Real isn’t how you are made. It’s something that happens to you.
Sometimes it hurts, but when you are Real you don’t mind being hurt.
It doesn’t happen all at once.
-Margery Williams, The Velveteen Rabbit
I stared at the chart and frowned.
“Delusions, hallucinations... defiance ? Defiance isn’t a medical problem. Certainly not in a…” I checked the age of the patient. “ Ten year old?”
“I didn’t write that part,” my coworker and friend, Joe said. “But the rest of it…”
“...Sounds more like a case for a psychiatrist, not a doctor,” I finished, returning the file to his desk before turning to go.
“Claire,” Joe called me back, and it was enough to give me pause, since he so very rarely used my first name. It was either Dr. Beauchamp in public, or his funny nickname for me; Lady Jane, when we were alone.
“You’re one of the best diagnosticians in the country,” he reminded me. “You really think this file would have made its way to you if every other avenue hadn’t been exhausted?”
I crossed my arms. It wasn’t that I was just resisting treating the child, but I had patients coming out of my ears already, and I was, quite honestly, getting exhausted. I didn’t like wasting my time on cases that could easily be handled by someone else. It wasn’t heartlessness, just practicality.
“What is it?” I asked him. “There’s some reason this means something to you, and I want to know what it is before I take the case. What, his parents big donors to the hospital or something?”
Joe smiled. He knew me well enough to know I would take the case. “Or something,” he said. “Kid doesn’t even have parents. He’s in the foster system.”
“Oh…” I replied flatly, beginning to understand. Joe himself had spent a bulk of his childhood and adolescence in foster care, until a good family finally adopted him at the practically un-adoptable age of fifteen. Naturally, it had giving him a special soft-spot for any child going through the same thing.
And I could certainly sympathize with an orphan. I was lucky enough to have a loving uncle willing to take me in when I suddenly became orphaned at five years old, but if it hadn’t been for him, I would have just been shuffled into the system like all the rest.
“So no, no one is putting up big funds for this kid,” Joe continued. “He’s been dismissed as a behavioral case by every other doctor he’s seen, but his case worker seems convinced that it’s a medical issue, not a behavioral one. No one is helping this kid because...no one cares. The case worker is an old friend of mine, she asked me personally if I could help. I can’t, but I thought maybe you can .”
I sighed and let my shoulders droop. “Oh fine ,” I said. “Have Rachel set up an appointment, but for now I have to go. Frank’s going to be pissed as hell if I’m late for our date again.”
“Oh, of course, can’t keep Frank waiting,” Joe droned, earning a glare from me.
It was no secret that he wasn’t Frank’s biggest fan, though he kept his opinions mostly to himself. But it was bullshit, because Frank was never anything but nice to Joe.
I took the file back from him and left, flipping through it on my way to the elevator.
According to his case worker, his hallucinations and delusions had persisted for as long as she’d known him, which was since he was seven years old. But they’d never caused a problem until recent months.
I rocked my head from side to side, considering. If it was a mental disorder such of schizophrenia, or even something milder like autism, it would make sense that issues with behavior or aggression would increase as the the boy neared puberty. I still felt like a therapist would be better equipped to diagnose him, but if no one else was taking it seriously, then I would.
I hurried into the restaurant, sort of hoping that Frank would be in the middle of a work call and wouldn’t have noticed my tardiness. But no such luck, the poor man was sitting at the table for two, staring off into the distance.
“I’m sorry,” I said, taking a seat opposite him. “Traffic was a bear.”
Frank nodded. “Yeah, I heard there was an accident on the highway.”
I was a little surprised. Frank was normally highly annoyed whenever I was late, and never tried to hide it.
“How was work?” I asked, picking up the menu.
Frank launched right into a rundown of his day, sharing a funny story about one of his students that came into class hungover but tried valiantly to hide it, and I relaxed, glad I wasn’t in the doghouse again .
Frank and I had been together for four years, having met by chance at Harvard while I was there presenting a lecture to medical students and he was on his way to teach his 8am history class. He was nothing like what I’d envisioned for myself in a life partner. He was quiet, serious, and taught my least favorite subject. But he was intelligent, responsible, had his shit together (unlike most men I’d dated,) plus, he was good in bed. We got along fairly well, had fun together, and respected one another professionally.
I suppose the only issues in our relationship were our challenges with etching out quality time together with our busy schedules (okay, it was mostly my busy schedule,) and his complete abohorrance of marriage.
His parents’ marriage had been a disaster, he said, and he had no desire to follow in their footsteps. I tried to reason with myself that it didn’t really matter if we got married as long as we were happy together, but sometimes it did make me sad that I wouldn’t get to have the whole wedding experience; white dress, big cake, the whole shebang.
Our other issue was a bit more of a sore spot…
“How’s your calendar looking?” he asked.
I chuckled. “Sometimes I can’t tell if you’re asking about my work schedule or my fertility schedule.”
“Well, they do have to match up,” he chuckled. “It wouldn’t do us any good if one schedule said ‘good to go’ and the other one didn’t.”
I laughed. “Good point. Actually, this is a good night.”
Frank smiled, pleased, and motioned the waiter for the check.
A year and a half ago, we’d decided that we wanted a baby. We were in good places financially, in a stable relationship, and it just felt right. It had all been so exciting those first couple of months. I took myself off birth control and we went at it like rabbits. But as time wore on, and nothing happened, the excitement wore off and anxiety settled in.
I’d wanted to go to a fertility doctor, but Frank was still hesitant about it. My OBGYN and friend, Geillis, suggested an app we could use to track the times of the month I was most fertile, so I’d been keeping careful track of my ovulation and the times we were intimate. It had only been a couple of months, so I hadn’t lost hope just yet, but every time I started my period, I felt defeated.
When we got back to the condo we shared, we went about our typical evening routine. Showers, teeth brushing, checking emails, packing lunches for the next day.
When we got into bed, Frank immediately pulled me into his arms, kissing me. I admit, I wasn’t really in the mood, but I did my best to give myself over to him and let the sensations relax me after my long day of work.
We were both able to settle into peaceful sleep after, hopeful that maybe this time would be the time.
I entered the examination room, smiling at my young patient.
Fergus St. Germain was born in the United States, but his France-native mother had taken him back to her country shortly after he was born. After she died of a drug overdose when Fergus was five, he was shipped back to America to live with his father. But the father, sadly, had no interest in raising a child, and turned him over to the system.
The boy sat on the bed cross-legged, peering at me through a curtain of dark wavy hair that hung in his face. He was a cute little thing; big blue eyes, freckles on his nose, and a quirk to his mouth which made him look like trouble - but in a good way.
“Hello, Fergus,” I said. “I’m Dr. Beauchamp. How are you, today?”
Fergus glanced off to the side, and then his face scrunched up and he laughed.
I looked over at his case worker, a woman by the name of Louise de la Tour, who shrugged. “He does that a lot,” she said.
“Fergus,” I repeated his name, trying to get his attention. “How do you feel?”
“Fine,” he said. “I’m not sick.”
I gave him a long look, needing to remind myself that this wasn’t one of my usual cases. I didn’t often treat children, but I supposed if I ever wanted to be a mother, I needed to learn how to talk to one.
“Oh,” I said. “Then why are you here?”
Fergus looked at me in surprise. Clearly he hadn’t been expecting such a question.
“I guess because Mr. and Mrs. Grant say I’m crazy.”
“Mr. and Mrs. Grant?” I asked, glancing at Ms. de la Tour.
“His most recent foster parents,” she explained. “He’s currently in a group home.”
I looked back at the child. “Why did Mr. and Mrs. Grant say you’re crazy?”
“Because they can’t see Jamie, and I can.”
“Jamie?” I asked. “Who’s Jamie?”
Fergus’s eyes cut over to the corner of the room, and despite myself, I followed his line of sight, seeing, of course, nothing.
“Jamie is his...imaginary friend,” Ms. de la Tour said.
It certainly wasn’t unheard of for a child to have imaginary friends, though I supposed ten was a little old for it. But still, I didn’t see how that was a problem for a doctor.
“Why don’t you tell me about him?” I asked Fergus.
Fergus perked up, seeming happy that someone was taking an interest. “His full name is James Alexander Malcolm MacKenzie Fraser. He’s from Scotland and he thinks you’re really pretty.”
Fergus cackled and leaned away, as if this person in question was cuffing him for saying that.
“Well…” I said, smiling. “Tell him thank you for me. Does Jamie ever tell you to do anything bad?”
Fergus scowled at me. “Of course not!”
“Do you...ever have any headaches? Dizziness? Do you ever see anything else that other people say isn’t there?”
Fergus shook his head after each question.
“Well...if it’s okay with you, we’re going to run a couple of tests, just to be sure.”
Fergus glanced to the side again, as if seeking council from his invisible friend. “Okay,” he said at last.
Once the nurse came in to take Fergus to his MRI, I wheeled the little stool around and sat facing his case worker.
“In Fergus’s file, it says that his delusions have recently caused issues with aggression. Can you elaborate on that?”
“Fergus is a sweet boy,” Louise said. “Truly, innately kind. But the past three homes he’s been placed in have complained of, quote, ‘disturbing behavior.’ Temper tantrums, fighting with his foster siblings, stealing, and other...unusual behavior. But that’s not even what they say is the reason they’ve sent him back. It all stems back to Jamie . This isn’t a typical childhood imaginary friend. Fergus really thinks that Jamie is there, and he becomes very agitated when that’s disputed.”
I sighed, folding my hands. “I have to tell you, I’m really not sure that this is a medical issue.”
Louise sighed as well. “A ten year old boy...already aged out of the most adoptable stage. A ten year old boy with a medical condition...even more difficult, but the sympathy factor is bound to reel in some well-to-do family, especially considering his cute face. But a ten year old boy with a mental disorder? He wouldn’t stand a chance.”
Finally I understood. Ms. de la Tour was just hoping something was wrong with Fergus medically, as twisted as that sounded. What was really sad was that she hoped that, because she cared.
“I get what you’re saying,” I said. “But I can’t fabricate something medically wrong with Fergus. Obviously I want to rule out a brain tumor, but I really don’t think that’s the case.”
“But you can check,” Louise said. “You can talk to him. Just...check.”
I offered her a smile. “I can certainly check.”
I sent the case worker to the cafe to get some lunch, and when Fergus came back from his MRI, I went to see him.
“Did it look like I was getting eaten by a monster?” he was saying, though there was no one else in the room. “No, it didn’t hurt.”
“Hey,” I said, announcing my arrival.
Fergus looked away from the side of his bed to me, and smiled. “Hi, Dr. Beauchamp.”
I walked in and sat on the edge of the bed. “How’s it going?”
“Are you a Sassenach?” Fergus asked suddenly.
I blinked, taken aback. “Am I a...” I chuckled. “God, I haven’t heard that word in forever. Where did you hear that?”
“Jamie called you that,” he said. “What does it mean?”
“From what I understand, it’s not all that complimentary. But basically, it means an English person, which is what I am.”
“He doesn’t mean it bad,” Fergus said, face scrunched in contrition.
I smiled again. “I didn’t think so. Your case worker says you’ve had some problems with your last couple of foster homes. Did Jamie cause any of that?”
Fergus shook his head. “No. It wasn’t his fault. All Jamie has ever done is look out for me.”
The boy said this so firmly, so seriously, that it gave me a chill. He really did believe that this ‘Jamie’ was a real person, and I found myself looking to the other side of the room, where Fergus had looked, and I mentally berated myself for being so fanciful.
“Jamie said that maybe he should leave,” Fergus said quietly. “That maybe I wouldn’t get into so much trouble if he wasn’t around. But I’m the only one who can see him.”
“How long have you seen him?”
“Ever since I came here after my Maman died,” he said.
I patted his knee. “Well, I don’t think Jamie ought to leave just yet.”
Fergus grinned. Beamed, really. “You hear that?” he said to the other side of the room. “If the doctor says it, you have to listen.”
Fergus’s MRI and blood tests all came out normal. There was nothing to indicate he was anything but a perfectly healthy ten year old boy. I did some extra reading on schizophrenia and other mental disorders, as well as neonatal abstinence syndrome, but Fergus didn’t have the right markers for any of those. If I had to wager a guess I’d say he could have ADD, but I was far from an expert on that and besides, attention-deficit-disorder didn’t cause hallucinations.
There wasn’t much I could do for him, but I couldn’t stop thinking about him. I wasn’t naive enough to think that his behavioral issues weren’t there just because in the hour total I’d been around him, he’d been nothing but sweet and respectful, but I couldn’t help but feel like any issues he had weren’t his fault, and were unrelated to ‘Jamie’.
I’d had an imaginary friend as a young child. Not uncommon for an only child. Her name was ‘Lacey’ and whenever I did something wrong; ate biscuits before dinner, broke a lamp, tripped a boy on the playground, I blamed it on Lacey. But I knew, really, that Lacey wasn’t real. I had imagined what she looked like, but I couldn’t actually see her. And by the time I was six and a half, I’d forgotten all about her. Fergus appeared to see Jamie as plainly as he could see me, but if that was true, then it was completely outside of my expertise and out of my hands.
I tried my best to put him out of my mind, but he would sneak in unexpectedly, with those sparkling blue eyes and that watered down but still noticeable French accent.
I never would have expected the page not even a month later that led me to the emergency room where Fergus was being brought in, with a broken arm.
“What are you doing down here, Dr. B?” Dr. Allen, one of the ER docs asked. It was true; I was rarely in the ER, outside of multi-car accidents and the weird night when everyone else was out sick.
“I heard you had a friend of mine,” I said. “Fergus St. Germain?”
Dr. Allen smiled. “Ah, the kid? Yeah, he’s in bed twelve. Just got back from x-ray.”
I tapped on the wall outside of the curtained area around bed twelve before pushing the curtain aside and stepping through. Louise was sitting on the plastic chair beside Fergus’s bed, and the boy himself was propped up by several pillows, the injured but yet un-casted arm covered up with a towel.
“Fancy meeting you here,” I said breezily.
Fergus’s face split into a wide grin, and it was adorably dopey thanks to the pain medication he’d been given. “Hi, Sassenach!” he exclaimed.
“Dr. Beauchamp,” Louise corrected.
“It’s alright,” I told her with a smile. “So what happened?”
Fergus’s smile fell, and his glance to the side informed me that ‘Jamie’, too, was present.
“He got into a fight with his foster brother,” Louise said, looking tired. “Fell down some stairs.”
I looked at Fergus again, and his brow was scrunched up in anger.
“Ms. de la Tour,” I said. “Do you want to go get some coffee while I’m sitting with Fergus?”
Louise looked relieved at the offer of a break. “I think I will, thanks. Fergus, want me to bring you anything?”
“Chocolate chip cookie?” the boys asked hopefully.
“Tell you what,” she said, standing and throwing her bag over her shoulder. “I’ll bring you two.”
After Louise walked out, I sat on the edge of Fergus’s bed, like I did before.
“Alright, kid, spill,” I said. “You didn’t really fall down the stairs, did you?”
Fergus’s eyes widened and looked aside. “Are you talking to her?”
“No, he’s not,” I said, arching a brow. “Let’s just say I’m perceptive.”
“Some cash went missing from Mr. Banner’s sock drawer,” Fergus said with a sigh. “Aiden is who stole it, and he was going to buy weed and blame it all on me. I confronted him, we fought, and he pushed me down the stairs.”
I shook my head, my heart clenching. “W...why didn’t you tell Ms. de la Tour that?”
Fergus bit his lower lip. “Because the reason I knew what Aiden was doing was because…” he looked away.
“Because Jamie told you?” I prompted.
The tech arrived to put a cast on Fergus’s arm, so I got out of the way.
“Is he okay?” Louise asked, arriving with a little paper bag in her hand.
I nodded. “He’s getting his cast, he’ll be fine. He told me that he was pushed down the stairs, by his foster brother.”
Louise sighed and pinched the bridge of her nose. “Dr. Beauchamp, I know what you must be thinking, but Fergus’s foster brother wasn’t even home when this happened. I just don’t know what I’m going to do about him. This was his fifth home in three months. One of them only lasted four days. I’m out of options.”
“What do you mean by that?” I asked.
“I mean I’m out of options,” she said. “I have no more foster homes available right now. He’s going to go back into the group home and…” she huffed and crossed her arms. “Despite their best efforts...it’s a rough place to be. Those kids, they’re all older. Bigger. All from broken homes. And Fergus, with a broken arm…”
“What does it take to be a foster parent?” I blurted suddenly.
Louise blinked. “What...do you mean you ?”
Admittedly, I’d spoken without really thinking, but the more I let it sink in, the more I was sure it was right. “I...yes. I’m financially stable, I have a spare room. I have...well, I have a boyfriend that I live with, but we’ve been in a committed relationship for four years, and we’ve actually been trying to have a child. I’m sure he’d be more than happy to take in a foster child.”
Louise’s eyes widened. “Dr. Beauchamp, if you’re sure , then...yes. There’s an application process, of course. House checks, background checks, all of that. But I can get all of that expedited. I mean, I trust Joe, and he gave you a glowing recommendation. Truth is...he needs somewhere to go tonight …”
“Okay,” I said, my mind whirling with logistics. “Just...tell me what I need to do.”
Louise smiled. “This is wonderful, Dr. Beauchamp but...are you sure ?”
“Yes,” I said firmly. “I’m sure.”