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“There’s a fox—” Alek stopped because he couldn’t think over the ringing in his ears.
At first, he had thought his brain injury had triggered the tinnitus, but now he knew the truth; that the ringing had always been there and his music was covering it up. His ears had been ringing since the day his uncle died. It had only grown louder when his uncle’s house burned to the ground, and his mother shot off a gun a few feet away from him in an empty room that echoed like ricochets, and louder still when he fell from the top floor of the Victorian after he’d decided that the only way he could love Ian was to let him go.
He should have died in that fall. Then the ringing would have stopped. Then they’d both be free.
Ian squeezed Alek’s thigh and Alek returned to the present, the ringing quieter now like it was locked back inside a box that didn’t open, hidden in a secret place beneath the roots of a dead tree in Bulgaria.
“You saw a fox?” Dr. Dhawan prompted.
“I thought she was real, but only I can see her. Only I can hear her. I first saw her a few days before the fall.”
Dr. Dhawan’s brow wrinkled. “You worry that you’ve been hallucinating even before your head injury?”
“What if I can’t trust my thoughts?” Alek’s voice cracked. “How will I know what’s real?”
“Ian, if I can borrow you for a minute?” Dr. Dhawan asked. “Was there ever any concern for Alek’s mental health before the fall? Did you ever notice anything abnormal?”
Alek held his breath.
“No,” Ian answered immediately. He took Alek’s hand and held it against his heart like he wanted Alek’s own heart to follow his slow, steady pulse like a metronome. “He’s always been a little brooding. I’ve occasionally worried about depression, but the other signs weren’t there. He’s always been energetic and passionate, slept well, no appetite changes, no substance abuse.”
The revelation that Ian had worried Alek had depression wasn’t a surprise. Ian was a fixer, and a researcher, and he’d brought his concerns to Alek before.
“Melancholy aside,” Ian continued. “I’ve never seen anything suspicious. I never saw any sign that he was seeing or hearing things I couldn’t—not until after the fall.”
“Do foxes bear any sort of importance to you, Alek?” Dr. Dhawan asked. “Perhaps your mother read you a story when you were a child that featured one?”
Alek shook his head. His mother never read to him. Sometimes his uncle had, but mostly he told stories from the timewhen old gods ruled the world, when civilizations were born in blood, when heroes died because it was what had to be done.
“Why can’t the fox be realanda hallucination?” Dr. Dhawan proposed. “Maybe you really saw a fox before the fall. Maybe that fresh experience made an impression on you.”
“I thought we weren’t supposed to entertain my psychosis.”
“No, we should not, but we also shouldn’t entertain the idea that everything can be explained by psychosis. Has this fox ever told you things?”
“No.”
“Does the fox make you feel persecuted or paranoid? Or maybe like you’re a god? More powerful, all-knowing?”
“Of course not.”
“Does it ever tell you to hurt someone or to hurt yourself?”
“I told you, no. It doesn’t talk. This isn’tThe Lion, the Witch, and the Fantastic Fucking Fox.”
She smiled again. “I think you have major depression with a psychotic component. Psychosis, like the fox hallucination you’ve experienced, can occur in the setting of severe, untreated depression. We’ll still do an MRI to rule out structural changes from the fall, but the treatment remains the same regardless?—”
“Why depression?” Depression felt like a personal failure, though Alek couldn’t pinpoint exactly why.
“Depression occurs in over half of patients who suffer a traumatic brain injury. You’ve lost your music, the use of your hands, your independence. Depression isn’t just being sad. It can manifest as anger, insomnia, a negative perception of yourself?—”
“You’re sure it’s not schizophrenia?”
“Based on the presentation and duration of your symptoms, it’s very unlikely. I know you worry about seeing the fox before the fall, and I understand your concern, but if you had schizophrenia, I think Ian would have noticed something amiss.”
Alek looked to Ian, who nodded his agreement with Dr. Dhawan’s assessment.
“You can continue the trazodone and I’ll add an antidepressant and antipsychotic, but medication alone won’t be enough. You’ll need to change the way you think about yourself, and your past. Talk to someone. Whether it’s me or a therapist. Someone. But you don’t need to get bogged down with that now. Let’s start some meds, get you some sleep, and when you’re feeling better, we can look at the harder stuff.”
