Chapter Fifty-One
I stare at the cursor blinking on my screen, then scroll through the twelve-page document I drafted last night.
CONFIDENTIAL PSYCHIATRIC OBSERVATION REPORT
Patient: Rex Cassius Wentworth Anderson
Prepared by: Olivia Lin, MD, Psychiatrist
Purpose: Observation summary, initial diagnostic impressions, and treatment recommendations for transfer of care.
Note: This report is compiled based on observation and informal clinical dialog. It is intended as a transition document for future formal care.
I. OBSERVED PRESENTING SYMPTOMS
The following symptoms were observed or reported:
Dissociative episodes: Includes moments of blackouts or “lost time,” particularly under emotional stress or after ingesting large doses of stimulants (e.g.
, Velowake). The subject had completed a sleep study in the past, and the blackout moments did not qualify under the clinical definition of sleepwalking.
However, the symptoms mimicked sleepwalking and may be other forms of dissociation.
Internalized hallucinations: Subject reports recurrent, lifelike conversations with a persona named “Casey.” The subject acknowledges this voice is not real but often experiences him as emotionally and viscerally present. Casey typically appears after the subject ingests Velowake.
Emotional dysregulation: Extreme guilt, shame, and persistent low self-worth, often masked by risk-taking behavior and performative charisma. Emotional outbursts and mood swings are often noticed by the practitioner.
Chronic insomnia and stimulant overuse (Velowake, up to 800mg caffeine daily) potentially exacerbate symptoms. Velowake is a drug currently under trials to treat narcolepsy symptoms.
Hypervigilance, emotional numbing, and avoidance when discussing early trauma or recent emotional intimacy. The subject would attempt to deflect the topic of discussion using various tactics, ranging from flirtation to belligerent threats.
II. PROVISIONAL DIAGNOSTIC IMPRESSIONS
Complex PTSD (C-PTSD) with dissociative features, stemming from:
Early childhood trauma related to maternal loss.
Chronic public scrutiny and unresolved survivor’s guilt.
Repressed grief around recent traumatic exposure.
Chronic sleep deprivation, adrenal overload. Severe sleep deprivation can cause hallucination-like experiences.
To Rule Out: Stimulant-Induced Psychotic Symptoms
Velowake overuse may contribute to hallucination-like experiences and sleep deprivation-related confusion.
Subject appears to be heavily reliant on Velowake. Recommend evaluation for drug addiction and rehabilitation protocols.
To Rule Out: Persistent Depressive Disorder
Given a baseline of low self-worth, functional impairment, and recent anhedonia.
The report goes on and on, a compilation of my notes from my past month. Casey’s identity is the final clue, tying everything I’ve observed together.
But still, I should’ve seen the answers, the diagnoses, sooner. They were in front of me all along.
Jessa and Rhys from the cruise texted me after the scandal broke out. I sent them polite replies, thanking them for their concern, and told them I was fine, but really, I wasn’t.
My life was upside down.
The OPMC suspended my license pending investigation after the photos and stories splashed all over the internet. They should. I deserve it. But at least, as promised, Fleur wired their donation to ADAS. They even issued a press release to announce their partnership with the organization.
Many people with mental health conditions will benefit from the funding and the attention. So at least there’s that.
Frankly, I wonder if I’m cut out for this. If my motives for becoming a psychiatrist were selfish instead of selfless.
But the sad thing is, despite everything, the price I’m paying…
I can’t bring myself to regret my time with Rex.
With him, I was alive. I felt seen.
I was loved for being me.
The screen blurs in front of me, my heart aching.
Then the doorbell rings.
“Coming!” Quickly wiping my tears away, I hurry out of my bedroom, brush past the small luggage I packed for my trip to LA, and open the door.
My breath freezes when I see who’s standing on the other side.
Rex looks wrecked—unkempt in a way I’ve never seen him before.
He’s unshaved, deep circles under his eyes, his hair sticking out in all directions. His plain white T-shirt stretches over his tall frame, but it’s wrinkled, like he grabbed the first thing in his hamper and threw it on.
“Olive,” he whispers, his familiar gaze, full of love and concern, twists the bleeding organ behind my rib cage. His gaze skates behind me to the luggage. “You’re leaving?”
Swallowing the lump in my throat, I reply, “Yes. It’s time for me to go home. My parents are worried sick about me.”
“I see.”
Ask me to stay, asshole.
He glances at his feet, his shoulders slanting. Then he looks up again.
“I regret everything.”
I can’t help the sharp gasp from escaping my lips. The damn tears are back again.
How can you regret us when I’m paying the price and I regret nothing?
I shake my head and step back into my apartment, hurt and anger boiling inside me.
“Fuck you.” I slam the door closed.
But he holds it open.
He steps inside, his eyes widening, no doubt realizing how his words came out.
Rex tugs me against him, and I flinch before fighting back, crying, screaming, scratching his neck, his shirt, anywhere I can reach.
“Damn you, Rex Anderson. Damn you to hell!”
He tightens his hold on me, pressing my face against his chest. I hear the rapid thudding of his heart. His masculine perfume wraps me in a tender embrace, and for a second, I want to stay still, to feel safe in his arms again.
But then I remember how he pushed me away, how he said he regretted us.
“Let go of me, you asshole!” I stomp on his foot.
He hisses. “No.” His hold tightens.
“You don’t get to do this to me! You don’t get to regret us. Regret me! You have no right!”
More fists to the back, followed by kicks to his shins.
Pained grunts reach my ears, but he doesn’t let go. Instead, he presses kisses to my hair, my temples. Tears slide down my face.
Everything I’ve been holding onto comes crashing down.
I’m a mess. Not the perfect Olivia Lin. Just a normal girl with her heart broken and her career in the pits.
“That’s not what I meant,” he murmurs, his voice hoarse. “But I deserve it. Your anger. I should’ve protected you better. Casey warned me. My sister warned me. Everyone fucking warned me this would happen, but I was too weak.”
He drops to his knees and hugs my thighs.
He looks up. “Don’t you see? I couldn’t stay away from you.
I wanted you for myself. You made me feel alive.
Loved. Accepted. You were the one addiction I never wanted to get rid of.
So I stole you from your safe little nest. I made you take risks you should never have taken.
Because I love you, and I’m so damn lucky you love me back. ”
My lips tremble as I clutch his face, finding his eyes gathering moisture.
Rex rasps, “I love you, Olivia. I’m sorry for hurting you, for pushing you away.
I should’ve known. My Olive would stay and fight with me.
We’re better as a team. I shouldn’t have taken the choice away from you, and I regretted it the second you walked out of the hospital room. Can you forgive me? Can you—”
He stutters and gasps, like his lungs can’t draw in enough air. I hold my breath too, because I know whatever he’s going to say will be monumental.
“C-Can you stay? With me? Be with me? I don’t know how we’ll get out of this shithole. I don’t know how to fix myself…if I can even be fixed. I don’t know if I’ll lose my mind and push you away again. But can you stay with me? I can’t live without you.”
His words echo in the small foyer, heavy and ladened with meaning. My heart beats so rapidly, I think it’ll tunnel out of my chest.
I know what I want to say, an impulse stronger than breathing.
But the last few weeks have exhausted me. Mentally and physically.
I deserve more. I deserve more. I deserve more.
I deserve a man who not only loves me, but will do everything he can to protect himself and our future.
The man at my feet isn’t him.
If we’re both broken, clinging onto each other with multiple holes in our raft, we’ll sink and drown.
Releasing a ragged exhale, I step back.
“Stand up. And wait,” I murmur.
I return to my room and print out the report, then I bring it back and hand it to him.
Rex’s eyes widen when he sees the title page. His eyes snap to mine. “What’s this?”
“Things I should’ve noticed. Concluded a long time ago. But, like you, I was haunted by the past and my feelings for you. I missed the signs. Rex,” I step up to him and cup his jaw. His eyes flutter shut.
“You aren’t broken. I think you have an addiction and you’ve been misled by the medical practice, which, unfortunately, happens often.
Most doctors don’t receive training to identify C-PTSD and dissociation.
It’s fairly recent when it’s gotten more attention, and even then, it still isn’t in DSM-5, the US diagnostic manual.
It’s only in the international standards. ”
His throat works and nostrils flare. He opens his eyes and whispers, “What are you saying?”
I give him a sad smile. “I don’t think you’re going crazy. I think you need the right help. It’s been long overdue.”
Then I step back again, my fingers tingling from the warmth of his face. A strong urge pistons through me—to run back into his arms and bask in his warmth and need for me.
It’ll be easy.
But it isn’t the right path.
And the new Olivia Lin isn’t afraid to do scary and hard things anymore.
That includes standing up for me.
“I deserve a man who’ll actively fix himself.
I deserve someone who not only will put me first, but will make sure he’s taking care of himself so we have the best shot at a happy forever.
You need to do the work, Rex. Velowake is easy, but it isn’t good for you.
Indulging yourself in pleasure and alcohol will numb your pain, but it doesn’t change you.
Words are cheap, action is hard. You need to put in the work, then we’ll talk. ”
My chest aches, but I know it’s the right thing to do. I need to put in the work for myself too.
For the next few minutes, there’s nothing but the quiet sounds of our breathing. His deep gaze roves over my face, as if he’s reading my mind, my thoughts, as if he’s memorizing every inch of me.
And I do the same to him. His beautiful, expressive eyes. His soft lips. The thick, rough scruff hiding his jawline.
Rex rolls his lips inward, then straightens, a new determined glint in his eyes. My report crinkles in his tight grip.
He dips his head in a curt nod. “Understood.”
Then he steps out of my apartment, but before he turns away, he gives me a vow.
“You won’t be disappointed.”