Real Life
Patient File
Name: Jackson, Katherine
Sex: F
Age: 20
D.O.B.: 06/17
Height: 6'6"
Weight: 198 lbs (at admission) / 212 (current)
Eyes: Hazel
Hair: Brown
Birthplace: Riverside Methodist Hospital, Columbus, OH
Nationality: U.S.A.
Referring Facility: Duke University Counseling and Psychological Services
Family History: Parents are Danielle Smith (age 58) and Christopher Jackson (age 60), of Columbus, Ohio. Siblings are Matt (age 27) and Diana (age 18). Danielle and Christopher's marriage was troubled, and they divorced when Katherine was 12. Matt was at college at Ohio State; Katherine and Diana resided with their maternal grandparents for 11 months during a protracted custody battle. Danielle was eventually awarded permanent custody. Both parents have since remarried. The relationship between Katherine and her stepfather Jim Hauptmann is self-described as cordial but distant.
Medical History:
Katherine Jackson is a competitive athlete, focusing in basketball and track. She has sustained minor acute and overuse injuries (Appendix C) during participation in athletic events. No major injuries, illnesses, or surgery.
One previous incident of disordered eating was recorded, when the patient was 14. The incident occurred at a point of personal and physical changes. She had just transferred schools after her mother's remarriage, and was undergoing a significant growth spurt. Careful home monitoring and outpatient counseling was successful, and the complaint did not recur during high school.
The present illness was discovered when the patient collapsed while exiting a classroom. She was unconscious for several minutes, and when she regained consciousness she was disoriented and suffering from vertigo. Two classmates (Ian Patrick and Brianna Rutter) escorted her to the campus clinic. At admission, blood pressure was 85/60 mmHg and pulse was 42 bpm. Normal resting values of 110/70 and 50-55 bpm had been observed previously. Blood sugar levels were low and patient condition improved after food and rest. A follow-up visit was suggested.
When the patient did not attend the follow-up visit, her emergency contact (mother) was notified. A second follow-up was scheduled. Patient did attend, and showed signs of continued malnutrition and weight loss. Additionally, during the interview, patient described a series of delusions which attribute various physical aspects to genetic engineering. This aspect was novel to the present illness.
Based on symptoms and prior history, admission to a resident care facility was recommended.
Working Diagnosis:
Patient has been diagnosed with Anorexia Nervosa and unspecified depression. Results from preliminary evaluations are included. EDDS, Appendix A. MCMI-III, Appendix B.
Recommendations:
Admission to a residential facility recommended to facilitate monitoring and establishment of healthy eating patterns. A college environment where students are responsible for purchasing food is subject to financial considerations as well as peer pressure. Once the patient has resumed a normal diet, transition to a more appropriate meal plan and a food diary are recommended for long-term maintenance.
Patient should be supervised at all meals but not invasively monitored; patient has previously exhibited evasive behavior due to self-consciousness. Nutritional counseling should be available on-demand and introduced after the patient has stopped refusing food. Behavioral counseling for self-image issues and depression should begin immediately.
Anti-depressant medication is not recommended at this time.
Current Status:
Patient has repeated claimed amnesia in support of these delusions, and becomes confrontational when questioned. Nursing staff should continue to avoid challenging these assumptions directly in favor of an integrative approach.
Patient has begun regaining weight and no further fainting incidents have occurred.
One minor injury has occurred during her stay at the institute. Patient fell while exhibiting compulsive exercise behavior during the field trip, resulting in a strained (Grade II) adductor magnus.
Other Information
Life History:
Katherine was a fairly normal child -- on the bright side of average, quiet and friendly. Then she hit a growth spurt and didn't stop; she was extremely awkward and clumsy for a while, and couldn't find age-appropriate clothes and stuck out in any crowd. Once she'd gotten a better handle on her hand-eye coordination, she started enjoying athletics. She started out in track and cross-country; the solitary nature appealed to her. But she was encouraged by everyone around her to go into basketball, and she did. On the court, she's 100% a team player; she knows basketball body language like the back of her own hand. Off the court, she's still awkward and shy, especially around other women. (The latter comes partly from the fact that she was put on teams with boys until she hit interscholastic competition, since only the boys could keep up with her. It alienated her from her female peers (who didn't like the special treatment) but she never felt like "one of the boys", either.
She has always had a healthy respect for authority if it respects her -- she got along with teachers well even when her relationship with her parents was rocky. (Neither of her gregarious parents knew exactly what to do with their quietest middle child. Her mother tried to help her look pretty and be a "normal girl" but without really acknowledging that it's hard to look normal when you're taller than your father at age 10, and her father was of the opinion that women are just confusing period, and as long as her grades were good she was doing OK.)
She was close to both of her siblings and had a handful of good friends [canon siblings] in middle and high school, but they all went off to different colleges, and while they'll send each other pictures on Facebook occasionally, they're not keeping close touch.
In her high school yearbook, she made two of the voted top ten-lists -- "Millionaires in Training", and "Axe Murderer or Librarian?".
At college, she's started trying on public personalities like she does dresses; none of them are a good fit, but she keeps at it. Being quiet and polite will get her through classes, but it isn't enough for a basketball squad captain, and it's easy to get lost in the crowd and not make friends. She's aware of that and is trying to reach out -- joining a literary magazine, doing community service tutoring kids with a local church, etc., but she still feels isolated and like everyone else knows how to do this college thing better than she does. The current iteration of her attempts to fit in is manifesting as an affected ennui -- "nothing we do matters, everyone's going to die, let's all read Sartre", but that's not really who she is. Self-esteem and depression issues aside, she's an optimist, and when feeling well she has to suppress her natural smiles to pull off this look.
Her body language is almost always a slouch; years of people talking at her chest has made her all but give up on meeting people's eyes. When she's on a date is a rare exception, because one) there are a variety of ways to sit cuddled where it's much easier, and two) she doesn't mind her chest being stared at in that context.)
Other Relationships:
Much of her success in high school, both athletic and personal, she will attribute to her Spanish teacher and assistant coach, Manuel Constantino. [Miles Naismith Vorkosigan] She had a schoolgirl crush on him (which was not reciprocated, as he is a happily married man).
Her relationship with her college coach Beatrice Stern [Bel Thorne, visitor] is less close although she respects Stern's knowledge and judgment.
The "science fiction" aspects to her delusions are mostly the fault of a recent, geeky ex-boyfriend (they went on a bunch of dates, but it sort of fizzled out) [no canon equivalent] she met in one of her classes; her tastes in books run more towards romances, chick lit, and biographies.
As of NS 46, these and the box they were in are in Taura's closet.
One small olive-colored purse (only large enough to carry what's in it):
hot-pink coin purse with no cash but a few cards -- coffee
buy-8-get-one-free card, copy card for the library. The slots that had her
driver's license, student ID, credit card are notably empty.
Dead-battery cell phone -- flip style, metallic pink.
Plastic keyring from the OHSAA women's basketball championships -- which has
snapped halfway through -- the end with the year is missing. A few keys on
it.
Emery board.
Compact foundation case thing (the kind with a teeny mirror).
Lip gloss, bubblegum in both color and flavor.
A tiny hairbrush with a hair tie around it.
A couple squashed diet meal-replacement bars, chocolate flavored.
And (not in the purse) a basketball.