Dr. Cruz's office was a haven of warm, professional light, filtering through the blinds and casting gentle shadows. Kai sat stiffly in a chair, his gaze fixed on the worn carpet, while Kara's concern was a palpable presence beside him. Dr. Cruz, his voice calm and reassuring, began, "Kaizen, your nightmare journal has been incredibly insightful, but we need to explore a few more areas to get a complete picture. One of those areas is substance use." He turned to Kara, "Kara, thank you for being here; your perspective is invaluable." He then addressed Kai, "Even though the lab results indicate no substance use, I still need to ask about your history with drugs or alcohol. Sometimes, the testing doesn't show every substance, and I need to ensure I have a complete understanding of your behaviors. Have you ever used any substances, Kaizen?" Kai looked surprised, even slightly offended. "No, sir. Never. I've never touched any of that stuff." Dr. Cruz nodded, observing Kai's reaction. "Thank you for your honesty, Kaizen. Kara, have you ever seen Kaizen use any type of substance?" Kara shook her head firmly. "No, never. He's always been against it." Dr. Cruz acknowledged, "That's good to know. The lab results confirm what you've both said, that there are no signs of substance use. This is good news."
The conversation shifted to the painful subject of Ethan's death. "The loss of a close friend, especially under such traumatic circumstances, can have a profound impact. It's understandable that you both are still grieving," Dr. Cruz said, encouraging them to share their memories and feelings. Kai recounted the bullying Ethan endured, the shock of the accident, and the gnawing guilt he felt for not doing more. Kara added her own feelings of guilt and the deep sense of loss. Dr. Cruz listened attentively, validating their emotions and acknowledging the complexity of their grief. "Kaizen," he continued, "we're going to incorporate several therapeutic activities into your treatment. This will include individual therapy, group therapy focused on grief, and art therapy. We'll also implement mindfulness techniques to help with the dissociative symptoms. And, to address the stress and get you moving, I'd like to suggest basketball. We have a court here, and it offers a range of therapeutic benefits."
Dr. Cruz elaborated on the advantages of basketball. "It's a vigorous physical activity, releasing endorphins that boost mood and reduce stress. Regular physical activity also contributes to better sleep, which is crucial for you. It requires focus and concentration, helping to distract from intrusive thoughts and improve attention. If you choose to play with others, it offers social interaction and teamwork, combating isolation. Even individual practice can boost self-esteem. Having a structured activity like basketball provides routine, which is beneficial for managing mental health challenges. We'll start with individual practice and progress to casual games if you're comfortable. We will also continue the community garden project with Kara. This will be a different form of activity, with different therapeutic benefits. We will monitor both projects, and your progress, weekly." He then moved onto medication. "Now, let's discuss medication. Given your symptoms, I believe a combination could be beneficial. We'll focus on addressing your anxiety, panic attacks, and sleep disturbances initially. We can start with a low dose of an anti-anxiety medication, likely an SSRI or a similar medication. We can also prescribe Prazosin, which can help with the nightmares. I understand that cost can be a concern. This is a public hospital, and we have access to government-supported medication programs. We can find medications that are either very low cost or completely free through these programs. We will check your eligibility, and make sure that you have access to what you need. It is very important that you take these medications as prescribed. We will start with a low dosage, and increase as needed, and as tolerated. We will monitor your progress closely, and make adjustments as needed. We will also monitor for any side effects. It is important that you tell us about any side effects that you experience. We will also prescribe a short course of sleep medication to help regulate your sleep cycle initially. This is not meant to be a long-term solution, but rather a temporary aid while we work on improving your sleep hygiene and addressing the underlying causes of your nightmares. We will also focus on sleep hygiene, and mindfulness techniques, to help with sleep. It's important to remember that medication is just one part of the treatment. Therapy, both individual and group, along with the therapeutic activities we discussed, are equally essential for long-term improvement." Dr. Cruz then explained the possible side effects of the medications and the importance of not stopping them without consulting him. He concluded by outlining the next steps, scheduling therapy sessions, and reinforcing the importance of open communication and ongoing support.
Kai and Kara stepped out of Dr. Cruz's office, the door closing softly behind them. They paused, momentarily disoriented by the stark contrast between the warm office and the clinical hallway. In one of the chairs, a man sat hunched over, muttering incoherently. His eyes darted wildly, and he occasionally jerked his head as if responding to unseen voices. He wore mismatched clothing, and his hair was disheveled. He repetitively tapped his fingers on the armrest, and whispered words that did not make any sense. A nurse was trying to calmly reassure him, but he continued to be very agitated. Kai's eyes were drawn to the man, and he froze. Kara gently touched his arm, "Kai?" Kai looked at Kara, then back at the man. A wave of pity washed over him, mixed with a sense of unease. Internal Monologue (Kai): "That could have been me. That could still be me. But... it doesn't have to be. Dr. Cruz's words echo in my mind: 'A path to healing.' Maybe... maybe there's a chance. Maybe I can get better. Maybe I'm not as broken as I thought." He looked at Kara, and a small, genuine smile flickered across his face. "Let's go," he said, his voice slightly stronger than before. As they walked down the hallway, Kai glanced back at the man, a silent promise forming in his mind: "I'll get better. I promise." Kara then said, "He seems really sick." Kai replied, "Yeah, he does. I hope he gets the help he needs." They continued walking in silence.