Circe by Jessica Penot

asked, "Have you been going to your morning therapy groups?"
    "Yes," he said.
    "It says here that they haven't seen you in over a month."
    "Oh, yeah. Maybe I haven't been going."
    "You also haven't been going to vocational groups or afternoon group."
    He looked confused and stuck his tongue out again.
    "Do you remember what we talked about the last time we met?"
    He shook his head.
    "You have to go to your groups before we can even talk about you leaving."
    "Do you think you can remember to go to your groups this week?" Nurse Brown asked.
    "They never tell me about them."
    "Yes. They announce every group on the speaker four times before each group. They tell you about them. It says here that Katie has even been coming in to remind you before groups."
    He shrugged despondently and began to tap on the back of his neck.
    Dr. Yoshi almost moved. He asked him, "Is there anything you need from us? Do you have any questions?"
    "I'm thirsty."
    "We've already talked about that," Gardner said. "You drink too much water."
    His tapping became more intense and more rapid. "Is there anything else that we can help you with?" I asked.
    He just began to tap harder and looked at the wall.
    "I think Mr. Guiles is done," Nurse Brown said, and with that the mental health worker ushered him out of the room.
    "I'm recommending another three months before review. In that time, he must attend reality therapy at least twice a week and see the hygienist at least three times a week. He must also make marked improvement in his ability to care for himself before a group home will be recommended," Ms. Gardner said.
    "Current course of medication will be maintained," Dr. Yoshi said.
    "I agree," Nurse Brown said.
    "Why three months?"
    "That’s the longest period we can recommend between reviews. It is also mandatory that we go to court at least every six months to ensure that his institutionalization is legal. We'll have to deal with that in three months. Only doctors can go to court. Psychologists or psychiatrists."
    "According to Dr. Allen's report, she indicates that he has been more responsive to working with Katie and her behavioral modeling program than with the reality therapy group. She recommends a change of group and a review in one month." I looked at Dr. Allen's report as I read, purposefully trying to avoid eye contact with Ms. Gardner.
    "Mr. Guiles is purposefully resistant to any treatment and we shouldn’t change his treatment until he is at least minimally compliant," Ms. Gardner said.
    "Prior testing shows that Mr. Guiles has a borderline IQ and virtually no contact with reality, I think it’s projection to think that he’s purposefully resisting any kind of treatment. Dr. Allen's testing indicates that he’s going to need to be spoon-fed a more basic treatment. His history shows that he has been doing reality therapy for 20 years now and we can see where that has gone."
    Dr. Yoshi moved to make eye contact with me, "You have to remember how poor Mr. Guile's prognosis has always been. We don’t expect him to improve. He's been on every antipsychotic we have.” Dr. Yoshi was almost impossible to understand.
    "Drugs alone can't be the answer," I responded.
    Dr. Yoshi shrugged. "Why not try your way?" he said.
    Ms. Gardner turned beet red. "You get to do the paperwork then, Dr. Black," She threw the enormous binder that contained his file at me. "Do you know what you’re doing?"
    "I'll figure it out."
    For every treatment planning meeting there is a mountain of forms to fill in, and every member of the treatment team has to sign every page. The patient and their family also have to sign every page of the treatment plan. I was to find out later that the better portion of my day would be spent doing paperwork such as this. Mr. Guiles was brought back in and we carefully explained to him about the behavioral modeling program he would be working on with Katie, a Psych Tech. We requested his approval and he grimaced and snorted and put a