✅ The Last New Start [NaNoWriMo2021]

101. Diagnosis

"My name is Doctor Lutwa, but you can call me Serra if that makes you more comfortable. Would you like to take a seat?"

"Thank you," Tess mumbled, suddenly shy.

"Now, I've looked over the notes from your last visit. But would you like to tell me some more of the details? When did you first notice this problem?"

"It was in autumn," she said, and then thought back. The date should have been burned into her memory, but she needed to check her phone to find out the day she had actually moved house. When the doctor heard that she asked if Tess had been worried on that day; how well she knew her cousin, and how she had felt about the possibility of leaving her parents behind. That made Tess think right away that the doctor thought this might be a psychological issue. If there had been some disease, or an excess of Unexpected Urination Hormone on her blood tests, these questions wouldn't have been necessary. She answered as best she could.

Then they moved onto the following months. Tess estimated that she had initially woken up wet only occasionally, with a week or a little longer in between. She said that she'd always rushed to wash the sheets, and that being able to deal with the problem herself had made her feel a little more confident about it. She mentioned looking online to see what could cause sudden bedwetting, and had found people talking about hormonal disturbances, as well as the possibility of infection. She described how much she'd hoped that it would stop by itself, and how scared she had been to actually approach a doctor.

She mentioned having sleep problems as well; not knowing if that had some effect on it. And her first few times drinking alcohol, which she'd blamed until she woke up wet after not having a drink at all. Tess tried to hard to reassure herself that she had been dealing with the problem like an adult. Listing the possible causes that her research had turned up, and how she had gone through them one by one until they could be ruled out. How she had wondered if it might be the different daily routine after moving to Palmerston, or something in Gabby's house that she was allergic to, or even a psychological thing from the way Gabby talked to her like she was a child; until the problem had persisted when she visited her parents over Christmas.

Tess described wearing diapers as well. She couldn't bring herself to say the word, so she called them "absorbent underwear", but it was pretty clear what she meant, and her face burned as she mentioned it. Taking precautions. And she said that after reading that this could be stress related, she'd tried something that was supposed to help with anxiety.

"Meditation? Talk therapy? Alcohol?" Tess's eyes widened at the last suggestion. "It's common for people to attempt self-medication if they believe an issue may be influenced by anxiety."

"No, none of that," Tess mumbled, and realised she had no idea how she was going to put this. Would the doctor think it was crazy? "Well, maybe meditation. Kind of. I tried with... hypnosis. Is that a normal thing?"

"I know you can buy tapes that are supposed to reduce these kinds of problems, as well as more general ones to increase calm and balance. I would like to keep an open mind about the former, although I haven't seen any reports of them being greatly effective. And in the latter case... hypnosis recordings, especially those sold through magazine advertisements and online, are often not designed by experts. But as they may include calming tones, the sound of birdsong or whales, and a lot of language about being calm and relaxed, I can see that they would still be beneficial to work on stress."

"Well, I..." Would Ffrances get in trouble, if someone knew she had hypnotised Tess without a proper doctor/patient relationship? "I found one that's supposed to promote faster and cleaner sleep to prevent bedwetting. If somebody tells me before I sleep that I'm going to sleep well and not... wake up wet, then I can get to sleep really quickly. It's pretty amazing, and I couldn't believe how well it works. But it says you could get dependent on it for sleep if you overuse it, so I ask my cousin to tell me to sleep maybe twice a week, on the days when I know I won't have time to shower in the morning. To start with it was great, and I thought that was proof it was just about the sleep. But a few weeks later I started waking up wet again. Never on the nights she said it, but it happened, and it's been slowly increasing. It's almost back to the level it was at before."

"Well, that's very interesting. I was going to say that your test results are all normal. There are no signs of any infection, and your hormone levels and renal function are all pretty close to the average for a girl of your age. We also tested for some toxins that can cause issues if you're exposed to them, and medications for which this can be a side effect, but found no trace of any relevant metabolites. At this point our options would either be environmental, psychological, or neurological. But for hypnosis to have such a profound effect, I think we can say that this is certainly related to stress. Whether directly, or as a result of disrupted sleep cycle, it's hard to say. But we can recommend a counsellor who may be able to help you to identify and address underlying issues that could be keeping you awake at nights. Would you be able to travel to Pine Ridge to see a specialist who might be more experienced with these specific issues?"

"No!" Tess answered quickly, and she could see all the questions lining up in the doctor's mind. Questions that she wasn't going to push into. "No, it's... I don't want my cousin to know that I'm worried about this."

"It's normal for doctor/patient interactions to be confidential, of course. But I'm curious why you phrase it like that. You aren't afraid of your cousin knowing about the problem, but knowing that it is a problem?"

Tess took a deep breath, and marshalled her words. She needed to get this right, so she could explain without giving any suspicion of Gabby's more embarrassing hobbies. She knew how to say it, she thought.

"Gabby used to babysit when I was a little kid. Like, when she was my age and I was three. When my parents dropped me off last year, she seemed kind of disappointed. Like the mental image she had of me was still that little kid. It's like a nostalgia thing, I think. That was like the happiest time in her life. So any time I do something that reminds her of those days, I can see it makes her more comfortable. Even just little things like she'll offer to brush my hair while we're watching TV. And I guess my problem gives her that same feeling of nostalgia. She said it might be stress, but then she's kind of dismissed it as a normal thing for little kids. She'll help me clean up and stuff sometimes, but she doesn't realise it's a big deal. She doesn't know how often it's happening now, and she doesn't seem to remember how old I am until I tell her. So if she knows I thought it's worth seeing a doctor about, it would just make her worry too. And another person's concern doesn't help."

"I see. Well, I think that is your choice to make, but I'd urge you to put your own health first if you have to choose. But I think it's unlikely that your cousin would know. Would you need her help to get to Pine Ridge? The rail service from Ashfields to Upper Ashfields actually stops at Pine Ridge, although the station is so small that a lot of people don't realise there is one."

"No, it's... Gabby's partner is a doctor at Pine Ridge. Doctor Jones. I think she's an assistant head of the psychiatric facility or something. Certainly a manager, and her job includes matching patients to the right doctor for their needs. If my name's on her computer when she's working from home, there's a chance Gabby would see it."

"I see. Well, we do also have a link to another service. An online therapy service, which we recommend for people who might have trouble attending an in-person therapy session, whether due to travel problems, social anxiety, or other issues. This would be simple talk therapy, conducted over a phone or video call. You can call from home, on your mobile if you can find a safe space, or you can use one of our offices when you get an appointment. They would be able to help you talk about any issues that might be enhancing this stress, as well as any feelings of obligation towards your family which might be making the situation more difficult for you. I believe that emotional balance may be the key to improving your sleep quality. And if sleep is the reason for your other problem, I hope you will start to see some improvement."

Tess nodded, but there was something missing there. Something she had failed to mention because of its humiliation factor, even though it was the straw that had broken the camel's back and forced her to actually seek out a doctor.

"Now, we can also offer a sleep-tracking bracelet, which might allow us to monitor if there is–"

"Wait," Tess interrupted. "There's something I missed out. It's just hard to say, and that's what I really don't want Gabby and Ffrances to know about. It's just..."

"It's okay. Take a deep breath, and think about the words. There's nothing to worry about here, your words will never leave this room."

"Yes," Tess gasped, suddenly feeling like she was out of breath as her anxiety spiked. "Thank you." She couldn't calm down now, she couldn't force herself to take a deep breath. But she knew that if she didn't say, then this would have been a waste of time. She said the words.