When Nadine left the ER area, she was followed by a male technician, and wandered past the radiology waiting room. She then started down a hall leading to the south hospital. She was clearly out of control now, but eventually took our suggestion to go back to the waiting room. She refused several chairs in the empty room, choosing instead to sit in a corner, legs pulled up, head down. After about 15 minutes, she was calm enough to coax back to the seclusion room.
Having seen part of this display, the ER attending insisted that Nadine be admitted to the hospital's psychiatric unit. Loudly objecting, she became agitated again and said she wanted to go home. I suggested we wait to see if she would regain her composure, and then reevaluate. But the consensus was for admission, and I did not disagree strongly enough to pursue the point.
Nadine called her therapist from a phone at the nurses' station, and spoke intently for some time. I went back to the office to work on my report, which had to be finished before she could be taken upstairs to the psychiatric unit. Then I got a call from Nadine's therapist, who told me that as far as she was concerned, Nadine had been certifiable all week; that Nadine sometimes did insert objects into her vagina; and that she would fight being hospitalized tooth and nail.
On the chance that the patient (whoever she was now-Nadine or one of the children) might have become more rational in the half-hour it took me to finish writing the report, I decided to ask her to sign herself into the psychiatric unit voluntarily, hoping to save the extra time and labor involved in the certification process. She was sitting in a chair just a few feet down the hall from the office, talking to a young male patient who was sitting on a gurney, legs over the side. In the few seconds I had to survey the situation, it seemed they were communicating rationally and happily.
"I will sign a voluntary," she said before I could get a word out, anticipating my request. "I just need a day or two in the hospital. I don't want to cause any trouble." Nadine was back, or so it seemed.
Two days later, I called the attending psychiatrist who accepted Nadine into the inpatient unit. The gynecology department had been asked for a consult. A gynecologist did a pelvic examination and removed a quantity of debris from her vagina that could have come from an ER bathroom wastebasket.
During an ER visit several months earlier, while she was waiting to be seen, Nadine had specifically asked for a female attending physician to take out objects that, she said, had been placed in her vagina by a hostile alter. A 10-inch piece of rubber tourniquet hose, a bent straw and a tampon that Nadine said had been soaked in bleach were removed. She later told me that the hostile alter who put these objects into her vagina was also trying to poison her by mouth. "Up here I have control," she said, pointing to her mouth. "Down here," indicating the genital area, she implied that her control was tenuous.
During this visit, Nadine's claim that "a man shoved garbage up me" first struck us as a delusion. Considering the history of physical and sexual abuse by her father, and following the DID dynamic model, one could ask whether a hostile alter (a part of her consciousness not under her control) may have reenacted her father's original violation. In her panoply of dissociated identities, where the father's trauma was not integrated into the structure of one personality, could one alter have taken on the role of the intrusively violating parent? Alternatively, could Nadine, deceiving herself, have done what her culture and the mental health care professionals she worked with told her that a hostile alter of someone with DID would be expected to do?
