Monday, July 15, 1996	4 pm. Initial session with Sylvia Bows. Sylvia is 38. She is originally from France, but moved to the US when she was 12. Spent her teenage years in San Francisco in the early 70s. Parents ran a French restaurant that is still extant. She still maintains that distinctive accent. Her hair is blond, but blonder on the ends than at the roots. She is married to a man named Tom who is a successful businessman. Tom seems quite manipulative, but Sylvia does not seem to be the type who is easily pushed around. I bet Tom didn't know quite what he was getting when he got married. Sylvia was a newspaper editor when they married. They made a decision not to have children because of their lifestyles. Several years ago, Sylvia changed that decision and Tom reluctantly went along. Couple of years of trying and no luck conceiving. Doctor checks out Sylvia and she's fine. Somehow last week she finds out that Tom had a secret vasectomy. Standard reactions of shock and then rage. She is having physical symptoms--anxiety attacks, rapid pulse and respiration, abdominal involvement, dizziness and insomnia. She describes her rage as murderous. She is talking about a divorce. She admits she isn't rational. Prescribed Zoloft. Follow up carefully.
Tuesday, July 16, 1996	At 10 am, spoke with Sylvia by telephone. Only took one dose of Zoloft, but seemed to sleep without dreams. At 9 pm, spoke again with Sylvia by telephone. She says that she feels more in control although she says that she feels detached. While before she said that she had lost 15 pounds since Tom's disclosure, now she reports an improved appetite. Strange because Zoloft usually causes appetite suppression. Told her to keep a log. The Zoloft seems to be effective. Since Zoloft is an inhibitor of neronal uptake of serotonin, Sylvia must be watched carefully for mania or hypermania, even though Zoloft is not a monoamine oxidase inhibitor. Although not likely because of Tom's unilateral vasectomy, Sylvia should be cautioned about the potential for Zoloft interaction and pregnancy. Zoloft reaches its peak after about a week of administration--adjust accordingly.
Thursday, July 18, 1996	12 pm. Second Session with Sylvia Bows. The woman surprised me. She laid a trap for me by opening a button on her blouse so that she exposed a nipple. Then she called me on looking at her. I didn't handle it well, denying that I had seen anything, but she knew I was lying. She said that she had done it on purpose. Apparently, the Zoloft has made her more distant from her own emotions. She describes being detached and observing her actions dispassionately. She says that she is more together at work, but it turns out that she skipped the day and instead went and had an affair with someone (Richard) she met at Starbucks. This was after silently taunting her husband by stripping in front of him, leaving the door open while she bathed, toweling herself dry in front of him, etc. She seems to have discovered that she can use sex as a controlling factor and as a weapon against Tom, who seems to be disconcerted not to be in control himself. Sylvia wants Tom to think about her all day, knowing that he can't have her. She is not having sexual relations with Tom since she found out about the vasectomy. I suggested that the Zoloft might be having an effect on her actions, and she denied it. I think I should be especially cautious about the dosage. Sylvia said that she had spoken with an attorney, but didn't particularly want to talk about that. Apparently, Tom is a good salesman. He is able to convince Sylvia's mother and others that he had the vasectomy for Sylvia's benefit. He uses his sister's bad experience with late pregnancy as a justification.
Friday, July 19, 1996	Got a look at the doodle that Sylvia brought me. It is on a cocktail napkin from a place called "Bull Market." It depicts an Octopus with one of its tentacles severed and dripping blood. The severed piece is still in evidence and the Octopus has a tear dripping from one eye. Great attention is paid to the suckers on the tentacles and to the oozing blood itself. Certainly, an image of primal pain and sorrow.
Monday, July 22, 1996	9:30 am. Telephone Call with Mr. Tom Bows. Sylvia apparently did not come home Sunday night. Tom believes that the Zoloft is responsible for her changed behavior. It's possible that he's right. He describes her as acting like a whore, dressing differently, etc. I believe he thinks that she is having an affair, but is prepared to forgive her and blame it on the drug and me. I got a certain insight into Tom's personality. He is more worried about appearances than his wife's actual fate. He tried to bully me in the beginning of the call with threats, and then tried to coopt me into a plan to institutionalize Sylvia. I told Tom to have Sylvia call me when she gets in. I think Sylvia and I need to discuss again switching medications. 7:15 pm. Telephone Call from Sylvia Bows. I got a call from Sylvia and I have to admit that I was relieved to have heard from her. She was fine. She seemed completely in command of herself and her situation. She scoffed at the notion that she was missing or that Tom was worried about her. She said that Tom had known about her plans for the evening--meeting with her cousin and good friend Rene. (Is Tom playing some sort of elaborate game?) Apparently Rene is a confidant. Sylvia agreed to talk about her medication during our next session tomorrow, but she said that she is feeling better than she has in a long time.
Tuesday, July 23, 1996	4 pm. Third Session with Sylvia Bows. Sylvia presented me with a diskette containing a collage which she called her family tree. Apparently, she put it together on paper with Rene during the night when they talked together and then transferred it to the computer at work. I promised to take a look at it tonight. We started to talk about Zoloft and I expressed my concern that recent behavior changes she's experienced could be due to the drug. Sylvia admitted that Rene thought Sylvia had become more bold, even in her mannerisms. Rene liked the differences, ascribing her previous, more restrained behavior to "corporate contamination." Sylvia said that she did not regret anything she had done so far. She thought that Zoloft might have been a catalyst to get her true self out in the open. She thinks that living with Tom has caused her to repress her more passionate side. She blames Tom for pushing her towards more lucrative but ultimately less socially relevant positions. Now, Sylvia feels a lack of purpose. Sylvia said that Zoloft allowed her to get some perspective on her life and that she didn't want to give that up. I told Sylvia that, since she was happy with the effects of the drug and since her anxiety was certainly lessened, I would allow her to stay on the Zoloft another week or so and then we will carefully evaluate the drug again. Sylvia said that she felt it important that I have a good opinion of her. I told her that I did, in fact. We then turned to her relationship to Rene. She told me some of Rene's history. Apparently Sylvia aunt (and Rene's mother) died in an auto accident when Rene was five and Sylvia was two. Although entirely blameless, Phillip felt responsible for his wife's death and never really got over it. Rene then lived with Sylvia's family in Paris during the school year and Summers were spent with Rene's father at a vineyard in the South of France. Sylvia remembers being scared of the vines at the vineyard during the funeral of her aunt. She has a memory of them being lifeless in the Spring--black and disfigured. During the Summers, Rene "adopted" Sylvia, who was without her real mother. Rene called herself Sylvia's "Summer Mother." Rene was and is protective of Sylvia. Rene would experience something first and then decide if it was right for Sylvia. This pattern continued through early drug and sexual experiences in adolescence. Sylvia remembers Rene punching a boy at school for kissing her in fifth grade. Rene seems to be quite a risk-taker. Sylvia tells a story about Rene going alone to some man's boat to buy marijuana and staying out all night. Later, Rene and Sylvia smoked that marijuana together. 8 pm. Looked at Sylvia Bows Family Collage. Rene and Sylvia spent the night talking and cutting up magazines. They rearranged the features of the pictures they cut up to create a collage representing members of their family. Profiled are Margarite, Sylvia's mother; Roland, Sylvia's father; Phillip, Rene's father; Jeorge, Sylvia's brother and Rene and Sylvia. Each of the images has some accompanying notes. The Collage Section on Sylvia has Sylvia writing a revealing autobiographical paragraph about herself. She talks about moving to San Francisco in the age of love and flower-power. Sylvia decided to become a journalist and moved to New York City to go to NYU. Sylvia says that "her parents openly grieved and secretly were relieved from the burden of knowing too much about their daughter." In New York, she joined up with Rene. As a freshman, she had an article published in the New York Times entitled "Women of Conscience," written from a jail cell after being arrested during a demonstration. The Collage Section on Jeorge discusses him as the Don Juan of San Francisco. Aged 33 and good looking, Jeorge likes to show off his body and play the violin. But he has a talent towards the Stock Market, mentored by Tom Bows. Converted to the joys of capitalism by Tom, Jeorge is now mostly interested in price earnings ratios. Sylvia describes Jeorge as being ruthless and cold when it comes to breaking the heart of the women with which he comes in contact. The Collage Section on Rene is written more tongue in cheek--quite literally. Rene announces the astonishing talent of tying a cherry stem in a knot with her tongue. Rene exhibits some maternal feelings towards Sylvia, taking credit for the "minimal damage sex drugs, and rock and roll did to Sylvia's brain tissues." The Collage Section on Phillip says that Phillip is a gentle soul but clueless. His wife Angeline died when Rene was 5. Phillip ran a vineyard in France and Rene and Sylvia spent long boring summers there, dreaming of escape and then actually doing it and hitchhiking around France. The Collage Section on Margarite says that she was born in a small town in France and apprenticed in her grandparent's tavern. She showed great talent and was apprenticed to a great chef in Paris, the renowned 3 star Tour d'Argent. Margarite left the Tour d'Argent to open a restaurant on her own, unusual in a male dominated world of high powered chefs, something Sylvia still admires. Sylvia remembers Margarite as very strict about everything but food. She obeyed her husband and ruled in the kitchen with the authority of an empress. Sylvia remembers a summer working for her mother in the kitchen of the restaurant and being humiliated by her mother's public browbeating of her for some offense. Tom Bows won over Margarite through effusive and knowledgeable compliments of her cooking. Tom and Margarite are buddies, often allied against Sylvia. The Collage Section on Roland says that he was responsible for getting his family to San Francisco. Roland is passionate about San Francisco, knowing detailed information (often excruciating detail) on streets and the history of San Francisco. But Sylvia writes that he hardly remembers that he has two children and a wife. Apparently, the move to San Francisco was forced on the rest of the family, over their objections.
Thursday, July 25, 1996	Sylvia Bows' Personnel File, Hiring Section shows that she was hired directly by the CEO of SII and was considered a find. Sylvia is definitely a high powered executive. Personnel was bypassed entirely in this lateral hire from CommSoft. It seems that SII was in desparate need of a person to fill the head of Customer Service. Will Sylvia's new found sexual freedom jeopardize her position with SII?
Tuesday, July 30, 1996	4 pm. Fourth Session with Sylvia Bows. Ms. Bows and I discussed the side effects from the Zoloft which I prescribed. She said that she had carefully observed her behavior during work and came to the conclusion that she had no memory loss or changes in her ability to concentrate. She said that her cognitive functions have not been impaired. However, she did tell me that she has experienced a sharp increase in sexual activity. She told me that she had a one-night stand with an engineer in her office named David, and she engaged in a ménage à trois with Rene and a photographer named Matthew. Sylvia claims that she is rediscovering sex and that while the drug may be influencing her behavior, it is a positive benefit of the drug. While Sylvia's behavior has changed, I believe that she is not acting under a compulsion respecting her sexual activity, but rather that she is in control of her sexual activity. Rene is considering a move to San Francisco. Rene has a twelve year old son, Robert, who Sylvia describes as very sweet but too serious. Robert, during the Summer, is living with his grandfather Phillip in the vineyard in France, just like Sylvia and Rene did when they were kids. Robert is interested in succeeding his grandfather in the family business and his grandfather is thrilled. Rene is a widow, her husband Tad dying of a brain tumor when Robert was still a baby. Sylvia has only been at home one night since our last session. She says that she has been staying with Rene. She believes that Tom is partly relieved because, while he hates it when things aren't under his control, Sylvia's coldness to him has really made him uncomfortable. Tom has been having daily contact with Sylvia's mother, who believes that Sylvia is making a mistake by desiring to get pregnant. Sylvia says her mother looks at her and sees "Down's syndrome, divorce, depression, and unemployment."
Tuesday, August 6, 1996	4 pm. Fifth Session with Sylvia Bows. Sylvia decided not to move in with Rene because she and Tom are getting very good at avoiding each other. Tom has moved into the guest room and Sylvia loves her house too much to give it up. While she doesn't want a divorce yet, Sylvia does not seem to be interested in getting back together with Tom. In fact, she seems so coldly analytical with respect to Tom and her relationship that I doubt she can have any love left for him. Anger has been replaced with a coldness and lack of regard so extreme that I doubt any reconciliation is possible. She is reticent about talking with me about her reasoning, but I wouldn't be surprised if she had drawn a line through a legal pad and written down the pros and cons of divorcing Tom. This is not a decision which she is making on passion. Sylvia didn't have an affair last week, although she is going on a date this evening with Richard, the man she met at Starbuck's a few weeks ago. He is a futurist at SII who made quite an impression on Sylvia. Sylvia claims that she carefully monitors her actions and is convinced that her motivations for her recent sexually activity are not originating in the drugs. She says that she is sleeping better, and is calmer and more self assured. Because she does not consider Tom her husband anymore, regardless of their legal status, she doesn't feel that she is doing anything wrong in her recent affairs.
Wednesday, August 7, 1996	6:05 pm. Telephone Call from Sylvia Bows. Sylvia called to invite me to a party celebrating the possible discovery of previous life on Mars. I told her that it might be awkward for me to go to a social event she was hosting, but she chided me on being stuffy and promised that she wouldn't consider it a violation of doctor/patient protocol. She's probably right and I think I'd have a good time, so I'm considering accepting.
Tuesday, August 13, 1996	4 pm. Sixth Session with Sylvia Bows. Sylvia and I talked about her Martian party on Saturday. She said that she had never before seen my legs. It's easy to forget how non-human a doctor can seem even in the midst of the most intimate exchanges. Apparently, Rene wants me to ask her out. Although I thought she was very attractive and quite vibrant at the party, I really must resist. She is just too close to Sylvia for me to be able to support such a relationship without ethical compromise. Apparently, Sylvia slept with four different men last week, continuing her wide swath through SII's male work force. Sylvia acknowledged that she liked to shock me. I wasn't really aware of the number of opportunities available for an attractive and compliant woman. She went out with Richard the night of our last session, drove around the City soaking up impressions and then concluded the evening with a sexual encounter. Then she had a date with Bruce Redot, a sculpture and designer and an old friend who was thrilled that she was having problems with Tom and capitalized on it by inviting her on a date and consummating their friendship. She slept with someone in her marriage bed on the night of the party--it could have been that Dion character who was hanging around her all night. And then, the real capper is that she slept with someone on her technical writing staff who sounded a lot like Hal Mainor. She knew he was married, but because he made the first move, she thought it was okay. She wouldn't tell me his name because she had promised him to be discreet. If Hal will stop canceling his sessions, I will have to ask him about this. I warned Sylvia about AIDS and safe sex. Sylvia said that she was not using condoms, but that she had things under control and knew what she was doing. I told her that she could not rely on her instincts, but she said that she wasn't, although she clearly wasn't getting a blood test from these guys before engaging in intercourse. I left it at that, but I had an uneasy feeling from the discussion.
Friday, August 16, 1996	10:30 am. Telephone Call from Tom Bows. Mr. Bows called me and he was very angry. He said that I am encouraging Sylvia's "unbelievably lewd behavior" and that he blames me for not counseling her differently and for continuing the Zoloft. He was also angry that I attended the Martian party last Saturday. Mr. Bows said that he intended to keep his marriage together. He then went on to intimate that I had sexual designs on Sylvia and threatened me with professional sanctions. He hung up abruptly.
Monday, August 19, 1996	I had a session with Hal Mainor, where Hal describes having extramarital relations with Sylvia, together with the effects on his marriage and his work life. Hal gives a different perspective on Sylvia as a boss, too.
Tuesday, August 20, 1996	4 pm. Seventh Session with Sylvia Bows. Rene is apparently moving out to San Francisco semi-permanently. Rene's son Robert arrived this week. Robert is twelve and is about to start 8th grade in a school. Sylvia is very attached to him. She thinks he is the reason that she changed her mind with Tom about having kids. Sylvia says that the Zoloft is stabilizing her sleeping and eating patterns, although she is sleeping more. She also says that Zoloft allows her to take things more in stride. However, I am still concerned that her sexual activity may be in part a consequence of Zoloft. She will not consider another substitute medication. Sylvia broke into the computer records of SII and found a list of men who had negative HIV test results. This is the list that she has been using to select her sexual partners. I was impressed by how cold blooded it all seemed, but Sylvia argued that she wanted sexual freedom without risking her life. I was getting nowhere pointing out the ethical problems, so I dropped it. Apparently, Brenda Wolfe is using this event to try to elevate her own importance at the company, because she sent out a memo knowing who had, in fact, compromised the files. Sylvia is particularly unconcerned about the effects her affairs may be having on the men involved.
Tuesday, August 27, 1996	4 pm. Eighth Session with Sylvia Bows. Sylvia reports that she had a confrontation with her mother. Her mother, although a very strong woman who was successful in business long before that was common for women, still believes that the man in a relationship should call the shots when it comes to issues that affect the family as a whole. For her, the crisis came when her husband forced her to abandon her successful business in Paris and to emigrate to San Francisco. For Sylvia and Tom's relationship, her mother believes, Tom was trying to act for Sylvia's benefit, saving her from the burdens of childbirth. Sylvia's mother doesn't see Tom's act as cowardly but rather as courageous. Needless to say, Sylvia doesn't see it this way and says that it is as if she and her mother occupy different worlds. Sylvia has not been forthcoming about her recent sexual activity with her parents and, for reasons of his own, Tom hasn't told them either. Sylvia had relations with three men this week, all of whom were new to her and part of her AIDS list. One of them, Victor Woodward, is a futurist who works with Richard. Sylvia fails to see anything wrong with her behavior, even when confronted with the possibility of a sexual harassment charge. She says that the contacts with these men were understood as one-night stands, without further commitment expected from either side. However, she admits that perhaps she needs to give both Richard and Brian more explicit explanation. She's planning on going away for the Labor Day weekend with Victor.
Tuesday, September 3, 1996	4 pm. Ninth Session with Sylvia Bows. Sylvia started with the now unremarkable news that she had another affair--this time with a guy named Victor. They spent the weekend together at some getaway. She's planning on speaking with Richard tomorrow about her non-exclusivity. Then Sylvia let loose her bomb shell. She's pregnant. Of course! Suddenly it all made sense--the revenge against the husband who would leave her barren, the desire to become promiscuous (and only with intelligent men), the wish for a little more time when I would have pulled her off the Zoloft, her evasiveness about reconciling with her husband. Sylvia's sure handed deliberation left me stunned! This was a calculated and methodical revenge. Sylvia told me that she had consulted a lawyer who informed her that a child conceived during a marriage is conclusively presumed to be that of the husband, regardless of the genetics of the matter. So Tom will have child support to pay in addition to the property settlement and alimony. Sylvia said that she is planning on bleeding him dry in the divorce. When Sylvia told me that she was pregnant, I realized that I hadn't told her about the possible effects of Zoloft on pregnancy. What a terrible mistake! I looked back in my notes and I mentioned it there, but not to Sylvia. It just never occurred to me! We talked about it and Sylvia, who is irregular in her menstrual cycle and has no idea how long it has been since ovulation, is going to check with her obstetrician to determine how long she has been pregnant. If Zoloft did cause a birth defect, my guess is that the zygote would be non-viable and she would suffer a miscarriage. I don't believe that Zoloft could have a substantial effect in the first few weeks (especially prior to differentiation) on a baby delivered to term. But I plan to talk to her obstetrician. Sylvia deliberately wants to keep the actual paternity ambiguous, but since she has been averaging three affairs a week, I don't think this is a problem! Sylvia still needs an antidepressant since I discontinued Zoloft so I will work with the obstetrician to determine a new alternative.
Thursday, September 5, 1996	There was a mention of a rumor that Sylvia had an affair with David, one of the programmers at SII, that Anna Green related to me in her session.
Friday, September 6, 1996	1 pm. Telephone Conversation with Rene Wolff-Bernstein. Rene told me that Sylvia is in the hospital. Apparently, she went to Dr. Malleson, her obstetrician, who confirmed that Zoloft was not likely to be responsible for birth defects. He performed a routine in-office, ultrasound examination and got an abnormal result. Sylvia might be having twins, but the zygotes are different sizes. Sylvia has been off any anti-depressants since Tuesday, and she reacted poorly to the news that there might be difficulties in her pregnancy. Apparently her pulse rate elevated abnormally and she fainted. She was admitted to the high risk pregnancy ward at UCSF Medical Center under the psychiatric care of the resident, a Dr. Rutenberg perhaps, who has administered some form of tranquilizer. Rene is with her. I told Rene that I would be right over. I went up to the hospital and saw Sylvia. She is resting comfortably after an injection of Valium administered by Dr. Wutenberg, the psychiatric resident. I found her tired and relatively unresponsive. She doesn't understand how she ended up in the hospital and she is angry that she can't find out more about her condition. Rene is with her and has taken charge, acting as Sylvia's defacto healthcare gatekeeper. I think it is essential that Sylvia gets back on an antidepressant. I'm pretty sure that the serotonin reuptake inhibitors are too new to have gone through pregnancy testing, so I need to do some research to find a tricyclic appropriate for pregnancy. Unfortunately, the tricyclics tend to be slow in onset.
Saturday, September 7, 1996	I acquired one of Sylvia Bows ultrasound images. The ultrasound appears to show two zygotes, one smaller than the other. The concern at the moment apparently is that one of the zygotes has some defect, except that Dr. Malleson, Sylvia's obstetrician, said that he didn't believe that was true. He said he would know more Sunday or Monday when they could do additional ultrasound studies.
Sunday, September 8, 1996	10 am. Telephone Conversation with Sylvia Bows and Rene Wolff-Bernstein. I called Sylvia at the hospital and spoke with her briefly. She was tired and despondent and turned me over to Rene. Rene said that Sylvia hasn't been getting a lot of sleep at the hospital, that she has been eating poorly, is anxious, is shaking, and has been complaining of stomach problems. She is taking Valium, which has calmed her down. Her next ultrasound, which should help clarify the situation, is scheduled for Monday. An ultrasound was conducted Saturday and the ultrasound technician told Rene and Sylvia that it was her opinion that there were two fetuses of different gestational age. She said that each fetus individually seemed normal. She judged one of the fetuses to be four to five weeks and the other to be six to eight weeks. I've heard that it is possible to ovulate while already pregnant (especially given Sylvia's age) and, if so, that it might be possible to have "twins" conceived at different times. But I'll defer to Dr. Malleson.
Tuesday, September 10, 1996	1 pm. Seventh Session with Cassandra Evans relating to Sylvia Bows. Cassie got some letter about her absenteeism from Ms. Bows which went into her personnel file. She is quite unhappy about that. Cassie also heard that Ms. Bows was in the hospital and she went to bring her flowers. She was quite surprised to learn that Ms. Bows was in the maternity ward. 4 pm. Telephone Conversation with Sylvia Bows. Sylvia called right at the time when she usually comes in for her session. She has started taking the Sinequan that I prescribed. Her twins are okay. Sylvia said that she is the star patient at UCSF right now, with medical students clamoring to see her ultrasounds. Apparently, she has twins of different gestational ages. So one is about five weeks and one is about eight weeks old. Her due date (at 36 weeks for the elder of the two) is March 15, 1997. I didn't mention it to Sylvia, but there is a good chance that she is having twins by different fathers. That's National Enquirer stuff. And I assume that when the news hits SII, there is going to be lots of speculation among Sylvia's various lovers as to who has the honor of paternity.
Tuesday, September 17, 1996	4 pm. Tenth Session with Sylvia Bows. Sylvia came in looking much better than I have seen her previously. While I won't say that she was glowing, she did look in much better health and spirits. She thinks that the Sinequan I prescribed may be helping her anxiety, listlessness, and sleep disorders, although I think it is a little early to be expecting such dramatic results. Sylvia is very concerned about breaking the news about the twins to Tom and to her parents. She has decided to postpone her parents, figuring that they will eventually accept and welcome the news. But Tom she can't postpone. She has moved back in with him and they are coexisting with a certain degree of hostility. Apparently Tom lost control at one point and started to denounce Sylvia, her promescuity, her intellect, and me--he said that he should sue me. Sylvia said that Tom had never seen her cry, so when she started to, Tom got very quiet and left the house, not returning until the following evening. Her lawyer has advised her to get a restraining order against Tom, mostly as a tactic rather than for any protective function, but Sylvia is resisting. She thinks Tom is capable of hurting her, but not physically. She doesn't believe Tom would ever resort to violence against her. Sylvia wanted me to explain to Tom about her pregnancy and desire for a divorce. I told her no. Sylvia also hadn't considered the possibility of dual paternity and hadn't realized that there may be some consternation among the men she slept with at SII. No one at SII knows about Sylvia's pregnancy except Cassie, apparently. At my suggestion to have Rene present when Sylvia talks to Tom, Sylvia said that Rene was very volatile emotionally and may not be the best choice as an arbitrator. I pointed out that she was really looking for a protector.
Thursday, September 19, 1996	Letter to Bill Bennett respecting Sylvia Bows. I spoke in part about Sylvia in my letter to Bill Bennett.
Tuesday, September 24, 1996	4 pm. Eleventh Session with Sylvia Bows. Sylvia is very concerned about how she is going to tell Tom about her pregnancy. For some reason, she feels that she should not serve him with divorce papers until after she has given him the news. But now she fears that he might already know. Now that I know she is pregnant, it is obvious to me that she is showing, which I guess is normal with twins at 10 weeks. But it's hard for me to be objective. I'm not sure I would notice if I wasn't looking for it. But she describes Tom as staring at her all the time. It may be paranoia on her part, but she even feels that he is acting solicitously towards her. She is planning on telling him in a public place to restrain his display of anger and then to hide at Rene's. Sylvia is having difficulties getting used to the physical side effects of her pregnancy, especially the nausea. She is also questioning the wisdom of performing an amniocentesis. I think Sylvia is more jittery, maybe a bit more paranoid, not as relaxed and sure of herself as she was when she was taking Zoloft. In some sense, my hands are tied because of the difficulties of finding an antidepressant appropriate for a pregnant woman, but I could wish for an improvement in her reaction to the Sinequan.
Friday, September 27, 1996	2:15 pm. Telephone Call from Jeorge Wolff regarding Sylvia Bows. I got a call from Sylvia's brother Jeorge who filled me in on some facts that Sylvia neglected to mention. Apparently, Sylvia has a problem with her cervix, resulting from a cancer which was operated upon, leaving it weakened and unable to support a pregnancy. When Sylvia told me that Tom and she were trying to conceive, she implied that Tom was outwardly helping her. Not so. Tom understood the danger to Sylvia of getting pregnant against her Doctor's advice, and was not even outwardly supportive of her effort to get pregnant. Sylvia surreptitiously stopped birth control and attempted at-home artificial insemination, even knowing the dangers. I'm afraid this puts quite a different light on Tom and Sylvia. I knew Sylvia was manipulative, but I didn't believe that she was deceptive. Jeorge also mentioned that Sylvia was having trouble with word-finding and that she appeared jittery--he mentioned her hands were shaking. I'm not sure whether this was a reaction to Jeorge or whether it was in response to the medication, but I think I should investigate some new medication that will be acceptable to her obstetrician just in case. I have to say that while Jeorge was somewhat threatening and belligerent, I believed him.
Tuesday, October 1, 1996	4 pm. Twelfth Session with Sylvia Bows. Sylvia heard me sneeze and was very concerned that I might have a cold. I reassured her, but it was clear that Jeorge was right about her being jittery, although I didn't notice her hands shaking as he described. I decided to confront Sylvia about Jeorge's revelations gently over the course of the session, so first I probed gently, asking her if there was anything in her pregnancy that especially concerned her. She clearly lied to me, by saying that there was nothing particular, beyond the fact of her unusual twins, and that as she passed each week she felt that she had passed a danger milestone. But she didn't mention the problem of her incompetent cervix. So I probed more and I mentioned the fact of Jeorge's phone call. Sylvia was clearly surprised that Jeorge had called me, although she tried to quickly cover. Sylvia told me that he showed up uninvited at SII in a theatrical manner, angry and insulting, and embarrassed Sylvia before her office staff. So I asked Sylvia about the cervical cancer and Sylvia admitted it, but said that the difficulties of carrying the twins to term was just one of life's risks--she was willing to take the risk, although she would try to minimize it. Sylvia is taking a set of reasonable steps to reduce the pressure on her cervix, including having a stitch to reinforce the cervix. She accused me of liking Jeorge, implying that I could take her side or Jeorge's and the rest of the family. She told me at one point that she could do it alone and fight all of us. Sylvia is feeling defensive and backed into the corner. I suspect she is lashing out because she is feeling a bit guilty about the whole thing. I bet she does believe that Tom is in love with her and that's one of the reasons that she didn't get a restraining order that her lawyer recommended. Now I wonder about Tom. Could Tom be a victim in this whole thing? I've gotten so used to thinking of Tom as the villain that it takes some reordering of my thinking to see Tom's side. Sylvia is clearly incapable of it, but I think that Tom might be wondering what he did that was so wrong. I ended the session by confronting Sylvia about her lies to me. Finally, she admitted that she deliberately gave me the impression that Tom had pretended to go along with her effort to get pregnant which she justified by saying that Tom knew she wasn't taking birth control pills. When Sylvia accused Tom of being controlling, I pointed out that Sylvia was one of the most controlling people I knew. Sylvia was taken aback, I think, but said that she decided to take my comment as a compliment.
Friday, October 4, 1996	12:15 pm. Telephone Conversation with Hal Mainor. Hal called me in a panic over Sylvia. He's noticed that she's pregnant and he's sure that he is the father. More than that, he thinks that Sylvia is punishing him at work because he told her that he couldn't have a relationship with her. Sylvia, if I remember right, thought Hal was sweet but really wasn't interested in him at all. Now all Hal can think about is the paternity suit that he is sure she will file and that will destroy his marriage and his life. I guess the baby could be his, but Sylvia doesn't really care. I told Hal not to invent problems for himself. 4:30 pm. Telephone Conversation with Dr. Brian Malleson. Sylvia's obstetrician called me quite upset about what he called a situation in his examining room with Sylvia. Apparently, he needed to change the appointment from Monday to Friday, so his receptionist left a message on the Bows' answering machine. Well, Sylvia is in stirrups undergoing an ultrasound examination when in walks Tom. Sylvia, to use the appropriate medical term, freaked out. Dr. Malleson was clueless about the current situation between Sylvia and Tom and assumes that Tom is the father. He couldn't quite understand Sylvia's reaction and attributed it to the Sinequan not being effective. I had noticed Sylvia's jumpiness at the last session in any case, so I agreed to increase Sylvia's dosage to 100 mg. once a day. But Sylvia's reaction doesn't sound so incomprehensible under the circumstances. And now Sylvia doesn't need to be concerned about how she is going to tell Tom about the twins. He played it very cool as he found out the news--pretending to already know. But Dr. Malleson did notice that he seemed a bit shaken.
Tuesday, October 8, 1996	4 pm. Thirteenth Session with Sylvia Bows. Sylvia is twelve weeks pregnant. She brought me baby pictures and one of them is a boy. Sylvia told about the scene in Malleson's office when she was in the stirrups and in walked Tom. Quite a scene! Tom is clearly a master of the game--he can keep his cool and take advantage of situations that present themselves. He clearly led Malleson to believe that the twins are his. Was this really to protect Sylvia's honor or did he just not want to portray himself as a cuckold or does he have some other design? Sylvia is also finding herself at the center of a storm of gossip at SII. The potential fathers are falling all over themselves trying to figure out who is responsible and it seems to have become a topic of general interest. Hal is clearly beside himself and his evident agitation is making Sylvia so uncomfortable that she is talking about terminating him. Richard assumes that he is the father as well, but he has a strange world view where phones are tapped and Sylvia is being followed by detectives. Sylvia is taking advantage of Richard's delusions to avoid speaking with him. Chicken. My impression is that Sylvia is just not dealing with the situation at work, including her employers, the putative fathers, and the gossips. Despite her elevated position in the organizational chart, Sylvia worries for her own job while she is on maternity leave, and hers is likely to be particularly long due to her probable necessity to be on bed rest. Sylvia intends to speak to Tom and her parents sometime this week and also to serve Tom with divorce papers. But she has been talking about the divorce papers for awhile, so it's possible she'll find a way of avoiding it again this week. Sylvia gave me a couple of ultrasound images of her twins.
Tuesday, October 15, 1996	4 pm. Fourteenth Session with Sylvia Bows. Sylvia finally told Tom and the Family officially about her pregnancy although her family already knew. Her mother is apparently unwell with some unspecified heart problems. Sylvia's pregnancy is adding to her worries and Sylvia now feels responsible for her mother's health as well. Although her family must know that the child is not Tom's since they know of the vasectomy, I don't think Sylvia told them about her plans to divorce Tom. And Tom waited for Sylvia in the dark to catch her unawares. He destroyed her fantasy of the ultimate in civilized divorce conduct--she had an image of handing him the papers over coffee in the morning and he saying something like, "Oh righto. I'll be gone immediately. Sorry it didn't work out. Chop Chop." Apparently it isn't going to be quite so easy, although Tom was perfectly calm about being presented with the divorce papers--clearly he has been expecting it. Tom was extraordinarily calculating in the way that he confronted Sylvia. He waited in the dark for hours, knowing her routine would drive her back to the kitchen to get something to eat before retiring for bed. He let her go through all her evening rituals, thinking she was alone, while he waited in silence. Maybe he wanted to see her going calmly through her routine--he could remember how it used to be in their relationship before there was such trouble in his house. Sylvia believes that he did it in order to gain the upper hand in their confrontation--clearly he rattled her. Tom is not above having both motives for his actions. Sylvia skipped town after the confrontation and I have a strong feeling that she hasn't yet heard the second shoe drop.
Tuesday, October 22, 1996	4 pm. Fifteenth Session with Sylvia Bows. Sylvia was in a weird mood during our session. She realizes that troubling things are happening for her, but there was a sense of unreality about it--like reading about characters you are fond of in a novel. She was disturbed by events, but responded somewhat lightheartedly. Tom is seeking sole custody of her unborn twins. During an unpleasant confrontation where Sylvia might have lost full consciousness at one point, Tom served her with a set of legal papers which claimed that she has demonstrated her unfitness to be a mother by, among other items, daring to have children at all given her poor medical state. Somewhat circular in reasoning, and an outrageous position for Tom to take, unless he is trying to utilize the custody of the children as some form of bargaining chip over Sylvia. Legally, of course, he is the father of these children even though he had nothing to do with their conception. Sylvia was counting on that legal principal when she got pregnant during their marriage. She wanted Tom to be financially responsible for them. Now, she is being hoist with her own petard. Sylvia seems to think that the whole matter will go away in a couple of days, but from what I know of Tom, I think she is underestimating him. He wouldn't have taken a step like this unless he knew what he wanted and thought there was a reasonable possibility of getting it through this maneuver. Sylvia is having trouble facing adversity--her pattern is that of running away unless forced to confront a situation. We should work on this, otherwise Sylvia will be subjected to a series of dramatic confrontations where she is forced to reckon with those from whom she has fled.
Tuesday, October 29, 1996	4 pm. Sixteenth Session with Sylvia Bows. Sylvia was in a strange humor today, almost passive which is at odds with her personality. She is trying to let things wash over her rather than attack them with the vigor that was once her custom. She has put the issue of Tom's custody suit squarely in the hands of her lawyer and is taking a fairly detached view of the proceedings--she believes that a judge will immediately throw out Tom's position and that Tom's petition will all be over in a few weeks. From the little I know of the legal system, I think she is probably mistaken. Also Kelly, her lawyer, seems a trifle on the sleazy side--once before she wanted to utilize a spousal abuse rationale to get Tom to move out and apply for a protective order, when Sylvia herself said that she was sure that Tom would never physically harm her. Now Kelly is trying to argue that Tom's motivation is to harm Sylvia and the babies so that he should be prevented from having any contact with them. This is contrary to what Sylvia believes. Tom is arguing that he needs to be physically present around Sylvia until the babies are born to protect them against some unnamed hazard. Sylvia is trying to blame herself for her mother's heart problems but I pointed out the obvious--that Sylvia is not responsible for her mother's heart disease. The prospective fathers are having a field day of speculation at SII trying to guess who is it. Richard has turned into a paranoid stalker, hanging around outside of Sylvia's house in a bizarre parody of some spy movie. Sylvia dealt with Hal by giving him an assignment and urging him to work a lot on it at home. I think it was probably a good idea. Sylvia referred to Hal as a spineless creep. She lied to Matthew about her due date to convince him that he couldn't have been the father. Sylvia is developing strategies to avoid the issues of paternity which she faces daily.
Tuesday, November 5, 1996	4 pm. Seventeenth Session with Sylvia Bows. Sylvia came in very angry at Tom over the latest twist in their legal battle. Apparently Tom has hired his own consulting obstetrician to advise on Sylvia's pregnancy and the health of the twins. Tom has served Sylvia with a legal document restricting her freedom quite significantly, even including a prohibition against orgasm during the remainder of her pregnancy. She is restricted to bed rest, forbidden to indulge in sexual relations, not allowed to drive a car, is supposed to be on a special diet, etc. I explained that these precautions might all have been prescribed by her own obstetrician soon due to her cervical problems, but Sylvia feels that they were created as a legal maneuver without reference to the health of the twins. She feels that Tom is just using this as a pretext to drive her insane or to destroy her will in the divorce action. She certainly is quite angry, although I sense that she feels, when able to look at her situation from an outside perspective, that there is a comical element. She apparently intends to immediately defy the order by going and staying at Richard's house and presumably engaging in sexual activity--a surprise given how she talked about him during her last session. I don't have any idea how Tom's lawyer believes he can enforce this decree against Sylvia, although perhaps they could utilize her disobedience in the custody fight as evidence against her ability to care for her twins after their birth.
Tuesday, November 12, 1996	4 pm. Eighteenth Session with Sylvia Bows. Sylvia is halfway through with her pregnancy now. She defied the court order which Tom obtained and went to live with Richard for a few days. Apparently Richard is doing some careful analysis of the dates when he and Sylvia had a relationship and has come to the conclusion that he is probably the father. He is delighted and wants to marry Sylvia. Sylvia surprised me by saying that she would have accepted under other circumstances--I thought she had more contempt for Richard than that--and that even now she is considering it. But Sylvia said that she couldn't accept the offer right now because of the "chess match" that she is in with Tom. Sylvia referred to it as a chess match, and I can see how it might take on that character. Sylvia's strategy is to force Tom to appear unreasonable to a judge in a courtroom. When Tom accused Sylvia of kidnapping (!) when she stayed with Richard, he was playing into Sylvia's hands. She believes that taking positions like that will diminish his credibility in the ultimate custody fight, and she might be right. Tom and Sylvia are both chess players, it appears.
Wednesday, November 13, 1996	11 am. Telephone Conversation with Hal Mainor. Hal, completely clueless, believes that he can become a successful writer by divorcing his wife, marrying Sylvia, and becoming a father to her child (he doesn't know they are twins). He thinks that it is obvious that Sylvia is pining for his affections. He even misinterpreted her orders for him to work from his home as an effort on her part to deal with her heartbreak over his rejection of her.
Thursday, November 14, 1996	4 pm. Twentieth Session with Anna Green. Anna mentioned Sylvia as a future single mother. I guess there is a lot of gossip and speculation at SII about Sylvia's current condition.
Tuesday, November 19, 1996	4 pm. Nineteenth Session with Sylvia Bows. Sylvia had a long talk with Rene's boy Robert, whose father died when he was an infant. Apparently, Robert takes very seriously Sylvia's decision to be a single mother. He has a rich fantasy life surrounding his imaginary father, who is very real to him. Even Rene has no idea of the extent of Robert's obsession with his dead father. Robert felt like he must come forward and tell Sylvia about a boy's need for a father. I was surprised to learn that Robert is another one who is keeping a chart of Sylvia's sexual liaisons while she was trying to get pregnant. Robert proposes to use the chart to help Sylvia's children in their inevitable search for their biological fathers. He expects that they will ask him for his assistance at some time in the future, and he will be there with his chart. Robert's revelations about his fantasy father hit Sylvia hard. She says that she has been thinking of little else since, and it made Richard's proposal all the more attractive to her. And she really doesn't want to have to marshal the strength to fight Tom. Tom has hired a live-in nurse to watch over Sylvia and to document her compliance or lack thereof with the court order. Sylvia is not allowed to drive herself, she must eat certain meals which are prepared for her. I can imagine how it must irk Sylvia, who is used to being truly independent. But Kelly is advising her to go along with Tom's wishes. Richard apparently decided to have it out with Tom over the telephone, suggesting to Tom that he should bow out gracefully. Tom let Richard have it, and Sylvia told Richard not to call her again at the house. There is something almost tragic about Richard. Despite what Sylvia says, and despite the fact that I have never met Richard, I can't imagine that he has a chance with Sylvia.
Tuesday, November 26, 1996	4 pm. Twentieth Session with Sylvia Bows. Sylvia is planning on attending the Thanksgiving Dinner of the Damned. Tom has decided to host a big family gathering with both his relatives and Sylvia's in attendance at their house. He has invited Sylvia to attend and she plans on accepting. It sounds horrendous, filled with agonizing silences and vicious confrontations--all the best elements of family gatherings everywhere. Sylvia's mother is apparently worse--she has given up the restaurant at least temporarily. And Rene and Jorge are not capable of hosting a Thanksgiving Dinner. Sylvia and Tom used to host the dinners over the last few years, so now Tom has picked up the slack. With Tom, I always assume there is a calculated benefit that he perceives gaining through this action. Sylvia believes that if she attends, she will be able to use it to her advantage in court, although I don't see how. In other court action, Richard apparently phoned Tom and had a heated verbal exchange. Apparently Tom was able to use that as a pretext to get a restraining order issued against Richard, keeping him away from the house during Sylvia's confinement. And Sylvia saw Hal at the office today. Far from being ready to bend to his advances, Sylvia described his touching her hand at one point as creepy and making her shudder. I hope that Hal doesn't do something precipitous with his wife over the hope that Sylvia will come around. He doesn't have a prayer with her.
Wednesday, November 27, 1996	9:30 am. Telephone Conversation with Hal Mainor. Hal called today. Apparently he saw Sylvia go into my building and assumed that she was coming here to see me. Of course she was, but I pointed out to Hal that she could have been coming to any one of a number of offices. I felt bad prevaricating to Hal, but I couldn't let him know whether Sylvia was a patient or not, and I told him so straight out. Hal has decided that he is going to wait until after the holidays to run off with Sylvia (or declare his intentions) out of consideration for his kids. Of course, Sylvia thinks Hal is creepy and I'm afraid that Hal is going to do something precipitous before discovering how Sylvia actually feels about him. I asked Hal to come in for a session to talk about these decisions and he agreed, but refused to make a definite appointment--his wife still doesn't know about these sessions.
Tuesday, December 3, 1996	4 pm. Twenty-First Session with Sylvia Bows. Sylvia described her Thanksgiving dinner with Tom and all her relatives. Everyone was on very good behavior and tried to pretend that nothing was the matter. It sounded like one of those Jane Austin stories where everyone is extremely civil on the outside while passions boil fiercely beneath. But the surprising thing is that Sylvia found herself almost losing herself in the civility of the moment. She remembered Tom and Thanksgivings from her past, and found herself slipping into the old feelings with Tom--the illusion that they were trying to create occassionally became the reality. Sylvia found herself leaning against Tom at the end of the evening as they stood at the door and said their goodbyes. When she realized what she was doing, she recovered with a start. She says that Tom is extremely attentive to her at home, trying to anticipate her needs and wants. Paradoxically, she thinks that Tom might be trying to drive her insane. I think she is having difficulty figuring out Tom's motives, ascribing evil motivations to his every action but not being able to figure out his game plan. That's what's making her anxious. But Tom might genuinely be concerned about Sylvia and the children. I don't know Tom like Sylvia does, but Sylvia has a tendency to paint everything in one color or another--it is either all black or all white. She talked about running away to France to have her children, a plan that makes absolutely no sense at all. I tried to dissuade her from pursuing such a course. All my patients are trying to flee one way or another--Helen, Phylis, Joseph, now Sylvia. I must not take it personally! At least Anna still needs me!
Tuesday, December 10, 1996	4 pm. Twenty-Second Session with Sylvia Bows. Sylvia has been ordered to bed rest. She met with Dr. Malleson who now believes that the pressure on her cervix necessitates her staying off her feet essentially for the remainder of her pregnancy. Sylvia is not thrilled, but at least she understands the medical necessity. This bed rest has been imposed upon her not through Tom's legal machinations but upon the orders of her own obstetrician. Sylvia is still ascribing evil motivations to Tom's actions which, under other circumstances, would be considered normal for an expectant father. He has decreased his outside travel and is staying closer to home. He has been going to Sylvia's appointments with Dr. Malleson, he has been reading books and watching videos in an effort to inform himself. Sylvia believes that he is a complete enigma, but I suspect that it is her own perceptual framework which is trying to stuff his actions into a motive with which she is comfortable. If she had to admit that Tom had a genuine interest in the children, she would have to confront issues of guilt, regret, and shame which she is clearly unwilling to do. Sylvia has always believed that she is completely justified in all of her actions and that Tom is a monster. I suggested that Sylvia try to talk to Tom--for starters just about why he is decreasing his travel. A non-threatening subject but one which I assume that Tom will use as an entree to tell Sylvia how important the twins are to him.
Tuesday, December 17, 1996	4 pm. Twenty-third session with Sylvia Bows. I went to Sylvia's house for this session. Tom wasn't there and Sylvia had herself installed into bed rest central--with the exception of a bathroom, all her wants can be satisfied within reach. Apparently SII has set her up with a networked computer and telephone to keep her involved with the company while on bed rest. Tom completely surprised Sylvia by taking her off by limo on an unexpected shopping trip for baby equipment. While Sylvia sat in a rocking chair, Tom arranged for a parade of equipment to be paraded past her for her inspection. Apparently they bought a lot. Afterwards, Tom took Sylvia to lunch. When they got back home, Sylvia found a new four wheel drive family vehicle in the garage with a giant ribbon around it and the license plate "TWINS". Sylvia was astonished at Tom's consideration and, more than that, she felt that he helped give the twins a certain reality as human beings in her mind. Sylvia felt that previously she had a selfish attitude towards the twins--worrying just about the pregnancy and how she was affected. After imagining how it would feel to bathe the babies in the little tubs that she just bought, Sylvia now feels that, mentally, she has made the twins solidify into individuals. What I found particularly interesting was Sylvia's unconscious use of the pronoun "we" when referring to the shopping trip. She sounded more like she was talking about her expectant husband than a hated litigant. I'd say Sylvia is softening somewhat in her position against Tom.
Monday, December 23, 1996	5 pm. Twenty-third session with Sylvia Bows. I saw Sylvia at her house. She just returned from a two day stay in the hospital where she went for pre-term labor. She had an uncomfortable night of cramps and Tom and his sister insisted that she get checked out. Apparently, she had been having a series of contractions. Dr. Malleson gave her an injection of terbutaline sulfate as a tocolitic, stabilized the contractions and sent her home with an oral dosage. Sylvia appeared pale and shaky, with a rapid pulse (130), possible high blood pressure, and shortness of breath. As hospital personnel saw her just two hours ago, I told her to call Dr. Malleson in the morning if she still felt the same way as she does now. Sylvia is terrified of losing the twins. She saw an ultrasound picture which really is remarkable--it shows the face of one of them looking a little like Bergman's vision of Death in The Seventh Seal, if truth be told. While she was in the hospital, Tom stayed with her night and day. She was grateful that he did. She seems to grow more and more dependent on Tom as her pregnancy progresses, and he seems to be there with his support. Perhaps they will ultimately be able to find some way to bridge the divide that separates them now.
Monday, December 30, 1996	11:30 am. Telephone Conversation with Tom Bows. I got a call from a clearly exhausted Tom Bows. He told me that Sylvia went into the emergency room just a few hours after our last session. She was having an adverse reaction to the Terbutaline: breathing problems, tremors and the like. My decision to stay out of it was incorrect--when I saw her last, I should have called Dr. Malleson to inform him of her drug interaction. They changed Sylvia's drug and sent her home. She tolerated the new medicine better, but it seemed less effective. She started to have serious contractions and went back to the emergency room. They switched her to an IV of Warfarin Sodium. Unfortunately, Sylvia ripped the stitch in her cervix. She has been ordered to spend the rest of her pregnancy flat on her back. Tom and Sylvia are both terrified about losing the babies--they are twenty-four weeks now. Tom said that Sylvia was completely out of it today, but said he'd call me when she gets home. Tom asked me to help Sylvia keep it together during her bed rest period and I promised to do all I could to help with that. The twins desperately need these next several weeks--every day they can stay in utero is an enormous plus.
Tuesday, January 7, 1997	4 pm. Twenty-Fifth Session with Sylvia Bows. I met Sylvia at her house for her session today. She is on complete bed rest, so she was flat on her back in bed during the session. Sylvia could not get over how wonderful Tom has been during the last few weeks. Far from distrusting his motives, Sylvia has now given Tom her health care power of attorney. She says that he is the only one she trusts now, excepting me. I asked her what her future plans were regarding Tom and she seems to be uncertain over the divorce. She said that she doesn't really know if Tom would want to remain married to her, but my feeling is that she really hasn't made up her mind yet. Sylvia said that she is feeling nauseated all the time as a result of the tocolitics which she is taking. She says that her mental processes are disorganized and cloudy. She's having difficulty concentrating. She is afraid she is losing weight. I didn't notice any particular disorganization in her conversation and found that she appeared to be lucid and able to maintain a coherent thread of conversation, but she felt that even in our conversation she kept forgetting things that she wanted to say to me. She described her thoughts as slippery. Sylvia's biggest fear seems to no longer be whether the babies will live, but now she is concerned over their condition upon birth. She is worried about brain damage and underdeveloped internal organs. When I told her about a story I heard recently about a girl born at twenty-four weeks who, a year later, is perfectly healthy, she said that she didn't want to be a newsworthy patient. She yearns to be a boring patient who can give birth in obscurity. Sylvia became tired, so we ended our session a few minutes early.
Tuesday, January 14, 1997	4 pm. Conversation with Tom Bows. Sylvia was asleep when I went to her house for our session, but it gave me a chance to have a conversation with Tom Bows, who I met for the first time in person. Although he has a lot of hostility towards me, I found him genuinely likable. The guy has clearly been run ragged. He is pale and haggard looking. I told him that I thought he needed some sleep, but he just shrugged my suggestion off. He seemed pleased when I told him that Sylvia had told me how helpful and supportive he'd been through the last few weeks. But Tom believes that I've never met the "real" Sylvia. He says that I erred in prescribing medications for her so early after I met her. I argued that the physical symptoms she presented in our early sessions demanded pharmacological action. Tom said that he knew she was in bad shape. He even said that he was the one who urged Sylvia to seek medical help. Now, Tom is focused on the kids, whom he thinks of as his. He doesn't believe Sylvia to be capable of raising them, even as he says that he doesn't want to take the children away from her. I startled Tom by asking him if he is still in love with Sylvia. He clearly is, although he claims it is irrelevant. I told him that I thought not, but Tom believes that Sylvia has made up her mind about the divorce and that nothing can change how she feels.
Tuesday, January 21, 1997	4 pm. Twenty-Sixth Session with Sylvia Bows. Sylvia was very interested in the content of my conversation with Tom last week. Tom was unwilling to give her any details at all and she surmised that it was more than the simple greetings that he would have her believe. I told her that I felt that Tom had a lot of hostility towards me, and that I felt that was unfortunate since we both had the same immediate goal of seeing Sylvia safely through a difficult pregnancy. Sylvia and I spent the rest of the session talking about Tom and his motivations. Rather than the complete turnaround which I sensed during our last session together, Sylvia has a more cautious attitude now. While she believes that Tom genuinely wants the twins to be healthy, she thinks it possible that the rest of his consideration is merely in service of that goal. Sylvia doesn't believe that Tom will ever be able to forgive her for her infidelities and, while the fuel for the fire of her anger over Tom's vasectomy has dwindled, she isn't sure that she will ever be able to forgive him either. Tom has agreed to put off all legal actions until after the children are born and so Sylvia desires not to face these issues until she has to. Sylvia was tired and we ended the session early.
Friday, January 24, 1997	4:30 pm. Fourth Session with Hal Mainor. Hal surprised me by showing up unannounced at my office this afternoon, just as I was preparing to go home. He's unhappy because he has run into a hitch in his plan to profess his love for Sylvia and leave his wife and kids. He has no access to Sylvia. Sylvia is at home, on bed rest, and isn't taking telephone calls, e-mail, packages, anything. Her plan of working out of her house has apparently been aborted. Hal tells me that he believes that Sylvia is being aced out of her position at work and that a new guy that has been shifted into the department has been trying to dig up dirt on Sylvia to use in the event that she challenges her termination. Hal is still completely clueless about the state of affairs between himself and Sylvia. He has concocted this fairy tale notion of Sylvia as pining away for him--completely disconnected from any reality. He wanted me to access Sylvia's personal information in the company health records and, when I refused, became somewhat abusive. I tried to bring him back to reality a bit by saying that I'd seen Sylvia and her husband in the hospital together and that they looked like they were reconciling--all true, although not to the full extent obviously--and Hal ignored the information and fixed on the fact that she might be in the hospital. So he took that as another avenue of access to her and rapidly departed.
Tuesday, January 28, 1997	4 pm. Twenty-Seventh Session with Sylvia Bows. Sylvia is at 28 weeks gestation with the older of the twins, 25 weeks with the younger. She is looking very pregnant. If I didn't know that she was pregnant with twins, I would say that she was in her last weeks of a 40 week gestation pregnancy. She says that the twins are extremely active--she describes them as squirming visibly sometimes, although I didn't see any movement during this session. She has a strange device next to her bedside--something that looks like an old Mac Classic computer with a telephone stuck into it. Apparently, she straps bands connected to the computer around her waist and the computer records her contractions and then transmits the information to a monitoring service via modem. A nurse on the other side of the phone can then interpret the contraction information and inform her doctor to allow him to adjust the dosage of the tocolytics appropriately. I was quite impressed. The device seems to allow a patient like Sylvia to spend time at home as opposed to being confined in a hospital connected to standard contraction and fetal heartbeat monitoring equipment. In fact, Sylvia bemoaned that she will not be able to go on her outings anymore. She'll miss them even though they are only to the hospital. Sylvia described how she has lost interest in the outside world--to the point of not reading the newspaper anymore. She says that her world has shrunk to the size of her uterus and she is aware of just how incongruous that is with her former personality. Sylvia said that she saw Hal in the hospital waiting room yesterday. He waited until Tom went to the bathroom and then came, knelt down in front of her, and placed his hands on her belly. Sylvia was appalled. Tom came back in and Hal did a little backtracking, although he told Tom that he and Sylvia were "very close." Sylvia said that she wanted to kick him and described his behavior as reminiscent of a weasel. She really is developing a sharp distaste for Hal. When I asked if Tom was suspicious of Hal, Sylvia said that she thinks that Tom believes that she had one lover and that was Richard. But Sylvia and Tom have clearly not discussed this at any length. Sylvia said that she hasn't been getting any e-mail from Hal or Richard for that matter, which makes me a bit suspicious of Tom. He might be keeping Sylvia isolated. I can imagine he could justify it by saying that he is trying to reduce Sylvia's stress, but I also imagine that it plays well into his agenda. When Sylvia said that she should try to contact Richard, I discouraged her and suggested that she wait until after the babies were born. Sylvia seems to be in the dark about her situation at work--she thinks that Lloyd has been doing his best to relieve the pressure of work for her benefit, although from what Hal told me, he might have more sinister motivations.
Tuesday, February 4, 1997	4 pm. Twenty-Eighth Session with Sylvia Bows. Sylvia is twenty-nine weeks pregnant now with the eldest twin--twenty-six with the youngest. We didn't talk about her health or pregnancy this time. It was all business--SII business. Sylvia has been cut off from the SII network, even after all the fanfare about setting her up with a command post at home. And, apparently, Tom has been logging on to Sylvia's personal e-mail account and deleting messages that he thought were somehow inappropriate--from a motive borne either of jealousy or, more likely, because he knows that something is up at work. Sylvia thinks that she is being fired. She called her own office and engaged her replacement, Nils Landors, in a fake interview by claiming that she was a reporter with Wired Magazine. Apparently her stratagem was successful, because she says that she and Nils chatted about how Ms. Bows gave it all up for motherhood. I got a sense that something like this was up when I talked to Hal. Sylvia is really angry about being dumped, and is threatening litigation and some nasty publicity. She was a newspaper reporter once and can probably wield the media with some effectiveness. Given their close professional relationship, I would have expected Lloyd to have at least talked to Sylvia prior to allowing Landors to shoot off his mouth to the press. I tried to urge Sylvia to focus on the task at hand rather than boiling over the injury done to her by SII, at least until the twins are born. Sylvia is too upset to follow this advice right now, although perhaps she will moderate her anger somewhat. She is sending Rene into SII to spy for her within her old department.
Tuesday, February 11, 1997	4 pm. Twenty-Ninth Session with Sylvia Bows. Sylvia is consumed with the facts concerning her ouster at SII. She believes that Lloyd Major, President and CEO of SII, has installed one of his homosexual lovers in her place and has interviewed members of her staff to gather information against Sylvia. Sylvia described it picturesquely as Lloyd conducting a witch hunt with Sylvia as the witch. But Sylvia is not without ammunition with which to fight back. Tony, a seventeen year old intern in Sylvia's department, was dazzled by Lloyd's attentions and was seduced into his first homosexual relationship. When Lloyd tired of Tony after about a month, he left Tony traumatized and visibly upset. Tony made Sylvia his confidant. So Sylvia has a powerful weapon against Lloyd--his homosexuality is not well known and, more importantly, Tony was a minor at the time of the affair. The weapon is effective only if unused, however. Sylvia told me that Lloyd made his fortune by patenting some weatherproof textile material. She believes that he views SII only as a toy that keeps him "cool and technologically hip." I expressed that it was disconcerting to be working for a company someone views as his toy. Sylvia described Lloyd as that "rollerblading, snowboarding son of a bitch." I remember getting a memo from SII when I first arrived, inviting me to Friday rollerblading on the Embarcadero with Lloyd Major and his gang. Not quite my speed, so I declined. Sylvia sent Rene to talk to Richard and send him her hellos. Richard had apparently tried hard to communicate with Sylvia, but had been intercepted by Tom. Richard told Tom that Sylvia was in trouble at work, but Tom decided that Sylvia should not be told while pregnant. Sylvia also told me that Rene disapproves of her efforts to reconcile with Tom. But Rene realizes the difficulty of raising children alone, having done so with Robert. And Rene knows that Sylvia was very much in love with Tom at one point. When I asked Sylvia if she still was in love with Tom, Sylvia became quite agitated, said "It's different now," and suggested that we end the session.
Tuesday, February 18, 1997	4 pm. Thirtieth Session with Sylvia Bows. The twins are doing fine, with a weight which would make them probable survivors even if they were born today. But Sylvia's attention is elsewhere--at the intrigue at SII over her position. Lloyd Major called her back last week and tried to set her mind at ease. Apparently, Lloyd stashed Nils Landor in her position as a temporary sop for an ambitious lover. Lloyd has no intention of firing Sylvia. But Nils is trying to secure his tenuous position. Interestingly, Lloyd might have encouraged Nils to instigate the investigation of Sylvia, knowing about Sylvia's indiscretions with many company men and her breach of company security respecting their health records. Why Lloyd would have taken such a step is a matter for conjecture. Tom and Sylvia both believe that he is up to something, but Tom is urging Sylvia to dismiss it from her mind until after the twins are born. Sylvia is still marveling at Tom's paternal turnabout. The depth of his genuine concern about the health of the twins has surprised her, especially after his prior strongly negative position on fatherhood.
Wednesday, February 26, 1997	4 pm. Thirty-First Session with Sylvia Bows. At 30 and 32 weeks gestational age, the twins are doing fine. Sylvia went to a prenatal check-up yesterday and there was Hal, lurking around the hospital. Hal pretended that he didn't see Sylvia so Sylvia pretended she didn't see him. But when she left, Hal tailed her car across town to her house. Apparently Hal wanted to find out where she lived. So today, Hal comes back with a big ladder strapped to the roof of his car. He puts it up against the side of Sylvia's house and, balancing a boom box and a basket of flowers, tries to play a balcony scene with Sylvia. Sylvia called for Tom, who was home, and Tom's entrance completely flustered Hal, who tried to rapidly descend the ladder. But he lost his grip and fell to the bushes below. Sylvia was laughing until she discovered that Hal had really injured himself. So, much against Hal's will, Tom took Hal to the emergency room where is he is now. I ended the session early with Sylvia because I wanted to go see Hal while he was still at the hospital.
Tuesday, March 4, 1997	4 pm. Thirty-Second Session with Sylvia Bows. Ah, poor Sylvia! Richard has decided that he is that father of the twins and has filed a custody suit against Sylvia and Tom. In his lawsuit, Richard provides a chart of Sylvia's lovers. All of this information is apparently news to Tom, who believed that Sylvia had just had an affair with Richard. So Tom blew up, called Sylvia a whore, told her that he was still seeking sole custody, and told her to seek alternative living arrangements after she's given birth. Sylvia is becoming hysterical when, optimally, she should still have several more weeks of pregnancy left. I tried to refocus her priorities back to the twins, but her current distress is obviously justified. I received her permission to talk to Tom and I'm going to try to get him to realize that this isn't something that's worth fighting about anymore.
Friday, March 7, 1997	11:30 am. Telephone Conversation with Tom Bows. I tracked down Tom at his office and was able to have a conversation with him. The conversation was very intense--he is very angry. I tried to explain Sylvia's point of view, while not making excuses for her. But Tom has an image in his head of Sylvia rutting with a dozen men. That image is eating away at him. My intention was to point out to Tom that they had almost achieved a reconciliation and that he had already forgiven her for having an affair. I wanted Tom to understand that this was one of the most important decisions he was ever going to make, and not to react out of some bruised ego or rage. I recommended that he see a therapist, but I don't think that went over particularly well. I don't know if Tom will take to heart the content of our conversation or not.
Tuesday, March 11, 1997	9:10 am. Conversation with Sylvia Bows, Rene Wolff, and Dr. Brian Malleson at the California Pacific Medical Center, Labor and Delivery ward. Rene called late last night. Sylvia's water broke and she went into labor. Rene called an ambulance and rushed her to the hospital where they were met by Dr. Malleson. Sylvia was put on an IV of Magnesium Sulfate which was successful in arresting the labor. When I saw her this morning, Sylvia was lying in bed and looking quite gray. She had an elevated heart rate and was perspiring freely. Sylvia was also attached to a fetal heart monitor, and at least one of the twins had a normal rate of 140 beats per minute. Apparently, the other twin wasn't being monitored. Sylvia hadn't had any serious contractions for the length of the strip--perhaps 3 hours. I spent most of my time talking with Rene because Sylvia seemed barely able to say hello. Rene was tired but very angry at Tom, whom she blames for Sylvia's labor. But Rene had tried to reach Tom, leaving a message with his secretary. I do hope that Tom comes through for Sylvia. She really seemed to want him there. The only time she became animated was when I was talking about the phone call I had with Tom last Friday. Sylvia was very anxious to know if I was successful in convincing Tom to reconsider his position. Sadly, I couldn't tell her that I was successful. Dr. Malleson arrived. He has that Old World charm that really cheers patients up--his bedside manner is excellent. But he was clearly concerned about the twins developing RDS. He is starting Sylvia on corticosteroid therapy. Although this is not my area of speciality, I believe that he is trying to artificially accelerate the development of the surfactant coating in the tubules of the lungs prior to delivery. But a side effect of the therapy is an increased risk of infection--particularly troubling here because the therapy won't work unless the lungs are given a chance to develop and, conversely, the delivery must take place if an infection develops after the water has broken. So Doctor Malleson also put Sylvia on a prophylactic antibiotic. Sylvia clearly needed rest and was being disturbed by my conversation with Rene, so I took my leave soon after Dr. Malleson left.
Friday, March 14, 1997	6:15 pm. Conversation with Sylvia Bows & Tom Bows at the California Pacific Medical Center, Labor and Delivery ward. Sylvia looked better today, even though she was still on the Magnesium Sulfate drip. She was extremely grateful that Tom had come. Sylvia wants to silently convey to Tom just how strong the bond between them still is, but she seems unwilling to actually discuss how she feels with him. When I chastised her gently for not telling Tom that she loved him, she said that she was scared that if she uttered the words and then Tom left her, that it would destroy her as a person. Tom came into the room and was his normal, businesslike, efficient self. He has educated himself about the medical procedures affecting Sylvia and was able to give me a lucid medical explanation of why Dr. Malleson wants to deliver the twins this weekend. He expects that the youngest boy will have to stay in the neonatal intensive care unit for a few weeks after birth. Obviously, with Sylvia in the room, I was not able to get a sense from Tom about how he is going to act with Sylvia once she has given birth.
Tuesday, March 18, 1997	4 pm. Conversation with Sylvia Bows and Tom Bows at the California Pacific Medical Center. Sylvia delivered her twins on Monday, St. Patrick's Day. When I arrived at Sylvia's room, she was alone and in good spirits. We even exchanged a few jokes. Roald, named after her grandfather, was born vaginally and is well enough to go home with Sylvia at the end of the week. Grant, the smaller of the two, began to suffer distress in utero and was delivered via c-section. He was just over 1.4 kilos at birth. He is now in the neonatal intensive care unit. Tom came by the room and, together, we walked over to visit Grant. Tom told me that, for now, Sylvia is going to come back home with him after they are released from the hospital. But the depth of his feeling that Sylvia is somehow unclean after having intercourse with a number of men is undiminished. He was clearly exhausted and opened up a lot more than I would have expected. He talked about having seen another father around the hospital worrying about an infant at the ICU, and then having seen him destroyed when he found out that his child had died. Tom identified with that father and, I think, realized how lucky he really is. At the ICU, Grant was completely enclosed in life support and isolation equipment. Tom could stick his finger in through a gloved port on the side of the incubator and Grant could grab a hold of it. Grant's strong infant grasping reflex has reassured Tom that he is a tough little boy. Tom almost gave me a complement, telling me that he was pleased I would be continuing the sessions with Sylvia. Then he said he felt that way because Sylvia obviously needed more therapy. I really hope that I can help them patch up their differences. After I left Tom, I wandered a bit around the neonatal intensive care unit. Tom was right, they are filled to capacity. I talked with a nurse and she said that there are still more infants that need treatment, but they are shipping them by ambulance up to UCSF's facility. The staff tried hard to make the place look like a nursery setting. A large mural right at the entrance had fairy tale pictures of little bunnies and flowers. But it didn't eliminate the feeling that this was a place full of painful struggle sometimes ending in death for tiny infants. I can't imagine how hard it would be to work there. I was impressed by their dedication. I saw one young doctor walk out of the ICU. He was momentarily embarrassed that I was there to catch him wiping a tear from his eye. He shouldn't have been.
Wednesday, March 26, 1997	4 pm. Thirty-Third Session with Sylvia Bows. At Sylvia's request, I cancelled yesterday's session and we met today at the hospital. Sylvia and Tom are spending most of their time at the hospital, living in the waiting room near Labor and Delivery with Roald. It's insane--the hospital released her and Roald on Friday, but Grant is still in the ICU. So what is Sylvia to do? She has to be near Grant, if only to feed him on schedule. And, of course, she has to care for Roald. If it weren't for Sylvia's exhaustion, it would be almost comical. But the nurses seem to be understanding, even if the hospital administration is not. Sylvia thinks that she is something of a celebrity and that the nurses are getting entertainment at her expense. Apparently, Richard showed up at the ICU, announced that he was the father, and demanded to see Grant. Richard and Tom almost came to blows and were both escorted out by Security. Another time Hal showed up and said that he was the father. So Sylvia, the lady with twins of different ages, has a kid with three men claiming to be the father. I have to admit that a story like that would have made the rounds back at Columbia. Sylvia has been trying to get Tom to talk about the issues facing their relationship, but has noticed that she can't even get Tom to look her in the eyes. Tom seems to be avoiding any painful issues by detaching himself from any personal emotional content that doesn't involve the twins. Richard is continuing his legal custody fight and has filed papers seeking visitation rights so that he can form a lasting bond with the boys while his petition is before the courts. I was looking for signs of postpartum depression, but for all her tiredness, I think Sylvia has escaped that. Perhaps she is just too busy. But there is an edginess to her that wasn't there before and that I can't ascribe all to sleep deprivation. Near the end of our session, she almost seemed to be expressing jealousy of Grant for garnering so much of Tom's attention. Or perhaps she is worried that Tom has a preference for Grant over Roald. Either way, it seemed strange and even Sylvia seemed to be uncomfortable with having those feelings. I should be watchful to see if those emotions crop up again.

###

---

Sylvia Bows' Patient File
Charles Balis' Notes by Patient



TheTherapist.com. Pipsqueak Productions © 1996, 1997. All Rights Reserved.