College Chemistry

by David Hagerty

The first time Paula came to see me was just before midterms.  I gestured for her to sit down and grabbed a chair opposite, leaning backwards so I wouldn’t crowd her.  My dorm room was big enough for only two beds the size of army cots and two desks with wooden chairs.  It was no place to see patients, but I had to make do for now.

“So what’s your primary diagnosis?”

Paula ran her eyes over me.  When I see patients I try to dress the part -- sweater vests, cords, horn-rimmed glasses -- to look professional.  Lately, I’ve even noticed I’m getting a paunch, which is good.  I think it makes me look older. 

“You have anything to drink?” she said.

She looked into my face.  Instinctively, I looked away but reminded myself to hold eye contact next time.

“I don’t drink on the job.”

“No, I mean for me,” she said.  “I could use a drink.”

She nodded over to where a mini refrigerator sat beneath my roommate’s desk.

“There’s water in the bathroom down the hall.”

This time her eyes broke contact, looking first at the posters of Fergie and Beyonce above my roommate’s bed then the SUNY banners and molecular models above my desk.

While she checked out the room, I got to observe her.  One of the things I’ve studied is interpreting non-verbal cues: facial expressions, body language.  Mostly it’s stuff that other people just do, but for me it’s an effort.  If I don’t analyze it, I have no idea what someone else is thinking.

She had her arms folded on her chest, and her legs were crossed at the ankle, signs of inhibition.  Still, her jeans were new, her gray turtleneck was a soft merino wool, and her face was made up with lipstick, so she clearly hadn’t given up on looking good.

“I can’t help you if you won’t tell me what’s wrong,” I said.

It was a line a Pdoc used on me once to get me to talk.  I couldn’t tell, but I felt like she was avoiding my questions.

“I’m seeing a Neuropsych right now for depression, but . . .”

She ran her fingers over the buttons on the front of her sweater, which is something I catch myself doing when I’m feeling over stimulated.

“I’m also diagnosed with an eating disorder.”

“You don’t look that thin to me.”

“Really I just don’t like food that much.  And like you said, I need to lose weight anyway.”

Paula was still clutching a piece of paper with my name, Tad Fordham, and room number, 326.  We’d met a couple days earlier in the cafeteria through a guy in one of my psych classes.  She’d told me then she wasn’t happy with the Prozac her Pdoc gave her.

“How long have you been taking meds?”

“Six months, off an on.  I want to quit, since they really mess with my sleep, but whenever I do the gloom comes back.”

I nodded and tried to think how to respond.  In my therapy I’ve also learned a lot about active listening, but it’s still a study more than a habit.  Since I couldn’t think of anything else to say, I decided to stick with the basics.

“I’d prescribe Wellbutrin.  It’ll take the edge off without the insomnia.”

My Oxford shirt was starting to bind at the wrists and neck, which was throwing off my concentration.  I wanted to unbutton it but didn’t know if that would send the wrong message. 

“How do you know so much about all this?”

Paula’s eyebrows pinched together and she turned her head to the side slightly, which put her expression somewhere between disbelief and uncertainty (at least, according to the line drawings they had me study in my special day class, but real faces are more complicated than that).

“I’ve tried all of them.”

Paxil, Prozac, Aderal... before they figured out that I didn’t have ADD or depression or social anxiety, my Pdocs had me on every med in the pharmacy.  After two years they finally realized it was Asperger’s, which was why I wouldn’t talk to anyone.  A couple months on Rispersal did me more good than all the other therapies combined.  So, when a client comes to me now and asks for a prescription, I can give them the expertise that only experience gives.

“For a while they were DXing me with everything.”

This time, Paula’s eyes opened wide and she looked to the door, which I’d shut for privacy.  Her shoulders were hunched in a stress position indicating either shock or fear, though I wasn’t sure which.

“And I’m studying to be a psych.”

Her shoulders relaxed and she let her arms fall to her lap.  That’s when I noticed how large her chest was, so much that it caused her shoulders to round.  It must be uncomfortable to carry around that much weight.

She ran her fingers on the wood rails of my bed which I’d brought from home since the metal ones the school supplied were too cold to the touch.

“So, do you have the drugs here?” she said.

Her mouth turned up into a smile.  From the back of my Formica clothes closet I pulled out the fishing tackle box where I kept my medicines.  Opening it up, I found a container with a couple hundred small, pink pills.

“What have you got to trade?”

The corners of her mouth descended to a frown and her eyes narrowed.  Then, without a word, she stood and moved toward the door.  That’s the trouble working with depressives; you never know what’s going to set them off.

“Wait,” I said.  “How about any Ativan?”

She paused in the doorway and turned her upper body like a model on the runway.

“What’s that?”

“It’s for anxiety.  A lot of depressives get misdiagnosed.  They end up with a bunch of half bottles that didn’t work for them.  Do you have anything left?”

She ran a finger along the buttons of her sweater, stopping to toy with the top one.

“I can probably get a couple tabs of X.”
           
“No, I only take prescriptions.”

She stared out the windows at the red and yellow leaves on the oak trees in the quad.  Her eyes had that look of detachment that’s more definitive than any list of symptoms in the DSM-IV.   

“Okay, tell you what.  Go to the university health center and tell them you’re having trouble sleeping.  Say it’s been going on for over three months, that it’s affecting your schoolwork, and that you’ve tried cutting out caffeine and sugar.  Make sure you tell them all those things, or they’ll just blow you off.  They’re going to prescribe you some Ambien.  Bring the pills back here, and I’ll exchange them for Wellbutrin.  Got that?”

She nodded yes, but I could tell by the line down her forehead that she wasn’t convinced.

“Don’t worry, it’ll work.  I do it all the time.  As long as you sell your story.  Remember the three things you’re going to say?”

“I can’t sleep, it’s getting in the way of school, and . . . I tried changing my diet.”

“Right on.  See you in an hour.”

With that she was out the door. 

While she was gone, I had studying to do.  Three midterms coming up at the end of the week, two for my psych classes and one for biological chemistry.  People said I was crazy for taking bio-chem. voluntarily.  “Nobody takes that crap except for med students,” my roommate Rafik said, “and even they fail it.”

I took it because my psych classes are so lame.  When I first started college, I thought we’d be learning about how to treat stuff that real people have: depression, anxiety, addiction, schizophrenia.  But they don’t teach any of that to undergrads.  The only class that touches on it is Abnormal Psych which is a total misnomer.  Mental illness can’t be that abnormal when twenty-five percent of the population has it. 

Instead of therapies, the professors taught a bunch of theory about childhood development and socialization: Piaget to Pavlov.  It’s part of the standard treatment, I guess, but you’re not going to cure anybody with classical conditioning.  They want you to spend eight years in grad school getting your PhD before you learn anything useful.  I can’t wait that long. 

I don’t want to see a bunch of other people go through what I did. Five years of talk therapy, which does nothing, and another three years of restraints and behavior modification, which assumes that your parents brought you up wrong, before I got any real help.  I would have gotten into NYU if I hadn’t spent the first half of high school hiding in a bathroom stall.  Really, all that stuff is based on old, outdated theories.  It’s not our parents who make us crazy, it’s their genes. 

Anyway, nobody calls it crazy anymore.  Now it’s all about differential diagnosis.  Do you have mania with or without anxiety?  Is your distractibility accompanied by hyperactivity?  How long does your depression last?  Any suicidal thoughts?  I’ve answered these questions so many times I not only know where the doctors are going with it, I know what answers to give so they’ll make the right assumptions.  Because if you don’t educate yourself about your diagnosis, you’re at the mercy of a Pdoc to get it right.

My mind was drifting; I needed something to help me concentrate.  From the tackle box, I pulled out a Ritalin and cut it in half, putting the second part to the side in case I needed to pull an all-nighter on Jung.

I hadn’t read five pages before my roommate, Rafik, slammed open the door and flopped on his bed with a moan.  People say I’m a social retard, but Rafik had the manners of a rodent.  Because he dressed all in black and wore a pork pie hat, people thought he was rebellious and cool, but even I knew better than to make fun of my farts in public.

“Oh, man, you got anything for a hangover?”

“Try water.”
           
“What about those new pills . . . What are they called?”

“RU21?”

“Yeah, that’s it.  I don’t know how you remember the names of all that crap.”

“Study.”

He rolled over on his back and laid an arm over his eyes.

“There must be something in your box of tricks.”

“You know I only deal in head meds.”

“I know, dude, and you’re totally missing out.  If you could hook people up with a way to head off the munchies, you’d be rich before you graduate.”

A lot of people assumed that I was some kind of drug dealer.  They came in looking for meth or X or GHB and got pissy when I told them I didn’t have anything illegal.  What I was offering wasn’t an escape from reality, it was an escape from suffering.  Rafik didn’t get that distinction.

My subconscious reminded me I’m supposed to practice active listening, but I didn’t feel like it.  Instead I tried to ignore him and went back to studying.

“Hey, why the geek clothes?  Did that girl from the cafeteria ever come by?”

I looked up again to see Rafik propped up on one elbow staring at me.  

“Which one?”

“The one with the Double Ds.”

He sat up and pulled out his T-shirt to Barbie proportions.  I assumed he was mocking Paula.

“We talked.”

Rafik and I had come to a truce over the two months we’d been stuck living together.  I gave him a supply of Percodan, and he let me run my business unmolested.  Part of that was not asking me about patients, an agreement he tended to forget.

“You going to hit that?”

I shook my head no.  On campus there were several other prescribers who’d trade drugs for sex.  I couldn’t do that without feeling like a snake oil salesman. 

“Somebody better get there before she puts on the freshman fifteen.”

I caught myself rocking in my chair and took a breath to stop.

“If you can’t show respect to my patients, can you at least show a little to me?”

He fell onto his back and held up his hands in a defensive posture. 

“Okay, I didn’t think you’d put a flag in her already.”

“She’s going to be back here soon, and I don’t want her thinking we’re planning to gang rape her.”

Rafik stood up, put on his sunglasses and hat, and moved to the door.  He paused with one leg out.

“I’m not saying we should run a train,” he said, “just a double team.”

*

Paula returned an hour later with the pill bottle clutched in her fist. 

“Great, I’ll give you a month’s supply of Wellbutrin.  If you like it, we’ll work out an exchange system for Ambien.”

Her sweater was different than before, a red cardigan she’d unbuttoned to her sternum.  She smelled of lilac and hair spray, which irritated my nose and eyes, making me sneeze.

“How do you know how much to take?”

From her raised eyebrows, I assumed that the question was admiration rather than skepticism.

“Online.  All the drug companies put dosages on their web sites.  Usually, there’s more there than on the crib sheets they give to doctors.”

I handed her 50 pills in a black film canister - which I use because they’re cheap and disguise what’s inside - took the prescription bottle and stashed it in my tackle box.

“You should take one of these in the morning.  Try that for a couple weeks.  If it’s not enough take another one at night.”

She walked past me and sat down on my bed, wrinkling the sheets.  So that we’d be at eye level, I sat at my desk.  It was tough looking her in the face though, so I pretended to straighten my tackle box.

“What about side effects?  Is this going to make me . . .”

She didn’t finish the thought, leaving me to guess which of the common ones she was concerned about.  Loss of sex drive comes with a lot of these drugs.  That’s usually what worries people most.  To doctors impotence may seem like a minor side-effect, but for patients it’s worse than vomiting or diarrhea.

“You mean, will it inhibit your libido?”

She rolled her eyes like my question was too stupid for a response.

“Will it make me fat?  I gained twenty pounds in a month on Zyprexa.”

Judging by her hips, she hadn’t taken the drug in awhile.  Then I thought about Rafik’s plot and pushed the idea from my mind.

“You don’t need to worry about that.”

She smiled and blushed. 

Through the open window, I heard the Hammond organ of reggae music drift in with the sweet smell of marijuana, opiate for the masses.

Turn your lights down low
And pull your window curtains

The music was putting me dangerously close to overstimulation, so much that I lost what Paula was saying.  By the time I had caught myself tapping with the beat, she had stood and moved to the door.

“Should I, like, come back and see you in a couple weeks?”

Was she asking because I was acting as her Pdoc, or because she liked me?  It was awkward -- I’m only comfortable around people if we’re talking professionally -- but she seemed needy.

“Anytime you want.  I’m always on call.”

*

If you’ve ever seen the TV commercials for anti-depressants, you’d never know them from allergy drugs.  There’s always people running in slow motion through fields of sunflowers or lavender.  The colors are so pumped up they look more like acid trips than the true effects you can expect from head meds. 

It’s not what they do for you so much as what they take away.  For me, they let me walk down a crowded street without shivering or eat dinner without getting hung up on the texture of the mashed potatoes.  When they work, I get to feel mostly normal.  Even at their best, though, they’re like waiting for a sprain to heal.  You don’t really notice much improvement until one day you wake up and realize it doesn’t hurt anymore.

So when Paula showed up at my room again late that night, I knew something was wrong.  She woke me up with a heavy knock and was leaned against the doorway when I answered.  She had changed into school sweats and her hair was tied up in a ponytail, which I took as signs that she wasn’t planning the visit. 

“I’ve been feeling really dizzy,” she said. 

I motioned her over to my bed to sit down.  Rafik didn’t move from under his covers, so I assumed he was asleep.  Her forehead was sweaty, and her pulse was pounding at a 100 beats per minute.  Touching her skin felt awkward, and I quickly moved across the room to my desk chair.

“Lie down.”

Sitting, I felt the cool air though my silk pajamas, the only kind that didn’t bother my skin.

“Is this normal?” Paula said.

“No, but let me do some checking.”

I fired up the computer and scanned the websites for uncommon side-effects.

“You’re not pregnant, are you?”

“God, I hope not.”

“What about diabetes or high blood pressure?”

I was reading as fast as I could when I heard a thud.  She was on the floor, arms and legs flailing around hitting the walls and bedposts.  I grabbed her chin so she wouldn’t bite her tongue, then held on as she bucked for probably 30 seconds, her jaw clenched and eyes rolling back into their sockets.

“Bro, I was just kidding about the double team.”

Rafik was sitting up in bed staring at me.

“Help!” I said.

He sat on her legs until the convulsions finally stopped.  That’s when I noticed her silver medical bracelet.  It read “epileptic, takes Dilantin.”

“She never told me she got seizures.”

“You didn’t look?”  Rafik’s jaw hung open in disgust, as though any street corner pill pusher would have known better.

“She had on a long-sleeve sweater.  It must have covered the bracelet.”

“Don’t you have them . . . fill out a form or anything?”

“You want me keeping a record of your prescriptions?”

As she came to, Paula’s eyes were glazed.

“Don’t,” she said.

When we let go of her wrists and ankles, Paula rolled over to face the wall.

“Guess she’s sleeping with you tonight, bro,” Rafik said.

My eyes ran over the curve of her hip and the swell of her breasts, but in the next moment I felt my anxieties coming on.  I’d never been able to sleep in the same bed with another person.  The heat and slickness of her skin would keep me awake all night.  Even poly sheets do it to me.

“We need to get her back to her room.”

I looked down at her for some reaction, but it was slow in coming.

“Don’t tell,” Paula said.

I didn’t know what she was talking about and couldn’t see her face to decipher the expression.

“Where’s she live?” Rafik said.

“Somewhere on the fifth floor.”

“So we’re going to drag a convulsing girl up two flights of stairs?  Why don’t you just let her stay the night here?  Afraid of ruining your virginal reputation?”

That was a low blow, and Rafik knew it, because I’d told him just a week before about my sensitivities.  Ever since he’d been clowning about my inexperience.

“What if she has another seizure?” I said.  “You really want to bring the school nurse up here and have her start asking questions about where Paula got the meds?”

“You think she’d flip on you like that?”

“How should I know, this never happened before.”

We both stared at Paula, but she was inscrutable.

“I don’t think she can walk.  You get her left side, and we’ll carry her there.”

Which is what we did.  The stairs were tricky; she weighed more than I would have guessed (probably the remnants of the Zyprexa).  Even with only half her weight, I was feeling totally smothered by the time we reached the fifth floor.  In the hallway, Lysol failed to mask cigarette smoke.  The backbeat of hip hop filtered from a closed door at one end, but otherwise the corridor was shut up.

“Which room is hers?” Rafik said.

Every floor of the dorms had about fifty rooms but no name tags.

“Look at the pictures.”

We scanned all the doors with photos, dozens of them, all of bleached-out faces smiling drunkenly into a flash.

“This her?” Rafik said.

I scanned a mug shot on room 543 but the hair seemed too blond.

“Why don’t we just leave her in the hall.  Somebody’s bound to know which one’s hers.”

“I can’t leave her.  I’m her doctor.”

“That’s why we’re trying to dump her before another seizure?”

Even I got the sarcasm in his comment but decided to ignore it.  Instead, I kept looking at photos, but none was decisive, especially in the dim light of the hallway fluorescents whose flickering was all I could stand. 

“I know, check her pockets,” Rafik said.

I glanced at her sweats and patted the hips.  I didn’t want to start digging around and scare her.

“Paula,” I said.  “Paula, we need your help.” 

Her head lolled toward me and her eyes seemed to focus on my face.

“Don’t tell my dad,” she said. 

“Typical girl, always worried about her reputation,” Rafik said.

Rafik was going to be no help; I needed to solve this on my own. 

While I thought through our options, Paula suddenly went stiff and smacked me in the mouth.  Instinctively, I let go of her.  She hit the thin carpet like a duffel bag, then started kicking the walls full-throttle.  Rafik and I were on her, pressing her arms to the ground but not quickly enough.  Three doors opened with girls in tank tops and boxers staring at us.

“What are you doing?” said one girl with pigtails and a Mighty Mouse T-shirt.

“She’s having a seizure.  I don’t want her hurting herself.”

“You’re too late,” the girl said.

I looked down at Paula and saw a trickle of blood on her throat, probably dripped from my split lip.

“I’m calling campus security.”

“No, wait,” I said.  I looked in her face, which was lined and red from being pressed to a pillow, and tried not to glance away.  “I lied.  Really she’s drunk.  And underage.  If you call anyone, they’ll bust her.  Give it a minute and . . .”         

The door slammed before I could make up anything better.

*

“Do you know if she takes any medication?” the police officer said.

The cop wasn’t much older than me with a buzz cut and pimples.  I looked back at Paula, who had an IV drip in one arm and two paramedics hovering over her.  She was awake at least -- her last seizure ended a couple minutes before the ambulance showed up -- but she hadn’t moved yet.

The cop stared at me without blinking, his pen hovering over the pad.  I didn’t want to get into all kinds of explanations, since it would inevitably go over his head.

“Maybe she’s drunk?”

The cop shook his head slowly left to right but never took his eyes off mine.

“No, I’ve seen a lot of drunks before and she,” he pointed the pen over his shoulder at Paula, “doesn’t look drunk.”

All the other people there -- Rafik, the girls standing in doorways, the dorm mother in a flannel nightgown -- were staring at me waiting for a response.  Plus the lights flickering overhead were practically strobing off the walls of the narrow corridor.  I felt myself start to rock.  Trying to control it was taking so much effort, I couldn’t think what to say.

“What about these?” the female paramedic said.

She popped open the film canister I gave Paula and dumped a pill into her palm.

“Wellbutrin,” she said.  “Three hundred milligrams.  Probably what caused the seizures. There’s something else, too.”

She removed a scrap of paper from inside the plastic, unfolded it, and read my name and dorm room number.  Paula must have stuffed it inside the bottle as a memory aid.

“Shouldn’t you call her parents?” I said.

The cop put away his notepad and looked first at me, then Rafik.

“Let me see your room.”

*

Three weeks later, Paula was still recovering.  At the hospital, they pumped her stomach, gave her some Dilantin, and diagnosed her with a concussion.  The doctors said it was lucky we hadn’t dumped her.  Another seizure could have killed her.  Rafik and I weren’t so lucky.

When the police searched our room and found my tackle box, Rafik was quick to tell them about my business.  Of course, he left out the bit about his own medications.  The only punishment he got was being kicked out of campus housing.

The police wanted to bust me for dealing, but the provost decided it would cause bad publicity, so he just kicked me out of school.  It saved them and me a long legal fight.  My dad wasn’t willing to let it go, though.  Driving me home, he kept shouting about how I could be “precocious” enough to play doctor.  “Is this what you got out of all those years of therapy?” he said.  I assumed what he meant was why had I misdiagnosed her.  I spared him the details and promised that I’d enroll somewhere else in the spring.

Which is true.  I’m not letting something like this kill my career.  I’m still going to be a Pdoc.  Luckily, I won’t have any criminal record to get in the way, and I learned some valuable lessons.  Like always take a complete medical history before you prescribe, and don’t believe everything the drug company’s website tells you.