Dr. Russo’s swollen belly hindered his ability to rest comfortably on the metal chair at the small wooden table where he sat facing Katherine. The disparity between his robust appearance and Katherine’s gaunt visage was comically macabre. He grunted, as he adjusted himself on the seat, the chair creaking beneath his weight. The girl’s eyes never left his face and it was all he could do to keep from moving away from her haunting eyes. They were so large on her thin face, bright green but out of focus by the effects of her medication. Her face was sunken in and her lips were so chapped they were covered in bright red dots of blood. Her long dark hair hung limply below her shoulders and she looked like she hadn’t showered in days, despite the fact that all patients were washed and cleaned daily. The contours of her face were so sharp she looked almost elf-like. Her collarbones protruded sharply and the doctor believed her entire body must look just as withered. He couldn’t help the pity he felt for her. He cleared his throat trying to erase the deafening silence in the small room. Not even her breath made a sound and she was so still that he glanced at her shoulders to make sure she was in fact still breathing. He hadn’t dealt with many catatonic patients before and the way they stayed motionless and unaffected by their environment always unnerved him. He much preferred the screaming violence of other patients to the eerie calm of the mentally unconscious.

“Katherine,” began the young psychologist. “Katherine can you hear me?” he asked in a slightly strangled voice.

 She stared back, her mouth slightly agape. Her figure remained hunched over, immobile. Her arms rested atop the table and he tapped her left hand with his but she made no indication that she felt it. The doctor who had physically examined her had said her nervous system was still responding properly for now but her condition would only deteriorate her physical health.  

The air in the room was stale and it was a wonder how the patients here managed to stand it. They probably don’t, he reasoned. It was a ghastly place to be in and although the staff did everything they could to make it comfortable for the patients, nothing could erase the clinical smell of ammonia that clung to the walls or the way the light always seemed dimmer in the patient wards. Even now, the light bulb above them flickered and he couldn’t help but feel anxious and regretful that he didn’t just see her in his office. The last time he had seen her in his office had not been pleasant, though. She had had one of her more violent outburst and scared the living hell out of him. She had grabbed large paperweight, which seemed too heavy for her lanky arms to carry, and thrown it across the office. He’d barely had time to dodge it and it was embedded into the far wall just under the window.

Today, after an hour of trying to get the girl to communicate with him, the doctor gave up and jotted down the same sad sentence that he wrote down every week in her file: Unresponsive; condition continues to decline. Her parents would be arriving in a couple of hours for family day and he had to give them an update on her health. It broke his heart to see such a young person so completely helpless. He recalled his first encounter with her with a heaviness in the pit of his stomach. She was hysterical, screaming about a fire and the burned girl, and the fear she felt was evident in her wild eyes. In her hysteria she had managed to hurt one of the orderlies trying to placate her but nothing they did seemed to bring Katherine back to reality. The moment she beheld the tragedy before her on that ill-fated night, she was gone. Her fragile mind left her in a perpetual state of limbo, where she kept reliving what she saw, unable to communicate with anyone. After the incident her parents had her brought to the institution in order to bring her back to reality. All she did day and night was scream about the fire that had consumed and killed one of Katherine’s classmates.

With a final glance at the troubled girl, he exited the small room and made his way towards his office to prepare for the arrival of the families of his patients. Katherine’s ever present orderly grabbed the girl roughly by the arm and shoved her out the door, hissing beneath her breath something that sounded like, “Move, bitch.”

“Greta!” Boomed a loud voice at the end of the hall.

“I, uh, yes Dr. Russo?” stuttered the orderly, loosening her grip on Katherine.

The doctor stared at the woman and the way her fingers shook slightly on Katherine’s arm. It seemed like she was trying to loosen her vice-like grip on the girl but he could still see the menace in the woman’s eyes. He had noticed the blueish tint of a bruise beneath Katherine’s ashen skin occasionally, attributing them to the fragility of her body. Her malnourishment could cause a small bump in her sleep to create a dramatic lesion in the morning. Looking at the way Greta held the girl, however, caused him to question his initial reasoning.

“Be careful with her. Please,” he added as an afterthought. He didn’t want Greta to take out her anger at him on the girl. The woman gave him a smile that looked more ominous than friendly and he nodded at her once and turned forward towards the exit of the patient ward. He took a final apprehensive glance at Katherine and her attendant, and saw them at the end of the long white hall as they turned a corner and disappeared. After the receptionist buzzed him out of the ward which was guarded by a large metal door, he climbed the stairs to the top floor where his office was located. The institution was rather large and one could easily get lost in the labyrinth-like halls.

He actually had gotten lost, when he first arrived just over a year ago, trying to find his office. He had made one too many left turns and had found himself walking in on a very married Dr. Theodore Fray, the director of the institution, with a nurse in an extremely compromising position. The next day he was directed to the second floor just above the patient’s ward. His office had been moved to a much more spacious room with a beautiful view of the woods. On the desk sat single oleander and a note from the director, officially welcoming him to the institution. Later, when a nurse walked in with some patient files he noticed it was the same nurse he had seen in the director’s office.

She had cheerfully exclaimed, “Oh! Is that an oleander?” pointing at the flower. “Hmm, you should be careful with those, they’re quite toxic. They are after all the flower of caution,” she said, her voice oozing disdain. With a smile that was almost too bright, she walked out. He had taken the hint and whenever he ran into the director he made sure to keep his distance and his head down.

Mentally shaking away the memory, he reached his office and was surprised to discover two people sitting in the visitors’ chairs across from the desk. They were Mr. and Mrs. Alistair, Katherine’s parents. Dr. Russo’s heart immediately sank at the hopeful glances of the mother. He gave them a shaky smile as he went and sat in his chair.

“Hello Dr. Russo!” Mrs. Alistair spoke first. She was always so optimistic and it saddened him to always see her bright smile falter whenever he relayed the same news to them.

“Hello Mr. and Mrs. Alistair,” he replied. Katherine’s father, a burly, serious man, nodded in greeting. His stoic countenance was always intimidating but Dr. Russo had met him enough times over the past year to know that it was just a front to hide the way it tore him up inside to see how ill his daughter was.

“How is she today, doctor?” Katherine’s mother was quick to get to the point.

Dr. Russo cleared his throat before responding. Dr. Fray, had informed him that due to Katherine’s mental deterioration, electro-convulsion therapy was the next step in her treatment and Dr. Russo was not sure how Katherine’s parents would react to the news.

“Mr. and Mrs. Alistair,” he began cautiously, “Katherine’s condition has not improved from the last evaluation and unfortunately, conventional medicinal methods have done little to help her move forward.” He paused to gage their reactions and their blank expressions told him he needed to be slightly less delicate. He wasn’t the best at delivering bad news. “Erm, what I mean is, what Katherine needs now is something stronger.”

“Stronger, as in a higher dose of the medication she’s on?” asked Mr. Alistair in a leveled voice.

“No. I’m afraid medication alone cannot bring Katherine back. What Dr. Fray has suggested now, as a last resort is something called electro-convulsion therapy.”

“Electric therapy!” exclaimed Mrs. Alistair, making the young doctor jump a little. “You want to electrocute my daughter? She’s not a science experiment doctor!” Dr. Russo had seen many emotional sides of Katherine’s soft spoken mother. Hope, disappointment and a sadness so profound that it still made his heart tighten at the thought of the way her face always fell when he delivered bad news. He had never seen her angry, and for some reason, he welcomed it. It meant she still had some fight in her and that she was still strong enough to bear whatever news he delivered.

“I understand your concern Mrs. Alistair. I know it sounds a bit extreme…”

“Extreme is right doctor,” interrupted Mr. Alistair. “You want to shock our daughter awake but what if she doesn’t come back. Won’t that only make everything worse?” He remained calmer than his wife but the doctor could see he had upset them both.

“Electro-convulsion therapy has been proven countless times to help patients with catatonia and other mental illnesses. The process is fairly simple and I promise, Katherine won’t feel any pain at all. All that happens is an electric current is sent into the brain causing a small seizure in order to stimulate and reverse the symptoms of her illness.” When he finished explaining he couldn’t help but shrink slightly under the glare of his patient’s shocked parents.

“It’s your only option,” he spoke softly but his words carried the weight of a hundred voices. Mrs. Alistair’s anger dissolved and she heaved a sigh as she looked up at her husband, her eyes glistening.

“We’ll think about it,” was all Mr. Alistair had to say before standing up and walking out with his wife. Dr. Russo ran a hand through his blonde hair and let out a long breath. He looked at the clock hung just above the window across from his desk. It read 12:50. At one, the visiting center would be open and families could see their patients. He exited the office and followed the Alistair’s to the visiting center.

 ###

When Katherine’s parents arrived at the visiting center, their daughter was already sitting at a small table facing the open doors to the other half of the room reserved for the more violent patients, where they had visited with her many times. She had only recently been allowed in the other room, as her state became nonviolent.

 The double room was surprisingly cozy with its ocean blue walls, big windows and fluffy brown carpet. The walls were lined with drawings brought over from the children’s hospital and the open windows allowed the clinical smell of the institution to diminish slightly. It would be more inviting if not for the orderlies who stood with rigid backs at each end of the room. Ready to take down whichever loony acts out first, though Mrs. Alistair with pity.

Mrs. Alistair tightened her grip on her husband’s arm when she saw Katherine.

“It’s alright, darling,” her husband reassured, pulling her forward as they made their way to the table. Katherine looked just as haggard as the last week they had visited. Her eyes stared straight forward, never focusing on anything and her sallow face made her look almost lifeless.

“Hey kitty cat,” whispered Mr. Alistair, his voice breaking on the last word. He cleared his throat and continued, “How’s my favorite girl doing today?” They had grown used to her silence but it never made these visits any easier.

“It is mom and dad, Katherine,” spoke her mother, as she reached out for her daughter’s hand. She held it in both of hers and let out a soft sob. Her hand like the rest of her was so skeletal and didn’t feel anything like it used to. Katherine’s pulse was barely palpable and Mrs. Alistair couldn’t help but think that her daughter didn’t have long to live if she remained sick.

“Don’t cry Elena, everything will be alright,” her husband tried to comfort, but she couldn’t hold back the tears that had been threatening to fall since Dr. Russo had told them their only option was to shock Katherine back into reality.

“But it won’t be, Sean,” she sobbed. “She’s going to die in here, look at her! She almost is.”

Katherine’s face remained apathetic as her mother fell apart before her. 

“Oh sweetie,” whimpered Elena as she tightened her grip on her daughter’s hand, trying to force a reaction out of her. “Please look at me. Talk to me,” she begged as her hope finally began to falter.

“As long as she can do things for herself, there is still hope,” she remembered Dr. Russo saying, and so she had clung onto those words like a lifeline.

When Katherine sunk into a catatonic state, Elena remained strong, believing it to be only a phase. The doctor’s had said this did not mean the end. And so again, Elena hoped.

Now, sitting across her daughter, fear and realization gripped her heart like a vice, and she knew it really was the end. If Katherine didn’t respond, she would waste away and there was nothing her own mother could do.

Sean held onto his wife as she silently sobbed into his sweater. When she looked up at him, his eyes were stony. He stared at his daughter with such force, almost hoping to get her to react by his look alone. But Katherine was gone, and all that remained was an empty vessel with what vaguely resembled the once beautiful face of his daughter. This small, broken person was a caricature of the girl they raised. Unlike Elena, he had given up hope long ago. She recalled how when Katherine finally stopped mumbling about the fire, he thought that was a good sign. One day, while visiting with her alone, he tried speaking to her about all the new books he had bought just for her. That was their thing—books. They had hundreds and they were always staying up late having conversations about whatever novel they were currently reading. Elena though about what Sean had told her about his visit with their daughter. All Katherine had done as he spoke to her was stare, he told his wife. He said her eyes would go in and out of focus and he knew then that she was gone. She may as well be dead, he had furiously thought.

“Why won’t you just talk? Just talk to me!” he had growled furiously. When she didn’t even flinch, he had pushed up off the chair causing it to crash with a bang onto the concrete floor. He left her that day alone, sitting on her chair, staring at something he couldn’t see. Since then, he never visited her without Elena.

When his wife regained her composure, she looked at her daughter and grabbed her hand once more. She started speaking to her, as usual, of all the things going on in their lives. All the things Katherine was missing.

“Your friend Gabriella doesn’t come around anymore,” she told her. “You know she graduated top of the class.” She looked longingly into Katherine’s eyes. Gabriella was Katherine’s friend since childhood and they had been inseparable most of their lives. She had emigrated with her family from Mexico at a young age and when she first got to town, Katherine was the first one to befriend her. After the fire, Gabriella frequently stopped by to get updates on Katherine’s health but wasn’t allowed to visit her in the institution. After a while, she stopped going over to the house and would only phone in occasionally. By now, she was so busy with school and college that she barely had time to call. As she reminisced, Elena couldn’t help her aching heart. The fact that Katherine had missed her senior year had hurt. She missed all the wonderful things that mothers fuss about and never made the memories all girls her age should make. They never went looking for a prom dress together, fighting over the length of the skirt; Katherine never had to save up all her summer money for the class trip to the beach the kids went on; and she never got to walk up the stage steps, her legs shaking, as she finally received her diploma. Elena’s heart broke for all that her daughter had missed and would probably never have.

  “Come back, Katherine. Please,” she pleaded. They stayed silent for a while, holding each other as the room emptied. In the other room, where the more violent wards had their visits, a low strumming could be heard. The guitar played a soft melody and as a voice began to sing softly, Katherine’s head snapped up sharply. Her green eyes grew wide and her breathing hitched.

“Katherine? Oh my God, Sean, she’s speaking!” Elena’s words came out in a rush as she tightly gripped her husband’s hand. Sean looked intently at Katherine as her chapped lips slowly shaped around what she was trying to say. Her voice was imperceptible.

“What is it, what are you trying to say?” asked Sean.

Whatever she was trying to say only came out like a dry rasp.
            “What? Katherine, honey, speak up, what are you trying to say?” But Katherine was done speaking. Her eyes remained wide and her head was held high, but she had gone back to her silent staring. No other words left her lips, but that was enough for Elena’s hope to rekindle.

“Sean go get the doctor!” she almost pushed her husband out the door. When he came back with Dr. Russo and another man in tow, she was holding Katherine’s face in her hands. As the men entered the room, the last visitors exited the visiting center and the patients were taken back to their rooms.

“Katherine,” began the doctor, “can you hear me? What did she say?” he directed his last question at Mrs. Alistair.

“I couldn’t make it out but she said something I swear it.”

“Do you mind?” asked Dr. Russo, gesturing for Mrs. Alistair to step aside so he could examine the girl. She moved to kneel beside Katherine’s chair, taking hold of her hand yet again. “Dr. Martin, if you will, please,” he called his colleague over. The man removed a small flashlight from his coat pocket and shined it in Katherine’s eyes. Her large pupils became pinpricks of black as the light swept from one eye to the next. Next, the doctor checked her reflexes and held his stethoscope to her chest, listening to her heart.

“Her heart rate is slightly elevated,” he announced, letting go of her wrist after checking her pulse. Turning to Dr. Russo, he shrugged his shoulders as if saying, nothing’s changed.

 “Did either of you say or do anything different?” asked Dr. Russo, turning to face the Alistair’s.

“No, we just talked to her like we usually do. If she spoke, does that mean she’ll be better now?” The desperation in Mrs. Alistair’s voice was clear.

“I’m not sure,” he replied honestly. “If she finally reacted to an external factor, then maybe what we talked about earlier might just be the last push we need to get her to come out of her stupor.” Mrs. Alistair turned to her husband and surprised everyone by saying, “Okay. Let’s do the therapy. If it’s our last shot, let’s do it.”

“Are you sure, Elena?” Sean looked into his wife’s face. “We don’t want to make any rash decisions.”

“We don’t have any other options Sean. This is our last chance to get our little girl back.”

Mr. Alistair took a deep breath and looked at Dr. Russo. “Alright. How do we get this done?”

###

Dr. Russo and took the couple up to the director’s office while Dr. Martin took Katherine back to his office for a more in depth examination before taking her back to her room. When they reached Dr. Fray’s office, Dr. Russo made sure to knock loudly and waited for the director to let him in. After discussing the treatment at length, both Mr. and Mrs. Alistair signed the forms which allowed the institution to move forward with the electro-convulsion therapy. The first session was scheduled for the following Wednesday.

“The procedure is so simple that we will bring the equipment right to her room so she doesn’t feel frightened in a foreign setting,” explained Dr. Russo. “The actual procedure will only take about twenty minutes, and she will be in the recovery room for another thirty. From there we will evaluate her again to determine the next steps towards her recovery.” His patient’s parents nodded in understanding.

“You’ll be able to visit her as soon as the treatment is over,” he informed them.  

After they left, Dr. Russo felt more tired than he had in a long time. As optimistic as he sounded when explaining the treatment to her parents, he wasn’t altogether convinced that Katherine would ever recover. To him, the girl looked exactly the same. Her body language told him she remained unresponsive, unfazed.  She seemed so far gone, her mind was so disconnected from her physical body. If she had really reacted today, it must have been merely a brain reflex or a spasm of her neurological system. If on Wednesday the treatment wasn’t effective, then all hope for Katherine’s recovery really would be lost.