“Good afternoon, Sylvia, why don’t you make your way inside and we can get started”. Stephen noticed early into the trip how such earth-centric terms caused a glitch in the thought processes of others. When you look out through the windows all you can see is the eternal black of space, the twinkling stars in the distance and around you the artificial brightness of the interior lighting. Stephen had pushed for softer lighting out of consideration for those with light sensitivities however the powers that be chose to allocate light filtering glasses when in public spaces on the grounds of health and safety. Should any critical error occur it was important engineering teams could effectively assess and repair any damaged system at any time. It was one of those common-sense problems that Stephen could not understand. Sylvia checked her wristband display. “I have it as just past dinner” she expressed with a hint of distraction and also confusion. Stephen stepped back from the doorway to allow her into the office. “Ah, you must be keeping your clock relative to your working day, yes? I think I read on your file you work on shift four in hydroponics, your day is my morning, and your night is my evening”. As Sylvia entered and sat down upon the couch, Stephen commanded “Betty, please set light levels for the office to evening preferences and allow Sylvia basic access to the lighting system”, as he moved and sat down opposite Sylvia he stated “advantages of being in a private, non-critical section of the ship is you get to control your environment more freely, adjust as you need to, Betty will save your preferences”. He picked up a folder from the table between them and flicked through as a performance, he had studied the file already but learned in training that people like to see signs of acknowledgement through the appearance of what a therapist should look like and how a therapist should act. They then form their own therapeutic relationship relative to emotional context and comfort levels afterwards.
“Sylvia, would you mind for the record just stating your full name, date of birth and I.D number please”. Sylvia looked away for a moment and tensed up “Sylvia Johnson, born February 4th, 2019, I.D number 179462.”
“Thank you, and I am required to ask you, given the nature of our journey and of this conversation pertaining to your health and wellbeing the session will be recorded for safety and quality purposes” Stephen recited, avoiding eye contact. He adjusted himself and placed the folder back down on the table. “Why does it need to be recorded?” Sylvia asked with a slight annoyance in her voice. “It is just something we have to do for your safety and mine, no one will look at this session unless there is a need for them to do so, like say for example I decide to deliberately give you some bad advice, or you might say something to me that might be considered aggressive or abusive…” Stephen caught himself for a moment, visibly uncomfortable with the suggestion “…not to say you would do anything like that of course”. Recovering here for a moment he added with as reassuring a smile as he could muster “It just takes one person to do something to bring in all these uncomfortable safety measures for the rest of us, so I understand your discomfort and it is okay if you do not want to go ahead”.
“No, no I do want to proceed” Sylvia said suddenly switching from annoyance to a nervous anxiousness, a defence response that Stephen knew he would need to work on with her. Stephen hated data protection questions, but if they needed to exist, he was certainly going to use them to inform himself more about how his patient was presenting.
“Go ahead and talk me through what you have been feeling, you mentioned on the intake that you were feeling low and anxious but did not want to put any more details on there?”
“Yeah, so like I just want to check first what we talk about, if it is about another person on this crew there is no way for them to see or access this session or any other information?”
“By crew do you mean any of the health support team? Regular crew would not have access to our work, but the health support team would have access if you engage with them and the information was considered relevant”. Sylvia started to appear distraught and was looking anxiously at the ground.
“I can encrypt the files so that access by other staff can only be approved by myself, haven’t had to do that before but I would be happy to offer this for you if that would help?”
“Yes, yes please, and there would be no way for them to access those files?”
“Well no, not without breaking a lot of rules and given we have another two years at least together I do not see anyone wanting to break the rules for their own personal gain or agenda”. He paused, in a flash of a moment his mind was trying to piece together circumstances wherein which someone would willingly want to put their own gains over that of a fellow shipmate given the confines of their journey. On earth he could think of many reasons, but in a closed environment with heavy controls and surveillance it would be practically stupid to attempt such an action. “What happened Sylvia?” He said softly, both with concern and curiosity.
“I…had been having a lot of pain recently in my abdomen, usually around the time of my period and had been trying to manage it with anti-inflammatory medication, eventually my partner Rob persuaded me to see one of the Doctors, Doctor Williams. At first, he was of the opinion that I was having a gastric reaction to some of the processed foods we have been having on board, you know like an intolerance?” Stephen nodded along assuredly, his pen had not touched a page, his hands were ready though forgotten in that moment.
“He had prescribed me much stronger pain medications to try and dull what I was feeling but I started to feel very unwell, stoned at one moment and then waking up itchy and agitated as though the entire day felt wrong and not just inside me”. Sylvia was now rubbing the side of her waist, just below the stomach, whether she realised it or not she was appearing to be making a physical connection to the pain in her memories, as though the pain she was feeling in that moment was not just that of distress and sharp discomfort, but the ringing of a thousand pains felt before and dulled.
“Do you know what Endometriosis is?” she asked suddenly. Stephen snapped out of his observant gaze as though pulled into another room where he was at a loss. “I know of it yes, but obviously I only have a textbook and anecdotal knowledge of the subject” he offered calmly, as though he was threading unsafe waters, trying to see where Sylvia would go next, but she was waiting. “I know that it can be mistaken for period pain, when in fact it is associated with such pain and that while we have made slight progression in encouraging women not to mask this pain, it remains a condition that some either do not know about or believe it exists due to the difficulties around diagnosis…” he paused and then relaxed gently into his chair, noticing his own tension through his body “…would you agree or would you add anything to this that I may have missed, it is important we articulate this correctly” he pressed the pen to the fresh page, poised and gaze sharp, listening with his eyes, letting Sylvia know she had this space now and she was free to be heard.
***
The door opened and Sylvia and Stephen emerged from the office, there were people waiting quietly on seats nearby and Stephen guided Sylvia towards the clinic exit. This place to her was one of healing but also of pain as he was acutely aware of how close the surgery was to these rooms. When they were out of immediate earshot he turned to her, “You are welcome back to this space, as and when you need it, and as agreed the file will be encrypted, no one should try to access it but I want you to go back to your quarters and decompress, spend time with Rob and we will see how you feel next session, if you need any note for your duty officer you can send a request to my terminal address.” She nodded, the mask firmly back on her face as she turned and walked confidently out of the clinic. Stephen stopped for a moment, holding the client space that had accidentally left the boundary of his office, lingering. She was an expert at masking and walking away, but this experience stayed on with him a moment longer than he would have liked, meaning to him that it had touched upon something he was not okay with, but that he was not allowed to discover just yet. He walked quickly back to his office and closed the door, closing his eyes and letting his forehead rest upon the cool metallic door, a shield from the outside and wall between him and the others. Looking down at his wristband display a reminder for his next appointment was illuminated. Letting out one long exacerbated sigh he opened the door with a warm smile and stepped out with a welcoming hand “Good afternoon, James, it is good to see you again, you go ahead and make yourself comfortable while I just grab a water”.
If you spot this tale on Amazon, know that it has been stolen. Report the violation.
James was a thin, average height, toned individual. He had an accent that would always leave you wondering whether he was from South Africa and then moved to Australia or maybe the other way around. Stephen loved placing accents; it was a type of cultural ritual in Ireland. You were either from Dublin and then you had to be mindful of what part of Dublin you were from, or you were beyond the Pale, an archaic phrase meaning outside of Dublin, in rural Ireland, but one him and James laughed about in one of their first sessions. James was someone you could be comfortable around; his world could be falling down around him, and he would still shoot a warm smile. More importantly James was familiar, meaning Stephen did not have to give him all of himself after Sylvia. He could be safe with James, gentle in approach, and James did not need to know this at that moment. This was his space now and Stephen was there for him.
Returning with his water, Stephen closed the door and nodded at James, who smirked knowing what was being asked of him. “James Evans, born June 7th, 2020, I.D number 179356, and yes I am okay with the session being recorded”. James relaxed back in his seat and took a breath in, shaking loose his shoulders and letting go, as though preparing for an emotional workout in a therapeutic gym. “So, James, how have things been since we last spoke, you were thinking of starting a new game, looking to make new connections outside of your area?”
“Yeah, so I put the word out on the network and had some interest, some of the people seem nice, we had a bit of a meet up and a drink, get to know one another and feel safe, I think they should be okay, two of them seem to know the rules at least which should be easier”
“How did it feel to be around new people though, given your apprehension before?”
“It really was amazing, like second nature to me” He paused, taking a moment to look outside into space as though he was back on earth looking out across a field for inspiration and solemnity. “I don’t know what I was so worried about” He uttered conclusively.
Stephen had only been half listening at this point, in his mind he already concluded where James was at due to his demeanour and his thoughts drifted back to Sylvia, specifically on how to address their concerns. He wanted to confront Doctor Williams but knew that he could not based on the present information. He considered whether he had given a false impression or whether more was expected of him, before realising that the conversation had slowed, and it was certainly his turn to acknowledge and hold his part of the performance. “Hmm, do you think this could be a repeating behaviour?” he muttered with a suggestion that the question had been selected pensively, but it was just an open ended, reflective question. Smoke and mirrors for when a therapist loses concentration but does not want to own it. “How do you mean?” James riposted, curious as to why his conclusion was suddenly being questioned. “Well consider…” Stephen shifted forward, gathered and composed this time, “…we have one data set now that proposes that this group are safe to be communicating with and you feel included, and this is going to subsequently increase the more you interact with them, yes?”
James nodded along, his mind racing to follow this thought. “Is it possible this social anxiety may flare up again in other circumstances, for example you interact with people on shift, and you are integrating more with a new game group, which is a positive step, absolutely. I’m just concerned we have not addressed what was causing the social anxiety in the first place given that this behaviour was not isolated” Stephen leaned back in relief, he knew he had made an excellent point, but he had not planned to do so, and what is more he felt like a fraud. Who was he to undermine this person’s conclusions on a hunch that this would all potentially happen again when he could not even reach a conclusion to his own thoughts. His success was not in the right question asked, but in that he managed to hide his flaws and still serve his audience without anyone dying with a saw stuck inside them.
***
Later that evening, by Stephen’s clock, he found himself in one of the communal areas between shift changes. This was the time where people would peel off and enjoy activities together after their shift or would be coming together to start their shift together. As the various groups dispersed across the ship it would leave a precious hour or two where few people would be about and you could enjoy a space alone, other than your quarters and bathroom. Stephen had his eyes fixated upon his data pad, switching between tabs, one moment enjoying a video feed from home, the next he was searching for ship policies on privacy and procedure. He would glance for a moment, convince himself he had done everything right with each patient today. If he was back on Earth, he might have searched more about difficult scenarios with patients when it came to duty and care in the context of an organisation. This was not an organisation though; it was from a technical sense a chartered voyage by a UN sponsored mining and colony organisation. In another sense it was an organism, a city in a bubble where you were never too far removed from your actions or the actions of others. This changed the dynamic somewhat, in the earlier months of the voyage the caseload had been easy, but this was one of the objectives of his placement on this voyage, to observe the long-term mental wellbeing needs of the crew, including himself. He was flying with limited support save for Andy and other medical personal at a stretch.
Stephen could hear in that moment a hum through the bulkhead beside him, like a thousand tiny drums beating at such tempo as to seem continuous and each beat knelling pressure that built inside his ears. He felt warm, a flush of heat surged through his collarbone, curling around the back of his neck and nestling at the back of his skull. Stephen placed the data pad down, the screen auto-lock darkening the bright stream of information, he buried his eyes in the palms of his hands and began to measure more deliberately the depth of his breaths. Seconds felt like minutes, but there was a comfort and calm to be found in the dark warmth of his palms. Rubbing his eyes and squeezing the bridge of his nose he looked up to see someone approaching. It was a young woman he had not met before, nor was immediately familiar with, but she was smiling and waving towards him. With a hushed, humble tone that tried to mask the eagerness in her voice she declared her intentions, formal diplomatic relations and salutations all summarised within “Excuse me Doctor Gallagher, would it be okay if I joined you?”