the bottom of the page:
Patient irritable, easily distracted, and intrusive. Speech is rapid and pressured. Psychotic or borderline psychotic symptoms present. Bizarre behavior has been observed. Inappropriate smiling/laughing. Patient oppositional toward hospital staff. History of multiple depressive episodes.
And then it just cuts off. There’s nothing else. Only the few snippets. Are they even his?
Someone also wrote psychosis in the chart, and it wasn’t the same person as the one who signed the note, because the initials are different. What does that mean? It’d be easier to write off as an outlier and excuse as someone else’s chart that accidentally got mixed in with Mason’s if there weren’t more pieces like it.
Others look like scribed video notes from a hospitalization at Children’s of Alabama.
Monitor 6 Video: ECT 21794, 6:00 a.m., 4 minutes
Patient stable after administration. Patient in position. Guardrails highest level. Patient unoriented to time and space. Citalopram 20 mg once daily and sodium valproate 200 mg two times a day.