Charles Balis' Journal for the Week ending 9/13/96

Saturday, September 7, 1996
I acquired one of Sylvia Bows ultrasound images. The ultrasound appears to show two zygotes, one smaller than the other. The concern at the moment apparently is that one of the zygotes has some defect, except that Dr. Malleson, Sylvia's obstetrician, said that he didn't believe that was true. He said he would know more Sunday or Monday when they could do additional ultrasound studies.

Sunday, September 8, 1996
10 am. Telephone Conversation with Sylvia Bows and Rene Wolff-Bernstein. I called Sylvia at the hospital and spoke with her briefly. She was tired and despondent and turned me over to Rene. Rene said that Sylvia hasn't been getting a lot of sleep at the hospital, that she has been eating poorly, is anxious, is shaking, and has been complaining of stomach problems. She is taking Valium, which has calmed her down. Her next ultrasound, which should help clarify the situation, is scheduled for Monday. An ultrasound was conducted Saturday and the ultrasound technician told Rene and Sylvia that it was her opinion that there were two fetuses of different gestational age. She said that each fetus individually seemed normal. She judged one of the fetuses to be four to five weeks and the other to be six to eight weeks. I've heard that it is possible to ovulate while already pregnant (especially given Sylvia's age) and, if so, that it might be possible to have "twins" conceived at different times. But I'll defer to Dr. Malleson.

Monday, September 9, 1996

9:30 am. Telephone Call with Dr. Halsey regarding Cassandra Evans. Doug Halsey over at UCSF gave me a call to report his findings on Cassie. He found her quite challenging. Physically, he found lowered magnesium and calcium levels with elevated titers for Human Herpes Virus 6 and a lower than average white blood cell count. She had various physical symptoms including low blood pressure, swollen lymph glands, abnormal heart rhythms and she reported a previous EEG finding of non-functional dysrethmia. Halsey's preliminary diagnosis is that Cassie is suffering from the "Yuppie Flu"--Chronic Fatigue Syndrome. There is no definitive test, rather it is the elimination of a number of other items which leads to a positive diagnosis. One of the factors is psychological and so Halsey asked me to opine on Cassie's mental state. I stated that while she was clearly suffering from depression, it was exogenous and not endogenous. I ruled out a diagnosis of primary depression and thus told Dr. Halsey that I did not believe Cassie's depression was a causative agent of her physiological disorders. Dr. Halsey was in agreement about putting Cassie on a serotonin reuptake inhibitor. Unfortunately, there is no generally accepted treatment for CFS. Halsey is going to talk to the international community which has had more success fighting this problem than we have in the U.S. But Halsey confirmed that CFS is definitely of physiological origin and is decidedly not psychosomatic. I believe that alone will be a great relief to Cassandra. Since it appears that there might not be a lot we can do for the underlying physical complaint, Dr. Halsey's job is to try to reduce the severity of the symptoms, while my job will be to help Cassie first understand and eventually accept her physical condition, to help her reduce her depression, and to cope with her life given her disability.

12 pm. Second Session with Phylis Birch. Phylis had a close call with Jack. He went to surprise her at the office and she wasn't there. Instead, she was at one of her dives. She managed to smooth it over, but she wants me to help her devise some form of memory system to aid her in her continued deception. The idea of stopping her activity hanging out at dives is abhorrent to her. She is not ready to quit, seemingly willing to sacrifice a happy marriage for it, if necessary. I've encouraged her to come clean with Jack, but she is resistant. She wants to have a sound, logical reason for her visits to the dives, but she doesn't have one. I told her that rather than helping her with her deceptions, I could help her articulate her need to visit dives. She also wants her journal to consist of photographs of the outside of these dives with her comments. I've encouraged this. We started to talk about what she does in these bars. Apparently, she has a fictional persona that she adopts--Martha--that has a complex history. She sticks with this one character so that she can keep her deception straight.

2 pm. Therapy Session with Sarah Wright. Sarah came into my office, took off her shoes and tucked her feet under her on the sofa. She is a white woman, quite short, 33 years of age. She has three children, ages unknown, and a husband named Jeff. Sarah suffered a heart attack three months ago, and is having related post-cardiac mental difficulties. Repeatedly, she has gone to the emergency room with chest pains, believing she was suffering a recurrence. And repeatedly, she has been examined, sedated and sent home. She is also suffering symptoms of panic attack and depression, long periods of crying, a feeling she describes as like she is going to explode or jump out of her skin, sleep disorder (can't stay asleep), recurrent nightmares (falling down a flight of stairs). She also describes an intermittent problem of confused speech where she says one thing but means something quite different. I didn't notice any evidence of disorganized speech (positive formal thought disorder) during this visit and certainly alogia is not indicated. The example that she gave did not sound like the disorganized speech manifests only in times of high stress or at times of other physical or mental extremes. She is hiding her speech problem from Jeff. Sarah was apparently under quite a bit of stress at the time of her heart attack, working two jobs part time in addition to her family responsibilities. She tries to justify her heart attack as happening for some cosmic reason, but she is clearly terrified of a recurrence. Sarah doesn't get along well with her mother-in-law. Until recently, she felt like other people were controlling her life, especially her husband and her boss. She wouldn't talk about her problems with her previous (?) employer. Sarah carries nitroglycerin pills and reports that the Ativan (lorazepam) she has been taking aren't working for her. I've switched her to alprazolam 1 mg. tablets t.i.d., and cautioned her against drinking and pregnancy. Xanax has withdrawal problems, so I must be careful especially if she goes over 4 mg. daily.

4 pm. Eighth Session with Joseph Mazurka. Joseph came to the session today obviously high on some central nervous system stimulant. His eyes were dilated, he couldn't sit still, his speech was hurried and disorganized, his anti-social ramblings were more extreme if anything. He was quick to anger and appeared to have psychomotor agitation. He was sweating profusely. He claimed that he was taking over the counter diet pills, but I don't believe it--this was not a reaction to a caffeine based preparation. My guess is that he is taking dextroamphetamine, methylphenidate, methamphetamine or phenmetrazine. Although it is possible that it is a cocaine reaction, I would tend to doubt it. I'm not sure whether ice--crystallized methamphetamine--has hit the black market in San Francisco, but at Columbia in New York it was prevalent. Joseph strikes me like many of the ice abusers I saw in the clinic there. Despite the restraining order, Joseph has apparently been haunting his wife's place, trying to watch her comings and goings. The house has appeared empty. He threatens her with a kidnapping charge if she leaves without notice and takes the kids. In his new drug-induced euphoria, Joseph feels like he can change everything that's wrong with his life--his failing marriage, his job, even his department and software scheduling delays. He went in and told his boss about his ideas and I wouldn't be surprised if his boss was somewhat disturbed by what he had heard. Joseph now isn't sorry about the beating that he administered to his wife. He professed a belief that a man is entitled to beat his wife and while he regrets the incident, it was partly Carol's fault because she knows how to push his buttons. Joseph also was making some pretty wild statements about trying to overthrow the government through violence. He even made semi-approving references to the Oklahoma City bombing and to Adolph Hitler. I told Joseph that he needed to immediately stop taking any drugs and to try to begin to follow my advice, but I'm not sure that it will effect any change. Joseph is afraid of being labeled a sociopath in his paperwork, and that may be the only reason why he continues coming to these sessions. Except that I believe that he knows, deep down, that he is in desperate need of help.

Tuesday, September 10, 1996
1 pm. Seventh Session with Cassandra Evans. Cassie and I spoke about her diagnosis by Dr. Halsey of chronic fatigue syndrome. Cassie is just beginning to understand what it is and how it is going to affect her life. She is very happy, though, just to have a diagnosis. Dr. Halsey suggested that Cassie find a CFS support group, a suggestion with which I concur. Cassie got some letter about her absenteeism from Ms. Bows which went into her personnel file. She is quite unhappy about that. Cassie also heard that Ms. Bows was in the hospital and she went to bring her flowers. She was quite surprised to learn that Ms. Bows was in the maternity ward. Cassie hasn't told anyone about her diagnosis yet--her parents are out of town and she doesn't know what to tell Brian. I told her that we would work together to find a way that she could explain the disease to others. She is to get a packet of information from Dr. Halsey on CFS probably forwarded on from the Center for Disease Control. But Cassie is very pleased to find out that there is a physiological causation to her illness and that it wasn't psychosomatic. Cassie is still crying a lot and feeling helpless. I prescribed Prozac, 20 mg. once each morning.

4 pm. Telephone Conversation with Sylvia Bows. Sylvia called right at the time when she usually comes in for her session. She has started taking the Sinequan that I prescribed. Her twins are okay. Sylvia said that she is the star patient at UCSF right now, with medical students clamoring to see her ultrasounds. Apparently, she has twins of different gestational ages. So one is about five weeks and one is about eight weeks old. Her due date (at 36 weeks for the elder of the two) is March 15, 1997. I didn't mention it to Sylvia, but there is a good chance that she is having twins by different fathers. That's National Enquirer stuff. And I assume that when the news hits SII, there is going to be lots of speculation among Sylvia's various lovers as to who has the honor of paternity.

Wednesday, September 11, 1996
Received another fax from the Anonymous Faxer. I'm starting to almost look forward to Wednesday morning and another graphic missive from my anonymous correspondent. This one is unique in that it is personalized, at least in part. I still think that I am one of many recipients, but this one has a little house with the label "Dr. Balis" on it. The graphic quality of the little house and the letters is so clearly distinguishable from the rest of the image, that I'm convinced that it was a customized afterthought, perhaps a whole series of these little houses, each with different personalized names, was stuck onto the high quality graphic image of the rest of the image. The image is that of a naked figure (male or female, I cannot say), lying on its side and pointing at the little personalized house. Spilled next to the figure is a bottle with the words "Drink Me" discharging its black, inky, and presumably poisonous contents. The background is that of some form of cracked stone. Drink Me may be a reference to the Alice in Wonderland story where Alice drinks some potion and becomes quite small--small enough to go through the tiny door. This Drink Me seems to have a poisonous effect rather than a dwindling one. This fax, now that it is at least semi-personalized, has prompted me to pull out the previous ones and look at them as a group. A suggestive similarity strikes me--all of the male figures are twisted or in agony, while all of the female figures are seemingly quite serene. Curious.

4:30 pm. Telephone call from Helen Gregory. Helen conquered her normal aversion to telephones to give me a brief and paranoid telephone call. She has had a vision, undoubtedly brought on by a passage in Matthew's letter about doing something that no river could long enough conceal. Well, Helen believes that Matthew has committed a murder after having a waking vision of a body in a river. So now Helen is leaving the country tonight. Helen thought the line was tapped and that her call was going to be traced so, after precisely three minutes, she hung up abruptly. She is obviously in crisis and there is no way that I can get in touch with her or help her in any way. I have to wait for her to contact me, and she may be leaving the country.

Thursday, September 12, 1996
2 pm. Visit from Ms. Ruby Dribner re: Helen Gregory. Ms. Ruby Dribner, Helen's lover, came to my office today bringing a couple of drawings from Helen. Ruby is in her early to mid forties. She might have been pretty, but she has a way of pulling her head back into her body like a turtle, as if she is very shy. She spoke very softly, but with a certain intensity that was almost unnerving. I had the feeling that as she scanned my office, she was remembering every detail. She wears old fashioned horn-rimmed glasses. Rudy said that Helen hasn't been herself lately. She confirmed that she flew off--out of the country is just a guess. Rudy said that it is like Helen used to behave years ago, when she led a "rather adventurous" life. She keeps Rudy in the dark about her activities and Rudy suggested that she thinks sometimes Helen does it just to be mysterious. But Rudy corrected herself and was on the verge of telling me something which would confirm the veracity of Helen's activities when she cut herself off and hurried out of my office. Just as she turned to leave, I noticed that she had a peculiar crease on her left cheek. I knew I had seen it before somewhere and then I remembered: a friend in college who played the violin had that same mark. We had talked about it then and she said that all violinists get it--it's from holding the instrument between their cheek and their shoulder while they are playing. So Rudy apparently does play the violin, as Helen said she did.

I looked at the doodles that are really more like drawings done by Helen. She is clearly a talented artist. The first shows a body floating in silhouette in a river near a bridge. Next to an abandoned hat, there are a set of footsteps, either coming or going, near the riverbank. This drawing is done very hurriedly without the usual careful rendering typical of Helen's other drawings. The body could have been thrown off the bridge. But the footsteps suggest something else. No sign of a body being dragged into the water and there wasn't two people walking. Could this have been a suicide? But then why from the riverbank and not off the bridge? Could the person at the riverbank have been a witness to the suicide, or perhaps even murder? I presume this is the drawing of Helen's vision. The second drawing is in Helen's usual, careful style. It depicts a cockroach type insect figure, standing on its hind legs, whose torso is that of a nude human female. One of the antenna of the creature is touching a nipple of the torso in a manner reminiscent of some form of alien masturbatory fantasy. Could this be a reference to Kafka's famous story? Does Helen feel trapped in some Kafkaesque nightmare? Does Helen think of Ruby this way perhaps? And why was it important to Helen that I get these drawings? The one of the body in the river, I understand I guess. This explains what her fears are in relation to her son. But why the standing insect?

4 pm. Eleventh Session with Anna Green. Anna was about twenty minutes late for our session. She had been at the Seybold Conference doing work for SII. When I gently chastised her on being late, she took it rather personally, as if I was truly angry. She became effusive in her compliments towards me, concerned that I might still be angry. She's also worried again that I might be bored during her session, and I assured her that I was not. Anna said that she is surprised when men react to her openness and frankness as if she was coming on to them. She describes her work environment, which seems to have a lot of sexual content, and says that co-workers feel free to talk about sexually related topics and stories in front of her, since her relationship with Bill. Apparently she gives as good as she gets, so she is treated as one of the boys on that score. There is a ritual about staying late, eating pizza, and watching pornographic movies in the company conference room, that is sanctioned by Anna's immediate supervisor. Anna says that he goes to get the tapes! I'm surprised that they haven't been caught or sued. However, Anna is clearly okay with it (although she apparently feels uncomfortable about staying through pornographic movies) so it isn't my problem. David, upon whom Anna performed fellatio once, wants to repeat the experience. He trapped her in the copy room and suggested a purely sexual relationship where he could prove to Anna his sexual prowess by being allowed to reciprocate. Anna apparently angrily refused his advance, for which I was very proud of her. David used his HIV negative status as an inducement to initiate sexual congress. SII's HIV testing program is having some unintended side effects. Anna said that she utilizes a vibrator to masturbate to orgasm. She said that she has difficulty reaching orgasm during intercourse because there are too many things to think about. But during a masturbatory fantasy, it is all about her and her pleasure. She describes a sexual fantasy about surrendering to an unseen stranger who initiates and performs intercourse while she is standing in a crowd watching a fireworks display. She never turns to see the face of the stranger. This fantasy seems perfectly attuned to Anna's history of submitting to unwanted sexual advances.

Friday, September 13, 1996
10:30 am. Telephone Call from Cassandra Evans. Cassie called and reported that she is having a poor reaction to the Prozac. She reports that she is feeling dizzy and lightheaded, nauseaus, and some slurred speech although I didn't hear it in our conversation. She says that she feels intoxicated. She started taking the pills on Wednesday, so she has only had three 20 mg. doses. I asked her to take one more dose on Saturday and to see how she feels on Saturday. From what Dr. Halsey said, CFS patients often have hypersensititivity to drugs and she could merely be experiencing a longer acclimation stage than normal. But if she is still experiencing problems after four days, I will switch to another antidepressant.

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