Emily liked to think that Claire’s psychosis was slowly developing. Although previously undiagnosed, that theory justified Claire’s decisions over the last years. As Claire’s sister, it made it easier for Emily to accept some of Claire’s actions and decisions—especially regarding Anthony Rawlings. Emily mentally reviewed the timeline: Claire’s initial concussion resulting in prolonged unconsciousness—hell, a coma—although, when she was capable, Claire refused to use that word—was in September of 2010. Though not a concussion, her second brain injury was in June of 2013, when she was attacked by Patrick Chester. Claire’s break with reality occurred in March of 2014...

“There have even been suggestions that a hormonal imbalance as well as weight gain, like that associated with pregnancy, could have exacerbated previous injuries...”

To Emily, it seemed very cut and dry—and the timeline worked.

Dr. Fairfield continued, “...Although Ms. Nichols’ brain scans support a history of traumatic brain injury, I do not share the theory that this has led to her psychosis...”

Emily’s neck straightened, and she turned to her husband. What was he saying? Of course TBI was the cause of Claire’s psychosis! It was all Anthony’s fault! He injured her. If it weren’t for him, she never would have been Patrick Chester’s target. Emily’s internal monologue drowned out the doctor’s words. She needed to listen.

“...The studies are less conclusive on the rate of recovery, from non-TBI induced psychosis. It’s true; this patient’s current scans indicate previous damage to the right hemisphere of her brain.” He projected various scanned images on the screen and utilized a small blue arrow to point to Doppler generated specifics. “You’ll note, as is consistent with TBI, the damage is most pronounced in the temporal and parietal lobes. What’s of specific significance with Ms. Nichols is the reduction in gray matter. As that reduction occurs, patients tend to feel pain. Ms. Nichols’ history does suggest problems with headaches. Now, if we compare the MRI of 2013 with the one taken two weeks ago, you can see...”

Emily listened, trying to remember the previous evidence. Everyone had said it was the TBI which indeed had caused Claire’s psychotic break. She recalled discussion of injury—evidence of concussion, yet as she tried to focus, Emily realized, Dr. Fairfield wasn’t nullifying that evidence. He had acknowledged that the injuries occurred, but he was also stating that he didn’t feel that the injuries were the cause of her psychosis.

Turning to Dr. Brown, Emily whispered, “Is he saying the head injuries aren’t the cause of her psychosis?”

Dr. Brown’s eyes opened wide as she turned to Emily, nodded, and shrugged.

Dr. Fairfield continued, “If the injuries prove to be the cause of the patient’s current state of mind, then in that case I’d have to agree with the conclusion of others that no further recovery will occur.”

Emily’s mind spun. Who said that? No one had voiced that opinion to her.

Dr. Fairfield went on, “I have based my current prognosis on the patient’s most recent DTI, or Diffusion Tensor Imaging. This is relatively new imaging and wasn’t commonly available at the time of Ms. Nichols’ break. As many of you know, I’ve worked with the NFL on this subject and have been personally involved with many of the more public cases. Accurately monitoring and measuring brain activity is essential in any prognosis. Let me show you this segment of consecutive DTI.” Again, everyone’s attention was brought to the screen. The image before them moved, or—more accurately—it pulsated. The defined areas of color moved, reminding Emily of an intense area of thunderstorm activity on a weather map. “Note the increased activity in this area of gray matter. What’s significant is that this image was recorded during one of the patient’s hallucinatory episodes. Let me also show you the increased stimulation in this patient’s auditory cortex. For those of you less versed in the medical terminology”—Emily knew he was specifically rephrasing for her benefit—“I’m saying that even though we may not hear what Ms. Nichols hears, or sense what she senses, she is indeed hearing and sensing. More importantly, her brain is active. Yes, there are areas of damage, but the human brain is very powerful and is quite capable of regeneration and compensation. I conclude that with the right antipsychotics and a significant change in therapy, progress can be made to bring Ms. Nichols back from her current state.”

As everyone discussed this new prognosis, the room buzzed with whispers. John leaned over Emily in an attempt to speak with Dr. Brown. Emily remained silent, contemplating the possibility that Dr. Fairfield’s assessment could possibly be true. Her mind fluctuated between hopeful optimism at the possibility of recovery and less than guarded indignation at the possibility that Anthony’s guilt could be more indirect than direct.

When the room began to quiet, Emily stood. Slowly, silence prevailed. Clearing her throat, she utilized the voice she’d reserved years ago for addressing students. “Dr. Fairfield, if brain injury wasn’t the cause of my sister’s condition, please enlighten us on what was the cause?”

Everyone turned toward the good doctor, watching as he shifted his footing. “Mrs. Vandersol, psychotic breaks can occur for a number of reasons. Let me emphasize that I’m not insinuating that your sister isn’t truly in the throes of such a break.”

Defensively, Emily stood taller. Pressing her lips together, she refrained from speaking as she waited for the doctor to continue.

“The most common causes of psychotic breaks include brain injury and drug use; however, it’s also well documented that a significant life event can precipitate such a break.” For all of his large words and doctor attitude, Emily saw a sudden shift in countenance as he asked, “Your sister had a significant life experience, wouldn’t you agree, Mrs. Vandersol?”

“Yes, Doctor, I do; however, the length of my sister’s break has—in the past—been reason to believe that there was more than a significant life experience to blame.”

It was as if they were the only two in the room. No one else dared breathe, much less speak. Dr. Fairfield continued, “As I stated earlier, the human brain is a truly amazing organ—one that’s essential for each of us to continue living. Without it, we would be incapable of simple involuntary behaviors such as breathing or the beating of our heart. That same amazing brain can also protect us”—he paused and waited; silence prevailed—“It’s my opinion that this patient’s break may have been initially associated with previous injury. It’s also possible that the swelling of blood vessels during pregnancy, her difficult child birth, and even the hormones associated with breast feeding could have contributed.” Dr. Fairfield cleared his throat and pushed on, “After observing more than one of your sister’s hallucinatory episodes, I believe your sister is where she wants to be.”

Momentarily, Emily was at a loss for words. She stuttered as she looked to both Dr. Brown and John. “Ex—excuse me, do—”

John’s voice prevailed. “So, am I correct to understand—you believe Claire is willfully keeping herself in this state? Are you saying she’s faking?”

“N—no, Mr. Vandersol, I believe she’s in a true psychotic state. She’s obviously delusional, blissfully unaware of her surroundings or the burden her behavior has had on others. I also believe she doesn’t know she’s a mother nor of the fate of her husband.” When Emily shifted, Dr. Fairfield added, “I didn’t ask her those questions specifically. Mrs. Vandersol, your directives were maintained; however, in an effort to assess Mrs. Rawlin—Ms. Nichols, I breached some subjects that had no effect on her. Which I may add, I feel is a shame—”

John interrupted, “Dr. Fairfield, could my wife and I continue this conversation with you in private?”