He has a hard time coping when he’s upset and reacts by biting his forearm, smacking his forehead, or slapping his thighs, which he did numerous times throughout his testing sessions. These descriptions remind me of Harper and how she reacts to stressful emotions by pinching herself or anyone else who dares get near her when she’s that upset. The first time she was evaluated, she pinched the evaluator so hard she left bruises, and staff had to come pry her off him. He refused to test her again.
Mason is a lot like Harper in other ways too. They both have hypermobility issues, so they share the awkward gait and problems with large-muscle control. Her issues are much more pronounced than his, though, and he doesn’t have the insensitivity to pain that she does. Physical therapy was recommended because of it, but it doesn’t look like he receives those services. That’s weird. Why wouldn’t Genevieve hire the best for him? I would for Harper if I could, but some of those specialized aides charge hundreds of dollars per hour. We get by on the PT covered by my insurance.
Unlike Harper, Mason has significant intellectual impairment. My heart aches for Genevieve for the additional challenge on top of an already difficult diagnosis. Mason has an IQ of 38 on most of his assessments and a mental age of around four in most things. All three of his functional skills are way below average, daily living skills being the lowest. He can’t do much by himself.
None of this is as unexpected or alarming as his multiple psychiatric hospitalizations. From what I can tell, he’s been locked in the inpatient psychiatric unit at White Memorial twice, but I only have one or two pieces of the progress notes from the hospitalizations. The rest of the reports are missing. There’s a single sheet that has to be from a psychiatric report there because of the letterhead of the hospital at the top and then the following:
PURPOSE OF CONSULTATION (include diagnosis at time of admit): psychosis
12 yo h/o seizures brought in by mother. Numbness on L side. Lower quadrant. Labile mood. Inappropriate affect. Agitated. Pt given Ativan prior ER. Mother administered. 3 34 qt/1
A history of seizures? There’s no mention of seizures anywhere else in the reports. Did I miss it? I wouldn’t have overlooked something that important. I quickly scroll through the earlier reports just to make sure, but it’s not there. That’s a really important piece of medical history to be missing. Why is it missing?
One of the doctors from what I’m assuming is the same hospitalization goes on to paint a very disturbing picture at the bottom of the page:
Patient irritable, easily distracted, and intrusive. Speech is rapid and pressured. Psychotic or borderline psychotic symptoms present. Bizarre behavior has been observed. Inappropriate smiling/laughing. Patient oppositional toward hospital staff. History of multiple depressive episodes.
And then it just cuts off. There’s nothing else. Only the few snippets. Are they even his?
Someone also wrote psychosis in the chart, and it wasn’t the same person as the one who signed the note, because the initials are different. What does that mean? It’d be easier to write off as an outlier and excuse as someone else’s chart that accidentally got mixed in with Mason’s if there weren’t more pieces like it.
Others look like scribed video notes from a hospitalization at Children’s of Alabama.
Monitor 6 Video: ECT 21794, 6:00 a.m., 4 minutes
Patient stable after administration. Patient in position. Guardrails highest level. Patient unoriented to time and space. Citalopram 20 mg once daily and sodium valproate 200 mg two times a day.
Monitor 7 Video: ECT 21794, 7:06 a.m., 2 minutes
Patient anxious. Alprazolam given. Muscle suppression still present. Possible atypical absence seizures noted. Postictal response.
These read like clinical notes for electroconvulsive therapy, but why on earth would they be doing that to him? It’s not a treatment for autism and definitely not any form of treatment that psychiatrists go around giving kids. A child has to be severely depressed to be given shock therapy, and even then, you have to get permission through a special committee. A thorough psychiatric evaluation has to be completed beforehand, but there’s not a psychiatric report anywhere to be found or a mention of depression in any of his intakes.
None of this makes sense, and it doesn’t line up with Genevieve’s descriptions of Mason. He clearly has more issues than she lets on. These are important pieces of Mason’s life. Is she hiding them on purpose? But then why give all this stuff to Detective Layne if she’s trying to keep it a secret? The questions compete for space in my head. There are lots of missing pieces, but one thing is certain—Genevieve never would’ve let a boy with the kinds of impairments and limitations described in these reports walk around next to a creek by himself.
SEVEN
CASEY WALKER
Annabelle’s smiling face on her reward poster greets me as I push open the coffee shop door. The entire town is plastered with her picture. Some people have it on their house windows or on signs in their front yards. Her reward poster is taped on every business door in town. People are petitioning for anyone with information to come forward with the type of fervor that is usually reserved for political elections. There are even buttons marked with JUSTICE FOR ANNABELLE and the anonymous tip-line number underneath that have started circulating. It won’t be long until everyone has one.
The shop is quiet. Barely anyone inside. This isn’t the place to go if you want to talk. That’s the Starbucks two miles down the road across from the mall. But it’s the perfect spot if you want total privacy for a conversation like we do.