The Clinic

by blankpagewhitenight

I peered over the magazine in my hands at the man seated across from me dressed in cotton sweats and slippers, his head inflamed and leaking. The sight of him made me want to pull my sweatshirt over my face.
“Nathan Broody?” The receptionist was standing beside the front desk with a clipboard in her arm. “Dr Townsend is ready, fourth door on the left down the hall. He’ll be with you soon.” She led the way up the hall and then turned back into her cubical. Most of the doors in the hall were closed. I walked slowly past an open door and saw a man sitting near a desk. He had a white plastic section of the human spine in his hands. The next door was Townsend’s and it was empty. There was an office chair and small dining chair next his desk filled with coloured manila folders and a few plastic joint-statutes of his own. Around the walls of his office were laminated prints of the human body dissected and quantified.
The view outside the office was of the clinic car-park, the Venetians two-thirds closed, the room lit with fluorescents. I took a seat in the chair. I hadn’t slept in days. When I closed my eyes there was a furious kaleidoscope of colour.
“Master Broody, your sleep has been causing you grief again?” Dr Townsend walked into the room dressed in light-green Dockers and a white shirt. Casually he placed another folder on his desk and a large plastic zip-lock bag, walked over to the small basin in the corner of the room and rinsed and dried his hands.
“Hi, Doc.” I coughed after I spoke.
“So tell me what’s happening, it’s been a few years since I last saw you.” He sat in his chair with his approachable smile. “Have you stopped sleepwalking in that time?”
“Kind of. I’d been living with someone, she usually woke me before I left the bed.”
“Have you been getting much sleep?”
“Not lately.”
“Well that’s not good. It’s important that you feel comfortable enough to sleep or you’ll end up much worse off.” He rolled sideways in his chair to the other end of his desk and opened the folder he walked in with. He found the sheet he was looking for and placed it on top of the folder and made some notes. His hair was parted perfectly along the right side of his head.
“You didn’t have to worry when you were with your girlfriend. You’ve complained of night-terrors as well, has that been a concern lately?”
“If the dream got out of hand it usually woke her, and her in turn me.”
“Do you notice any difference between a dream and a night-terror,” he asked, leaning back in his seat tapping his fingers together.
“I always thought they were the same thing.”
“A particular difference could be that dreams are usually pleasurable experiences?”
“Most dreams tend to get out of hand and I end up thrashing in bed.”
“When you’re sleepwalking?”
“Depends on the dream.” He makes another note on the page.
“Do you remember your dreams when you’ve been walking?”
“Yes. Once she woke me and I was standing in the room with a hammer, I’d been dreaming the car had broken down in the desert at night.”
“That’s unusual.” He rolled his chair back from the desk and stood. “I’ll be back in a moment.”
I sat up as he left the room. I sat there completely still until he returned some minutes later.
“I thought it might be the case.” Townsend had a text-book that must have been 5 or 6 centimetres thick. The cover had an image of a person’s head, again dissected, it had geometrical shapes floating out of it. The Journal of Psychosomatic Medicine. He slid a finger along the contents page and then flicked through wads of pages to find the relevant one.
“You sending me to a shrink?”
“Do you want to see one?” He looked up from his text-book and gave me direct eye contact; insuring a sincerity.
“You’re looking in a book of psychosomatic medicine.”
“You don’t suffer any mental illness, Nathan. This just had an article on a condition that might be similar to yours. I think, in fact, that you may have a neurophysiologic condition. The problem is the symptoms you’re describing are similar to what a person with, say, dementia might complain of.”
“I thought we sorted this, I have a sleep disorder.”
“Yes.”
“Parasomnias.”
“I thought that originally, but you said something before.” He leant back in his chair again, turned it so his back was facing me as he looked out the obscured window. “Though, it’s relevant that you’re back at your grandmother’s and the sleepwalking occurred again.”
“Trace would wake me.”
“Before your dreams got out of control,” he turned in his seat and faced me again. My phone vibrated against my thigh. “I hope that’s yours,” he asked.
“Yes.”
“You can check it if you like.”
“It’s fine.”
“Your dreams are the key here, Nathan.” Dr Townsend griped the edge of his desk and pulled himself in closer to the desk and near me. “We may have misdiagnosed you earlier.”
He now had my undivided attention.
“There are four different stages of sleep that occur.” He slipped a square piece of blue note paper between us and wrote: SWS, and REM. “The two stages that concern us here are these later stages. Slow Wave Sleep is what we refer to when talking about deep-sleep. This is when an episode of sleepwalking usually occurs, and this is usually because the person is disturbed during Slow Wave Sleep. This is why I think you may not be sleepwalking after all.”
“But that’s usually when I end up walking, when I’m fast asleep.”
“No, because you’re also telling me that while you’re out of bed roaming you are dreaming as well.”
“Yes.”
“REM sleep is the final stage of sleep we fall into, usually lasting twenty-five percent of the sleeping period. This is the clinch, Slow Wave Sleep occurs during the first stages also known as NREM, or Non-Rapid Eye Movement. If you were sleepwalking, as in a text-book definition, you wouldn’t be dreaming. During REM sleep, when we’re dreaming our breathing can become irregular, blood pressure can even rise, but there is a distinct loss of muscle tone; paralysis occurs. The only thing we really move when we’re dreaming is our eyes.”
“But people can wake from a nightmare. Most people move when they’re asleep.”
“You’re right. Though we’re up against a massive misconception of people when they sleep here. There are some reflexive movements that occur, but moreover we’re completely still when dreaming. It’s when people leave the REM stage and return to the earlier NREM stages that they can react to a fear or impulse the dream contained. The paralysis that we endure is a safety mechanism to protect us from hurting ourselves by moving in our sleep. The problem is this mechanism is inactive in you.”
“So what’s causing it?”
“It’s hard to say, and this is because there is so much of what the brain does that we are still very much unaware of. During sleep, though, especially when we dream, our brains are highly active. Activity recorded by EEG monitors have found the brain is just as active during REM as it is during wakefulness. Fascinating stuff, considering it has recourse to all the corridors of thought we entertain during consciousness, it hardly seems fair to disregard a dream as poppycock.”
“What’s EEG?”
“Electroencephalography; the measurement of electrical activity in your brain. There isn’t much in this book on the condition, I’m thinking it would be a good idea for us both to look into it at home. Do you have the internet?”
“Yes.”
“Keep a journal. We’ll watch it for a while and see if it fits.” He slid the blue piece of note-paper in front of me and pulled himself back along his desk. At the top of the note-paper he had written: (RBD) REM Sleep Behaviour Disorder. The acronyms were coming thick and fast.
“Is that it, I just go home and look it up, decide for myself?”
“There’s no test for it I’m afraid. We’ll keep an eye on it.” He opened his drawer in his desk and pulled out another note-pad and wrote something on it. “Four seasons today.”
“What’s that?”
“The forecast. Beautiful morning, later in the afternoon a front is moving in. It’s going to be a miserable night.” He tore the page off and handed it to me. “This is a prescription in the mean-time. They’re an anti-anxiety medication, going to help you get the sleep you need. I’m concerned with how agitated you appear from lack of it lately.” What was I thinking coming here in this state, probably look like a meth-head.
“I’ve had a few coffees this morning because I was out with a friend last night. I’m not usually this wired.” I took my phone out of my pocket and checked the message I got earlier.
“No one likes to feel they’re out of control but losing sleep is a terrible catalyst for a lot of health problems. Hopefully these will help you get some rest without sleepwalking.”
The message was from Rachael, still with Kyle and Billbrat at the Baychimo: Geoffrey T is having a party tonite!!! Can u handle the jandle?
“So the medication will stop me dreaming?”
“I don’t want you to stop dreaming, Nathan. Hopefully the medication will cease your somnambulism. If it doesn’t let me know, you should be noticing a difference in the next couple of nights. Get a hold of me regardless, I want to know either way.” He backed his chair out from his desk and interlocked his fingers on his lap. We were done.
“Clonazepam?”
“There are side-effects so make sure you read the literature that comes with them. Call me in a couple of days.” He got up from his chair and closed the door behind me. And just like that I had my prescription and my acronym and everything was going to be alright.

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