Page 4 of The Last Session

I stayed in the conference room a minute longer, breathing in the stillness before opening the door. Thudding music and piercing basic cable news blasted from the nearby TV room. Halfway down the hall, a patient shouted at full volume, but as I approached he went back to muttering. Several other patients paced the hall, two of them silent, one laughing to himself. While the art therapy patients were pretty lucid, many others—because of medications or difficult diagnoses—were not.

At Diane’s office I knocked, pausing in the open doorway. She motioned me in, setting down her phone. A Black woman in her fifties, Diane was consistently poised, her raspberry lipstick always perfectly in place. Her ability to stay regulated sometimes amazed me.

“Thea. You have time for a new patient?” She watched me expectantly.

I cleared my throat. “Yes, of course.”

“Good. I have a new admission; she just came from observation.” Diane handed me a folder. “Jane Doe. Found wandering the Brooklyn–Queens Expressway three days ago; police brought her to CPEP for eval. No drugs or alcohol in her system. But really no other info.”

“What did she say?”

“Nothing.” Diane paused. “She’s mute.”

“Selectively?”

“We don’t know. But so far, she hasn’t said a word.” Diane smoothed her braids, which were twisted into a low bun. “That might change; we’ll see. She’s a 9.39 for now; we set her up in Block D. One milligram of Ativan TID. I want you to keep an eye on her.”

9.39 meant that we could involuntarily hold Jane Doe for up to fifteen days. Diane often asked us to watch out for the younger female patients, though for the most part they were able to hold their own against any SAO (sexually acting out) by other patients.

“Of course,” I said crisply. I often felt like I had to prove myself toDiane, though I suspected that tendency came more from my own insecurities than her expectations.

“Bring some paper.” Diane shrugged. “Maybe she’ll write something down for us.”

I glanced through the intake form and psychiatric evaluation notes as I headed to Block D, one of the female-only rooms. The notes were carefully handwritten and more descriptive than usual.

White female

Age unknown (20s/30s?)

No drugs/alc in system according to tox report

Arrived wearing new clothes—sweatshirt still had Target tag

Fingers scraped and scabbed—one fingernail half torn off

Scratches and bruises along arms + legs

PT refuses to make eye contact or speak

PT can do basic functions (eat, urinate) when prompted

Working diagnosis: Psychosis Not Otherwise Specified

Differential diagnosis/Rule out: substances not showing up in tox report, organic etiologies, schizophrenia vs bipolar/MDD with psychotic features, acute stress disorder

The back of my neck prickled. The unit was always full of a variety of patients cycling in and out, but the root causes of their issues were normally pretty straightforward: untreated disorders, lack of housing and resources, drug use, often connected and exacerbated by a societal lack of support.

This case seemed less obvious. What had happened to this woman?

Lonnie stood motionless in the entrance to Block D, hands pressed to the sides of the doorway.

“Lonnie. You know you’re not allowed here.”

He turned slowly, then smiled. “Hello, Thea.”

“Time to go.” I tried to say the words with authority, like Diane would. But he just watched me, eyes narrowed. “I’m serious.”

“I know her.” He nodded with his chin. “I think we dated.”

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