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Case File #763

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I. The Client

There’s a new client on Jessica’s caseload, and the file comes with a note that she is emphatically not to re-assign this client to any of the student interns she supervises, because he’s expected to be long-term and continuity of care should be a priority.

Jessica scans the available case notes: 35-year-old former NHL player, hasn’t played in three years after one last concussion took him out.  He was playing for one of the Canadian teams, but his family’s in Minnesota, and now so is he.  Lives alone, but his mom and his younger brother and sister-in-law check in on him frequently. 

The man himself is tall, brown hair going a little gray, body perhaps not quite to pro athlete standards but in better shape than the random guy on the street.  He’s cooperative enough with the intake interview, though by the end of it Jessica was quite sure that Mr. Brouwer’s – Mike’s, he did tell her to call him Mike, so Mike’s – picture could illustrate definitions of “flat affect” in any clinical text. 

There doesn’t seem to be much he enjoys in his day to day life.  He likes to cook, when he’s feeling up to it and the headaches aren’t too bad, and he tries to make enough so that he’s got food to get him through the days he doesn’t feel well enough to do it.  He reads, when he can stand it, and he’s slowly coming around to the idea of audiobooks being better than nothing.

He doesn’t watch hockey, or sports at all.  He’ll keep up with wins and losses in the newspaper, sometimes, but he can’t stand to watch the games themselves anymore.

 

II. The Brother

Jessica hears from Tom Brouwer first, because he’s listed on all the emergency contact, power of attorney, health care proxy forms.  Means she’s allowed to talk to him about Mike – Mike’s signed paperwork and everything.  He’s a little smaller than his older brother, a bit less athletic, with a friendly, easygoing charm that leaves Jessica wondering how the two of them are actually related.

Tom thanks Jessica for “helping Mike keep it together” and laughs about the idea that Jessica could possibly get Mike to talk about his feelings.  Which – Jessica’s never been the “so tell me how that made you feel” kind of counselor in the first place, she really hates that stereotype, REALLY hates it.  But she gets it, a little, Tom sees “social worker” and if he doesn’t think “those fussy old ladies who take kids away” he thinks of someone more like that marriage counselor he mentions having seen with his wife a few years back.  Someone who listens to both of them and then listens to how they listen to each other, and translates the hurtful things they say into hurt feelings that they don’t know how to express.

Jessica’s job isn’t like that.  Especially not with Mike.  It’s mostly to get him talking about anything at all so she can check for changes since the last time she saw him.  Do his hand shake more, does he seem more or less bothered by light, are his clothes in better or worse repair, what side effects is he complaining about from the latest medications?  She runs through the cognitive tests, checks how his focus and memory are, makes note of it when things are worse.

She wishes there was more of a chance to make note of things being better.  She tells Tom this much, and he gives her a sympathetic nod.  “We all wish that.  But head injuries…” Tom trails off.

Unfortunately, “but head injuries” seems to be exactly right.  Sometimes spontaneous significant recovery happens.  Mike doesn’t seem to be one of the people it’s going to happen for.

 

III. The Doctor 

Jessica consults with Dr. Singh on a somewhat regular basis.  She works with a lot of clients who have some kind of brain injury, and Dr. Singh is the neurologist who tries to come up with the medications that will make things at least a little bit better.

Today, she needs to consult with him about Mike Brouwer, because Mike’s pissed off at the Topamax he’s taking.  He says that yeah, it makes the migraines better, best of anything he’s tried so far, but it has one side effect in particular that he went on a fifteen-minute tirade at Jessica about.  Apparently, it’s making soda taste wrong to Mike, and that pisses Mike off because come on, he already can’t have a shot of whiskey or even a fucking beer with his buddies, and now this new fucking wonder drug is going to take even Coca-Cola away from him, even if it’s caffeine-free and diet?

That, he grumbles, is far too much for one man to put up with.  What’s he supposed to do, pretend that he’s, oh, twice his age, and make prune juice his drink of choice?  He then manages the terrible pun that “seems like a pretty shitty choice.”

Mike has a dry, sarcastic sense of humor, and Jessica enjoys working with Mike when it’s on display.  She doesn’t enjoy how often it seems to come from Mike feeling frustrated and helpless and old before his time.  So she asks Dr. Singh if cutting back on the Topamax would help, and he has a surprising answer: this side effect sometimes happens while titrating the dose up and then disappears when the ideal dose is reached.  So the annoying side effect might help them figure out together what the best Topamax dose is for Mike.

Mike’s okay with that when Jessica explains it the next time she sees him.  Surprisingly cheerful, even.  Almost hopeful. 

 

IV. The Mother

Mike’s mother brings him to a session one day, because Mike wasn’t feeling up to driving.  The migraines are better, better than they’ve been in months now that he’s on the right dose of Topamax, but every now and then he gets hit with a bad one, and this is just one of those days.

She sits in the waiting room with a gardening magazine while Jessica meets with Mike.  Then at the end of the session, Mike goes to make a stop in the restroom, and she approaches Jessica.

“I know the rules.  You can’t tell me anything about how Mike’s doing.  That’s okay.”

Jessica nods.

“But – I just want you to know a little more about us.  I don’t know how much he tells you, when he doesn’t want to talk he just won’t talk.  And you know, after everything ended with his dad, he was twelve, thought he had to be the man, take care of us.  And I still feel so bad about that.  I let him take care of Tom, more than I should have, and then I didn’t say no when he sent us probably half of his checks.  It feels like blood money now, the way things ended, but it was so good to not have to worry all the time, to get his little brother the things he needed, even to do things for myself.”

Mike’s mom pauses, searches Jessica’s face.  “I just want to make sure you know – we’ll take care of him.  Even when things get worse.  If you can tell us, or someone can tell us, what we need to know about.”

“There’s a friends and families group,” Jessica says, “One of the interns I supervise runs it – she had someone in her family with a brain injury, and she said it helped her a lot when there was a group near her so she wanted to do one here.  Thursday evenings, seven o’clock.  I’ll write you out a card.”

 

V. The Partner

In June, Mike unexpectedly cancelled a few sessions with Jessica, saying he was going to be out of town. 

She doesn’t think much of it, until she’s watching the Stanley Cup Finals, and she swears she sees him in the audience, sitting next to the parents of one of Detroit’s players.  It’s not like Mike’s appearance is that distinctive, or like the announcers comment on there being a random retired NHL player in the audience, but she’s sure it’s him.  He looks uncomfortable, like the combination of a migraine and a question he really doesn’t want to answer are making things harder on him than he’d like.

She doesn’t say anything about it, when Mike comes back a couple weeks later, and he doesn’t bring it up.  But she thinks about it again, when there’s a minor news item about one of the players from that Cup-winning team in Detroit hitting free agency and signing a long contract with the North Stars. 

And she thinks about how she thought about it when, one day, the new #71 of the Minnesota North Stars is in her office with a stack of paperwork.

“Finally got that pain in the ass to sign everything,” he says to her with a laugh and a shit-eating grin.  “So now I’m allowed to talk to you and you’re allowed to talk to me and I’m sorry if you had no idea about any of this, since the stubborn bastard won’t even admit he’s got a boyfriend, but here I am.”

Jessica blinks, surprised.  It was true, Mike had talked about a lot of guys he used to play with, but she doesn’t remember him ever actually mentioning Liam Fitzgerald.  And it seems there was, or would be, a lot to mention.  Mike never mentioned being in a relationship with anyone, had made clear that that topic was essentially off limits in his first few sessions with Jessica. 

She gets it.  Just because Marc LaPointe and Julian Perrault came out doesn’t mean that’s a comfortable choice for everyone, and Mike doesn’t want to deal with coming out or with the whole dating-a-slightly-famous-person thing.  At this point in his life, with his limitations, Mike seems to think the fewer people, the better.

Liam’s obviously on to that.  “I want to talk to you about getting a service dog for Mike.  I’m here now, not in Detroit, but I’m still playing so I’m – not home with him all the time.  And I know his mom stops by a lot, but…I just think it would really help him, do you think we can do that?”

Jessica smiles.  “I can’t just pick up a trained service dog somewhere and give it to Mike.  There are rules and he’s going to have to participate a little bit in the process.”

“That’s fine!  I just…Mike said you’ve worked with him for a while, you know how he gets by now.  I just want to make sure he has what he needs when I’m not right there.  I’d retire for him, you know?  But he’d dump my ass on the spot if I tried.”  Liam pauses for a moment, then continues.  "I'll look into it as much as I can, and I'm sure Lori - that's Mike's mom - will help.  But I know there are dogs that help with the kinds of things that give him trouble, and really I'd feel better if it was a dog because of how much he yells at people to go away.  Even me.  Especially me."

This is veering into territory that Jessica isn't comfortable with.  "Liam.  Liam, I -"

"Yeah, I know.  You're not my therapist, and that's fine.  And I'm definitely not here to mess things up with that, I'm glad that he's actually showing up on some kind of regular basis.  But if you can help with who in the area would train the right kind of service dog? Like, I've done enough reading to know it's not a therapy dog, that's something different, but I just moved here so I don't know who's good locally yet."

Jessica actually does have a list, which places are good, which ones are rip-offs, and she goes over it with Liam.  Reminds him that he has to talk to Mike, that Mike has to agree.  Thinks, privately, that Liam can probably charm Mike into it, somehow, in ways that are really none of her business.