The medical center is larger than it appeared from the outside. Patricia walks me through the examination rooms, the small in-house pharmacy, and the supply closets. There’s a break room with a decent coffee maker and a bulletin board covered in community announcements. A flyer for a bake sale catches my eye. Another advertises yoga classes at the community center.
Everything is clean and well-organized, professional despite the small-town setting. The staff we pass greet Patricia warmly and eye me with friendly curiosity. A nurse named Skylar introduces herself. A medical assistant named Tom offers to show me where the good snacks are hidden.
The consultation room is at the end of the hall, painted a soothing sage green, with two comfortable-looking chairs positioned at an angle to each other. A small desk sits in the corner with a laptop and a filing cabinet. A window overlooks the trees behind the building.
“Perfect,” I declare, and mean it.
“Your first appointment is at ten. Michael Henderson, seventeen. His mother is worried about his mood swings.” Patricia hands me a thin file. “Standard adolescent stuff, from what I can tell, but I’m not the expert.”
I flip through Michael’s intake forms, already slipping into professional mode. Depression screening scores are in the moderate range. Family history section is mostly blank. School performance has been declining over the past six months. Classic presentation for adjustment disorder, possibly masking underlying anxiety.
“I can work with this.”
“I’ll let you get settled in. Let me know if you need anything.” Patricia pauses at the door. “And Fern? Welcome to Silvercreek. I have a feeling you’re going to fit in just fine here.”
After she leaves, I spend twenty minutes arranging the space to my liking. I move the desk just a bit and adjust the chairs for optimal eye contact without feeling confrontational. I find a notebook and pens in the desk drawer, along with a box of tissues. The basics.
I test the laptop, check the filing system, and organize my materials. Anything to keep my hands busy and my mind occupied.
Then my phone goes off. I check it automatically, then wish I hadn’t.
Unknown number. I hover my finger over the message.
You can’t hide from me.
My hands shake as I delete the text and block the number. It won’t stop him; he’ll just use a different phone, a different approach. He always does.
A knock at the door makes me jump.
“Dr. Ramos?” A teenage boy stands in the doorway, gangly and uncomfortable in his own skin. Michael, I presume. His mother loiters behind him with worry etched into every line of her face.
I force a smile and tuck my phone away. “Come in. You must be Michael.”
The mother introduces herself as Linda and explains that she’ll wait in the lobby. Michael slouches into the patient chair and stares at his shoes. His hoodie is pulled up despite the room being quite warm. Classic teenage armor.
“So,” I begin as I settle into my own chair, “your mom says you’ve been having a rough time lately.”
“She worries too much.”
“Maybe. Or maybe she’s picking up on something real. Want to tell me about it?”
“Not really.”
“Fair enough. Then let me tell you how this works.” I set down my notepad, making it clear I’m not taking notes yet. “This is your space. Your time. Whatever you say in here stays between us unless you’re planning to hurt yourself or someone else. I’m not going to run to your mom with reports. I’m not going to judge you. I’m just here to listen.”
Michael’s shoulders relax just a fraction. “Yeah?”
“Yeah. So. What’s going on?”
The session goes well. Michael is guarded at first, but opens up once I establish that I’m not going to push him or patronize him. His mood swings aren’t depression—they’re anxiety manifesting as irritability. His parents’ recent divorce is the trigger. His dad moved to another state. His mom works two jobs now. He’s essentially raising his younger sister while trying to keep his grades up and pretending everything is fine.
“Sounds exhausting,” I acknowledge when he finishes.
“It is.”
“You know what I’m hearing? That you’re doing an incredible job holding everything together. But you’re also human, and humans have limits. It’s okay to admit when you’re overwhelmed.”
“What’s the point? Nothing’s going to change.”
