Differential Diagnosis
Posted: Thu Oct 25, 2018 10:58 pm
((CONTENT WARNING: Mental Illness))
((Caroline Ford continued from Least of All Young Caroline))
She was curled up in a comfortable maroon armchair. On one arm of it sat a box of tissues, unused. On the other, Caroline’s trembling left hand.
They were reaching the end of their session. She felt like she was only just beginning to understand how bad things really were. Her eyes darted to the art on the walls. The office was part of her therapist’s home, out of which he ran his practice. Abstract paintings in soft colours hung on several of the walls, no doubt intended to be comforting. They only seemed to overstimulate her tired eyes.
Sat across from her was a thin man in his early fifties, clad in a worn-looking corduroy jacket, rumpled green shirt and faded jeans. He had the persistent just-barely-a-beard facial hair of a man who doesn’t shave terribly often, and the intense glare of someone whose intellectual faculties far outstripped most of the people he met. His thinning grey-brown hair was combed back, though it always looked like he’d done so in something of a hurry.
George Bernard Paulson, Psy.D, PhD. Specialist in Abnormal Psychology. Over fifteen years of clinical practice under his belt. He had tenure at the University of Tennessee, and was apparently selective with his patients. For a family friend, he made something of an exception; Caroline’s mother knew him from her book club, which had been meeting regularly for many years. His friends called him Geordie. Caroline always called him Dr. Paulson. He was intimidating at first, but after the first session she found his presence quite comforting. It was good to hear from someone who at least seemed to know what they were talking about. Who might know what was going on with her. It was hard to imagine he didn’t have at least some idea. She certainly didn’t understand it.
She had been talking for what seemed like hours, starting and stopping as different facets of what she’d been experiencing came to the surface. She went into detail in some cases, left out others entirely, but she did not lie. It was important not to lie to him, because he was the only one who could help. He had to know what she had gone through.
Dr. Paulson had spent most of the past hour listening silently and writing into a patient ledger. Caroline continued her stumbling, monotone outburst, though at this point she felt that she was only repeating things that she had already said in so many words.
“Every day I have these thoughts that come to me. Horrible things. It’s like they’re not even mine. Things I wouldn’t even like, think. It just doesn’t stop and I can’t even remember what it was like to not be like this. It’s like I just found out something and I can’t forget it, even though I want to. Is this just how I think now? Not like I think that way, what I think isn’t the things that I’m a believer in; I don’t say the things that I really think. I mean, my head isn’t saying the things I think, they’re different things.”
Caroline’s eyes darted around the room. Dr. Paulson waited, patiently, though she could see the gears turning in his mind. He had been helpful so far. Maybe he had an answer that wasn’t the one she had come to. Her answer was much worse.
“Come unto me, all ye that labour and are heavy laden, and I will give you rest. I don’t feel very close to God right now. Maybe I just need to leave here. Maybe I’m not meant to stay up here. In my head. It’s wrong, and I know it isn’t something I should be thinking about. Maybe it’s just those intrusive thoughts again. But if I… like if I died, maybe that would be better than this? What even is this, this thing that‘s… hounding me?”
Dr. Paulson put up a hand, motioning for her to stop. He spoke with a distinctive and broad Midwestern accent, which gave him a strange levity to his voice, even when he was completely serious.
“Look, Caroline. This all seems very intractable. Experience tells me it isn’t. But there isn’t anything I or anyone else can say that is going to cause any sort of fundamental shift in perspective right now, it’s not quick.”
He scratched the end of his nose and ran his hand across his face, almost as if he was just realizing he needed to shave. It was a tick, one he expressed whenever he had a salient thought that was still forming as he said it.
“Look, there are a lot of things that can cause depression, and we don’t necessarily know exactly what they all are. We know some of them, but it’s never a sure thing. You’ve spoken about how have a difficult time explaining the distance you’ve put between yourself and your peers. In many respects you are correct in thinking it’s impossible to try and explain it – like, it’s hard for people who aren’t in this position to imagine what you’re going through, just as really bloody difficult right now for you to imagine being out of it.”
He reached to the small table next to him, setting aside his ledger, and taking a drink from a coffee mug before continuing.
“It’s a product of your biochemistry, of how your mind is developing. Just because everywhere you look is catastrophe, that there’s no way out of it, that you have no hope – does not make it so. You cannot necessarily trust your instincts right now, in fact I’d say you more often than not have to fight against them, tooth and nail. It’s very difficult for a lot of people to admit that they cannot necessarily trust in their firsthand perception of reality. Really, quite difficult.”
Caroline sat forward, locking eyes with Dr. Paulson. If she didn't, his words would slip past her and she would get lost in her own head. All of her strength was poured into trying to find a line, anything she could hang onto, in what he would say.
“So I would first say that you need to remember that you aren’t alone in living with this, and there are those who I would say lack the internal fortitude that you possess, who have lived through it. Yes, there are people for whom I have seen it to be nearly impossible to help, you’re not wrong to think of this as an almost intractable problem.”
Dr. Paulson seemed to hang on that last point. His eyes drifted as he seemed to recall something that troubled him. He suddenly held up a finger, counting off a list of issues – clearly those he had seen or experienced personally, though described in a distinctly clinical tone.
“…but usually these people have no job, no friends, no intimate relationships, some kind of health problem, or a drug problem. It’s hard for them to dig themselves out because they might make progress on one front - and the other drags them back into the ‘pit’ like you’ve described. They’re so buried in what’s happening to them that they can’t even deal with the mundane, everyday aspects of their life.”
“…Things just pile up.” Caroline interrupted, trying to contribute to what he was saying. She wanted him to think she was listening. Even though she felt like the emotional equivalent of a dead lightbulb, she knew what he said had merit and didn't want to appear disinterested or ungrateful. Trying to signal emotions felt like being in a play where everyone except Caroline had the script.
“Exactly. You could ask them about a routine, and there’s just, there’s nothing. It’s not always the people you’d expect either –it could be someone who just finished their Ph.D and is just stuck in the mud without an objective or palpable direction and it’s this absolutely crushing, intimidating experience. It could be someone in a high-stress job who just has one bad day and can’t come back from it. Y’know, they just find themselves lost and stop actually living their lives, and it just spirals out of control. Even if they saw the real problem, it’s like everything’s just such a mess they wouldn’t even know where to start. It takes years – if at all.”
A moment of realization struck Caroline. Could he really know what this was like. Had he been there?
“-but that isn’t you. You’re not stuck on pride or ignorance. You took the big steps early. You know you have an affliction, and you’re doing what you need to do to get better. Just like anything else.”
Dr. Paulson paused, his gaze scrolling from one of the paintings to the other, then back to Caroline. She wondered what it was that they did for him, if they confused and disoriented her so much.
“You’ve got a lot going for you. You’ve got clear goals, you are a person who enjoys and embraces routine, and you’re looking after your physical health quite well. Your faith is an important structure in your life and everything I’ve seen tells me that your community has been a major pillar of support for you. In a way we’ve eliminated a lot of possibilities as to the genesis of what you’re going through right now.”
She cocked her head. He knew what it wasn’t – what use was that?!
“That’s part of what we’d call differential diagnosis – eliminating possibilities until we find the most likely cause. I suspect that this is predominantly a problem of chemical imbalance, perhaps with some relationship to an autoimmune disorder. Even at this early stage, the work that you’re putting into keeping your head above water is quite frankly impressive, given what you’ve told me. You’re coming to see me, you’re still keeping up with your studies, you’ve started on medication-"
With a sudden jerking motion, Caroline rose from the armchair, her fists clenched and her voice raised. It was theatrical, almost deliberately so.
“The pills don’t work! I can’t pat myself on the back for taking steps to get better, if it isn’t making me feel better! Or feel anything at all! I hate this, this gray world. What happened to the old one? I miss the old colourful world. I don’t want to just try and watch nothing change, or just keep my head above water, I want out!”
If she had actually felt angry, her voice would be trembling. She cried whenever she got really angry. There were no tears though, and she spoke clearly and deliberately. She raised it because she wanted to be angry. Faking it didn’t work. Dr. Paulson calmly continued, and Caroline slowly slid back into the armchair. Things didn’t feel any different standing up, so there wasn’t much point in making a scene.
“Caroline, I understand that you’re frustrated. It is frustrating that we can’t figure out the exact combination of medical treatment and therapy right off the bat. I’d gladly take the pay cut if it meant I could hand every patient a panacea on their way in but it doesn’t work that way.”
“Dr. Paulson, I want to die. Do you understand that? I don’t feel anything anymore, and this makes me want to die.”
Do it! Charlatan. Con man. Kill yourself, he doesn’t deserve your money.
“The place you’re in still has possibilities, and the opportunity to change, as awful as it feels. Suicide limits your options, arbitrarily so. We can’t work on you when you’re dead. We can’t exhaust every available option. You can’t throw out those possibilities before you’ve given them a chance. There are technical reasons why antidepressants work. It takes time.”
“Do I even have time? Do you think I can keep the negative thoughts away? They don’t stop.”
“You’re already ahead of the curve. I’ve had patients that it’s taken two years just to get them to even try an antidepressant. You’ve already started. It’s just one month. One month, and we’ll know.”
It may as well be a hundred years, Caroline thought.
“We might find out in a month or two and we’ll know this isn’t working out. Or it may help a bit, but not as much as we wanted. Then we try something else. We can’t be under any illusion this is the fix, but it’s a necessary step. It’s the best shot we have at getting you to a better place. All you have to do is hang on. Fake it until you make it, because one key element is that you have to convince your subconscious that everything is okay, because that’s the part of the body that actually induces the kind of response that creates these negative thought patterns in the first place. It has more to do with what’s going on under the surface than it does with your conscious intentions.”
“I’m… barely able to get up in the morning. How much do you think I can do?”
“Obviously there’s a lot of negotiating with yourself as to what you’re willing to do and what might be too much. You can fulfill your least objectionable responsibilities such that you can go to sleep at night, at the right time. Just check off the boxes, do something and make it to the other side. Find a reason – pride, spite, faith, whatever motivation you can get even the slightest purchase on. Remember to count your victories, however small. That’s the trick.”
“Just get through the days until the drugs can start to kick in. Then I can get out of here?”
“Out of therapy?’”
“Out of this gray world, like I said. The place where nothing feels real, where God feels far away and nothing seems to matter. You know, where I live.”
“…Yes, I suppose that’s one way to put it. The symptoms you’re describing – derealisation, that can abate with the right combination of therapeutic strategies and medication. It’s not an uncommon experience in those who deal with severe depression, though some report it as an initial side effect of antidepressants themselves. Again, that’s something we’ll have to wait and see for, probably in a week or two. At this point, two sessions in I still want to see if we can really get a handle on the full scope of this before we pursue any one angle of treatment in particular. Have you been keeping the thought diary, like we spoke of before?”
The dizzying tempest of words that Dr. Paulson spewed forth never felt especially warm. For someone like Caroline, the scholarly way he approached her problems was easy to understand. It wasn’t comforting, but it was helpful. A few things he’d said stuck in her mind from the last session, and she spoke them like mantras when things got really bad. In many ways it was more helpful than the pitying affection she got from friends and family. Their looks of concern felt like pressure from all sides.
Dozens of voices that just wouldn’t shut up and actually do something useful.
Dr. Paulson was a man of science, and a man of faith. He saw a problem he knew was solvable and he believed she could solve it. He was an expert, and if he knew what she knew, he’d understand how to solve her problem. The only problem was finding a way to tell him. She produced a wrinkled dollar-store notepad from her bag, and handed it to Dr. Paulson. He looked reticent, not reaching out to take it right away.
“You know, I don’t need to read it. It’s enough that you keep-“
“Please, read it. I finished this one anyways, it was cheap, you can give it back to me next time. Just let me know what you think. If you know more, then you’ll be able to help, right? It’s sometimes hard to say things out loud. I’ve got a second one I’m writing in now.”
Dr. Paulson reluctantly took the journal, and set it on the table beside him without opening it. Feeling a tingling restlessness, Caroline grabbed her bag and stood up, heading for the door. They were already ten minutes over. Someone was probably watching them, checking the time. Someone was watching them.
“Alright. I’ll see you next week? You have my number if you need to talk to me. If the ideation-“
“911. I know.”
“I see you, Caroline. I see you.”
Caroline turned to look at Dr. Paulson as she left, and her eyes widened. She blinked, and looked away from the tall, rapidly trembling figure looming behind Dr. Paulson.
“I’m sorry, what did you say?”
“I said I’ll see you next week ,Caroline.”
“Oh. Right.”
She reached out to shake his hand, and he took it with a firm but gentle shake. He always looked like he hadn’t slept much, himself. Paying little mind to the ever-widening, toothy mouth of the maroon silhouette that stood behind him, she turned on her heel and walked out the door, nearly slamming it shut on her way out.
((Caroline Ford continued from Least of All Young Caroline))
She was curled up in a comfortable maroon armchair. On one arm of it sat a box of tissues, unused. On the other, Caroline’s trembling left hand.
They were reaching the end of their session. She felt like she was only just beginning to understand how bad things really were. Her eyes darted to the art on the walls. The office was part of her therapist’s home, out of which he ran his practice. Abstract paintings in soft colours hung on several of the walls, no doubt intended to be comforting. They only seemed to overstimulate her tired eyes.
Sat across from her was a thin man in his early fifties, clad in a worn-looking corduroy jacket, rumpled green shirt and faded jeans. He had the persistent just-barely-a-beard facial hair of a man who doesn’t shave terribly often, and the intense glare of someone whose intellectual faculties far outstripped most of the people he met. His thinning grey-brown hair was combed back, though it always looked like he’d done so in something of a hurry.
George Bernard Paulson, Psy.D, PhD. Specialist in Abnormal Psychology. Over fifteen years of clinical practice under his belt. He had tenure at the University of Tennessee, and was apparently selective with his patients. For a family friend, he made something of an exception; Caroline’s mother knew him from her book club, which had been meeting regularly for many years. His friends called him Geordie. Caroline always called him Dr. Paulson. He was intimidating at first, but after the first session she found his presence quite comforting. It was good to hear from someone who at least seemed to know what they were talking about. Who might know what was going on with her. It was hard to imagine he didn’t have at least some idea. She certainly didn’t understand it.
She had been talking for what seemed like hours, starting and stopping as different facets of what she’d been experiencing came to the surface. She went into detail in some cases, left out others entirely, but she did not lie. It was important not to lie to him, because he was the only one who could help. He had to know what she had gone through.
Dr. Paulson had spent most of the past hour listening silently and writing into a patient ledger. Caroline continued her stumbling, monotone outburst, though at this point she felt that she was only repeating things that she had already said in so many words.
“Every day I have these thoughts that come to me. Horrible things. It’s like they’re not even mine. Things I wouldn’t even like, think. It just doesn’t stop and I can’t even remember what it was like to not be like this. It’s like I just found out something and I can’t forget it, even though I want to. Is this just how I think now? Not like I think that way, what I think isn’t the things that I’m a believer in; I don’t say the things that I really think. I mean, my head isn’t saying the things I think, they’re different things.”
Caroline’s eyes darted around the room. Dr. Paulson waited, patiently, though she could see the gears turning in his mind. He had been helpful so far. Maybe he had an answer that wasn’t the one she had come to. Her answer was much worse.
“Come unto me, all ye that labour and are heavy laden, and I will give you rest. I don’t feel very close to God right now. Maybe I just need to leave here. Maybe I’m not meant to stay up here. In my head. It’s wrong, and I know it isn’t something I should be thinking about. Maybe it’s just those intrusive thoughts again. But if I… like if I died, maybe that would be better than this? What even is this, this thing that‘s… hounding me?”
Dr. Paulson put up a hand, motioning for her to stop. He spoke with a distinctive and broad Midwestern accent, which gave him a strange levity to his voice, even when he was completely serious.
“Look, Caroline. This all seems very intractable. Experience tells me it isn’t. But there isn’t anything I or anyone else can say that is going to cause any sort of fundamental shift in perspective right now, it’s not quick.”
He scratched the end of his nose and ran his hand across his face, almost as if he was just realizing he needed to shave. It was a tick, one he expressed whenever he had a salient thought that was still forming as he said it.
“Look, there are a lot of things that can cause depression, and we don’t necessarily know exactly what they all are. We know some of them, but it’s never a sure thing. You’ve spoken about how have a difficult time explaining the distance you’ve put between yourself and your peers. In many respects you are correct in thinking it’s impossible to try and explain it – like, it’s hard for people who aren’t in this position to imagine what you’re going through, just as really bloody difficult right now for you to imagine being out of it.”
He reached to the small table next to him, setting aside his ledger, and taking a drink from a coffee mug before continuing.
“It’s a product of your biochemistry, of how your mind is developing. Just because everywhere you look is catastrophe, that there’s no way out of it, that you have no hope – does not make it so. You cannot necessarily trust your instincts right now, in fact I’d say you more often than not have to fight against them, tooth and nail. It’s very difficult for a lot of people to admit that they cannot necessarily trust in their firsthand perception of reality. Really, quite difficult.”
Caroline sat forward, locking eyes with Dr. Paulson. If she didn't, his words would slip past her and she would get lost in her own head. All of her strength was poured into trying to find a line, anything she could hang onto, in what he would say.
“So I would first say that you need to remember that you aren’t alone in living with this, and there are those who I would say lack the internal fortitude that you possess, who have lived through it. Yes, there are people for whom I have seen it to be nearly impossible to help, you’re not wrong to think of this as an almost intractable problem.”
Dr. Paulson seemed to hang on that last point. His eyes drifted as he seemed to recall something that troubled him. He suddenly held up a finger, counting off a list of issues – clearly those he had seen or experienced personally, though described in a distinctly clinical tone.
“…but usually these people have no job, no friends, no intimate relationships, some kind of health problem, or a drug problem. It’s hard for them to dig themselves out because they might make progress on one front - and the other drags them back into the ‘pit’ like you’ve described. They’re so buried in what’s happening to them that they can’t even deal with the mundane, everyday aspects of their life.”
“…Things just pile up.” Caroline interrupted, trying to contribute to what he was saying. She wanted him to think she was listening. Even though she felt like the emotional equivalent of a dead lightbulb, she knew what he said had merit and didn't want to appear disinterested or ungrateful. Trying to signal emotions felt like being in a play where everyone except Caroline had the script.
“Exactly. You could ask them about a routine, and there’s just, there’s nothing. It’s not always the people you’d expect either –it could be someone who just finished their Ph.D and is just stuck in the mud without an objective or palpable direction and it’s this absolutely crushing, intimidating experience. It could be someone in a high-stress job who just has one bad day and can’t come back from it. Y’know, they just find themselves lost and stop actually living their lives, and it just spirals out of control. Even if they saw the real problem, it’s like everything’s just such a mess they wouldn’t even know where to start. It takes years – if at all.”
A moment of realization struck Caroline. Could he really know what this was like. Had he been there?
“-but that isn’t you. You’re not stuck on pride or ignorance. You took the big steps early. You know you have an affliction, and you’re doing what you need to do to get better. Just like anything else.”
Dr. Paulson paused, his gaze scrolling from one of the paintings to the other, then back to Caroline. She wondered what it was that they did for him, if they confused and disoriented her so much.
“You’ve got a lot going for you. You’ve got clear goals, you are a person who enjoys and embraces routine, and you’re looking after your physical health quite well. Your faith is an important structure in your life and everything I’ve seen tells me that your community has been a major pillar of support for you. In a way we’ve eliminated a lot of possibilities as to the genesis of what you’re going through right now.”
She cocked her head. He knew what it wasn’t – what use was that?!
“That’s part of what we’d call differential diagnosis – eliminating possibilities until we find the most likely cause. I suspect that this is predominantly a problem of chemical imbalance, perhaps with some relationship to an autoimmune disorder. Even at this early stage, the work that you’re putting into keeping your head above water is quite frankly impressive, given what you’ve told me. You’re coming to see me, you’re still keeping up with your studies, you’ve started on medication-"
With a sudden jerking motion, Caroline rose from the armchair, her fists clenched and her voice raised. It was theatrical, almost deliberately so.
“The pills don’t work! I can’t pat myself on the back for taking steps to get better, if it isn’t making me feel better! Or feel anything at all! I hate this, this gray world. What happened to the old one? I miss the old colourful world. I don’t want to just try and watch nothing change, or just keep my head above water, I want out!”
If she had actually felt angry, her voice would be trembling. She cried whenever she got really angry. There were no tears though, and she spoke clearly and deliberately. She raised it because she wanted to be angry. Faking it didn’t work. Dr. Paulson calmly continued, and Caroline slowly slid back into the armchair. Things didn’t feel any different standing up, so there wasn’t much point in making a scene.
“Caroline, I understand that you’re frustrated. It is frustrating that we can’t figure out the exact combination of medical treatment and therapy right off the bat. I’d gladly take the pay cut if it meant I could hand every patient a panacea on their way in but it doesn’t work that way.”
“Dr. Paulson, I want to die. Do you understand that? I don’t feel anything anymore, and this makes me want to die.”
Do it! Charlatan. Con man. Kill yourself, he doesn’t deserve your money.
“The place you’re in still has possibilities, and the opportunity to change, as awful as it feels. Suicide limits your options, arbitrarily so. We can’t work on you when you’re dead. We can’t exhaust every available option. You can’t throw out those possibilities before you’ve given them a chance. There are technical reasons why antidepressants work. It takes time.”
“Do I even have time? Do you think I can keep the negative thoughts away? They don’t stop.”
“You’re already ahead of the curve. I’ve had patients that it’s taken two years just to get them to even try an antidepressant. You’ve already started. It’s just one month. One month, and we’ll know.”
It may as well be a hundred years, Caroline thought.
“We might find out in a month or two and we’ll know this isn’t working out. Or it may help a bit, but not as much as we wanted. Then we try something else. We can’t be under any illusion this is the fix, but it’s a necessary step. It’s the best shot we have at getting you to a better place. All you have to do is hang on. Fake it until you make it, because one key element is that you have to convince your subconscious that everything is okay, because that’s the part of the body that actually induces the kind of response that creates these negative thought patterns in the first place. It has more to do with what’s going on under the surface than it does with your conscious intentions.”
“I’m… barely able to get up in the morning. How much do you think I can do?”
“Obviously there’s a lot of negotiating with yourself as to what you’re willing to do and what might be too much. You can fulfill your least objectionable responsibilities such that you can go to sleep at night, at the right time. Just check off the boxes, do something and make it to the other side. Find a reason – pride, spite, faith, whatever motivation you can get even the slightest purchase on. Remember to count your victories, however small. That’s the trick.”
“Just get through the days until the drugs can start to kick in. Then I can get out of here?”
“Out of therapy?’”
“Out of this gray world, like I said. The place where nothing feels real, where God feels far away and nothing seems to matter. You know, where I live.”
“…Yes, I suppose that’s one way to put it. The symptoms you’re describing – derealisation, that can abate with the right combination of therapeutic strategies and medication. It’s not an uncommon experience in those who deal with severe depression, though some report it as an initial side effect of antidepressants themselves. Again, that’s something we’ll have to wait and see for, probably in a week or two. At this point, two sessions in I still want to see if we can really get a handle on the full scope of this before we pursue any one angle of treatment in particular. Have you been keeping the thought diary, like we spoke of before?”
The dizzying tempest of words that Dr. Paulson spewed forth never felt especially warm. For someone like Caroline, the scholarly way he approached her problems was easy to understand. It wasn’t comforting, but it was helpful. A few things he’d said stuck in her mind from the last session, and she spoke them like mantras when things got really bad. In many ways it was more helpful than the pitying affection she got from friends and family. Their looks of concern felt like pressure from all sides.
Dozens of voices that just wouldn’t shut up and actually do something useful.
Dr. Paulson was a man of science, and a man of faith. He saw a problem he knew was solvable and he believed she could solve it. He was an expert, and if he knew what she knew, he’d understand how to solve her problem. The only problem was finding a way to tell him. She produced a wrinkled dollar-store notepad from her bag, and handed it to Dr. Paulson. He looked reticent, not reaching out to take it right away.
“You know, I don’t need to read it. It’s enough that you keep-“
“Please, read it. I finished this one anyways, it was cheap, you can give it back to me next time. Just let me know what you think. If you know more, then you’ll be able to help, right? It’s sometimes hard to say things out loud. I’ve got a second one I’m writing in now.”
Dr. Paulson reluctantly took the journal, and set it on the table beside him without opening it. Feeling a tingling restlessness, Caroline grabbed her bag and stood up, heading for the door. They were already ten minutes over. Someone was probably watching them, checking the time. Someone was watching them.
“Alright. I’ll see you next week? You have my number if you need to talk to me. If the ideation-“
“911. I know.”
“I see you, Caroline. I see you.”
Caroline turned to look at Dr. Paulson as she left, and her eyes widened. She blinked, and looked away from the tall, rapidly trembling figure looming behind Dr. Paulson.
“I’m sorry, what did you say?”
“I said I’ll see you next week ,Caroline.”
“Oh. Right.”
She reached out to shake his hand, and he took it with a firm but gentle shake. He always looked like he hadn’t slept much, himself. Paying little mind to the ever-widening, toothy mouth of the maroon silhouette that stood behind him, she turned on her heel and walked out the door, nearly slamming it shut on her way out.