Patient name: Tobirama Senju

Date of birth: 25/04/1995

Journal entry: 16/1/2023

Currently: Meet patient to evaluate if the Compulsory Psychiatric Care Act can be written off. Patient says the permissions have been good for him. Has been in touch with his boss, whom he claims to have a good relationship with and whom waters patient's plants as he's hospitalised, and there is a plan for slow return to work. Will start working 50% in a month, then 75%, then full-time. Patient denies suicidal thoughts. Says he looks forward to coming home, but if we deem that he would benefit from staying longer he would be fine with that, too. With this, he does no longer fulfil the requirement to be held within the Compulsory Psychiatric Care Act. We deem that the patient can be written out with a planned appointment with outpatient team within the week. Write prescription for Sertraline.  

Psychiatric status: Good formal and emotional contact. Patient laughs several times during the meeting. Converses adequately, good ability to reason about his current and previous situation. Displays a wide range of facial expressions. Normal eye contact. Not motorically still or agitated. Nothing overt psychotic. No suicidal communication.

Planning: Outpatient treatment planned, first appointment within the week. 

I had been frightened to go on permission alone.

With Izuna, it had been a different thing entirely. I had looked forward to it, not feeling unsafe once, knowing we were there to protect each other.

On my own, however...

"It's normal", the doctor said. "Most patients feel nervous to go on permission. Some even try to avoid it. We need to really motivate them, then."

I was surprised by this. Didn't everyone want to get out of here? At the same time, I couldn't help but feel relief, relief that there wasn't anything wrong with me, at least not more than the others that were in this place.

"What are you afraid of?" the doctor asked.

"That I will find myself on top of the bridge again", I said.

"Do you have any such thoughts?"

I thought for a while.

"No. No more beyond being frightened of it."

"Do you feel life is pointless?" I shook my head. "Do you wish you were dead?" I shook my head again. "Then I think we feel as safe as we can feel. Also..." The doctor looked over his glasses at me. "I no longer seem I have enough substance to give you care under the Compulsory Psychiatric Care Act. Which means that from here on out, you're here on your own free will. Do you understand what that means?" I furrowed my brows. "It means you're free to leave. It means that if you ask us to unlock the door so you can get out, we have to. It means that if you go on permission and don't come back tomorrow, we won't send the police to look for you."

"Can't you keep me under the Act for a while longer?" I asked in a desperate attempt to keep myself safe.

The doctor smiled a sad smile.

"Legally, I can't. Just by asking that very question, you don't fulfil the criteria anymore."

"What criteria?" I asked.

"You're not in unconditional need of in-patient care. You do not deny healthcare, nor are you ambivalent to it. And you no longer have a serious mental health condition. With your question, the second criteria can already be written off. But you don't fulfil the first or third one, either."

"Fuck me..."

"I really want you to go on that permission, Tobirama. Can you please? I've had a long day and don't really feel like bargaining."

Memories washed over me then, memories of late nights in the office, of finishing a task only to realise you had another, over and over. I had also had long days. I wouldn't feel like bargaining then, either.

"Fine", I said.

And once I did it, once I went on that first permission, I was surprised by how easy it was. How good it felt. It was as if as soon as I got out of the ward, into the winter sun, my soul decided to step up to keep me sane, to keep me safe. And I couldn't get enough of it from there on out.

That first time, I went home first thing I did. I cleaned my apartment. I went grocery shopping and cooked lunch boxes which I put in the freezer. I changed bedsheets, took a shower and when I was done, I realised it was close to midnight. I went to bed, read my book in the comforting light of my bedside lamp. I must have fallen asleep like that, because I woke up with the book covering my face, the light of the bedside lamp faint in the morning light. I checked my phone, realised I needed to be in the ward in just a couple of hours, got up and made myself breakfast before I left. The entire situation was oddly robotic, strangely void of any emotions, but I didn't hate it. And I couldn't remember last time I'd had that many hours of uninterrupted sleep.

As I came back into the ward, I realised just how much good that permission had done me. I didn't feel at home in the ward anymore, didn't feel part of it, but longed out. It scared me how much I'd gotten used to living in the ward, to its familiar routines, to how safe it was, how impossible it was to kill oneself in it. But I realised that being scared of how at home it could feel was a positive thing.

I walked through the corridor to the room where I was to meet the consultant, but as I rounded the corner of the L-shaped ward, I came face-to-face with Izuna.

I looked at him, lost for words. He looked at me, equally lost.

Then, I looked away, and walked past him.

"You're jumping your leg."

I didn't speak. I could feel the stiffness of my face, how stern it was, how closed to the world as I looked out the window from my chair opposite the consultant, feeling that chair was a throne on the only world I would ever know. I didn't think his statement was worth a reply. He respected that.

"How was the permission?"

"Good."

"What did you do?"

"Cooked. Cleaned. Slept in my own bed."

"Any thoughts of self-harm?"

"No."

"How would you feel about another permission?"

I turned to the consultant.

"I want to be written out next week."

He raised an eyebrow.

"Really?"

"Yes." I thought for a bit. "Although the thought scares me. Being in a world with so much access to the possibility of killing myself."

"This ward is full of means to kill yourself." It was my turn to realise an eyebrow.

"Isn't the ward supposed to be idiot proof?"

"Yes, but on what planet are you an idiot?" 

I was written out the next week after a long row of uneventful permissions where I cooked, cleaned, and exercised. I started running again, realising I needed to get back into shape cardio-wise; even if I'd managed to keep my strength up in the ward gym and even build some, I hadn't done any cardio and I felt it. It came back to me easily, though, and within a few weeks I ran 10 kilometres in forty-five minutes with ease before breakfast twice a week.

I had contacted my boss the day before I was written out. I had thanked him for watering my plants, and we had met for lunch as my permission that day. We had decided on me coming back to work 50% after a month, then increase to 100% in a pace I deemed good for me together with my doctor. The rest of the lunch was spent chatting amicably, and I felt I was happy in this entirely normal situation that had seemed so far from my life not at all long ago.

"If there anything you ever need, just let me know, son", my boss said before we left the restaurant.

"Same for you", I offered warmly, doing my best to hide how touched I was.

The day before I started working, I couldn't sleep, terrified that this would cause me to spiral back into depression. I tossed and turned for hours, but must have been able to fall asleep at some point because suddenly, it was morning. I ate breakfast, showered and got dressed before I took my car and drove to work. To my great surprise, everyone seemed really happy to see me. The company was medium-sized, making me believe I had always melted into the background, but apparently not. People came to me, greeted me, hugged me. I was oddly touched by this. In my office, my desk was full of Get Well-cards. It was unbelievable to me. Maybe, life hadn't been as bad as I thought it had been. Maybe, I had just been unable to see it. Wasn't it Izuna who had asked whether jumping truly was my only way out, or if it was just the only way out that I was able to see? I suddenly understood what he meant.

I got to work behind my computer. It had been a while, but I immediately got back into it. I opened the document with the task, a bug in a code we would sell to a hospital that needed to be fixed. It had cost us a lot of money due to a several week delay.

"Don't worry", my boss said. "I don't expect anything. I just want you to get the hang of it again."

I solved the bug within an hour.

And I found that at lunchtime, when I was finished, I wasn't filled with dread but with a sensation that I was good at what I did, that I was worth something, could provide something as important as a program for a hospital.

It continued like that for weeks. I came to work, was given tasks, finished them. I started socialising a bit during coffee breaks. As I started working 75% and thus got a lunch break, I preferred taking them alone in my office, needing the time alone, but nobody seemed offended by this. I took my medicine every day. I went to my doctor's appointments every other week. I still had the energy to work out, to cook, to clean, to do my laundry. Before I knew it, two months had passed since I started working, and I was working a hundred percent. I felt more competent at my job than I had ever done, and learning cure was steep. I got promoted, was offered more money. I gained friends at work. Everything was going well in my life.

Too well.

I came home one Friday evening, hung my spring coat in the closet in my hallway. I undressed, changed clothes, went to my kitchen to fix something to eat. It was a rest day, meaning I wouldn't exercise, so I planned on solving crosswords while having tea. I sat at my kitchen table, eating cake with my tea while solving.

And I thought about Izuna.

I allowed myself to well and truly think about him.

I wondered what he was doing during exactly this moment. Like, exactly now. Was he solving his cube? Was he playing pool? Showering? For some reason, it was hard to imagine him existing. He felt like a dream from a different life as ungraspable as night-time. I'd heard nothing from him except for that one text message so long ago, asking where I was. When I hadn't replied, he hadn't contacted me again.

I asked myself, not for the first time, what had happened. The answer wasn't that complex. I had realised exactly how much psychiatry there was to the man, and had learned that I didn't want any part of it in my healthy life. I was done. Well and truly done with it. I didn't feel any regret regarding it. I knew I needed to put myself first, or I would sink, not swim. But at the same time, I wondered why I wasn't a better man who could accept Izuna for who he was, the way he believed I was.

I had finished my crosswords. I stood up, went to the drawer where I had my Sertraline. I furrowed my brows. I was well now. So, so well. Not depressed. Not even sad. I was fine. I was living my life. I was working. I could provide for myself.

I looked at the pill one final time before putting it back in the drawer and closing it again.

I was well now.

But I knew what the true reason was behind me stopping my medication.

Punishment for having stopped loving Izuna.

That was the beginning of my deterioration.

Of course it was. I never learned. I never learned that happiness wasn't for me, that it was not in the cards for me to live a normal life.

I was leaning over my toiled bowl, vomiting over and over again, the taste of wine mixing up with the acidity of bile in my mouth as tears sprinkled salt on it. I did not enjoy the taste in particular. Neither of the sweet-acid wine nor my salty tears.

I cried as I remembered the conversation with my boss earlier that day.

"You've been deteriorating, son." I had felt my heart sink to the other side of the planet and drop into space until it was captured by the gravity of the earth and started soaring around the planet like the moon. Like the moon who was never allowed to come down to rest. "What's wrong?"

"I'm fine", I said.

"Do you take your medicines?"

"No", I said. I had difficulties lying. Just like Izuna. Although for him, it was a cute feature whereas for me, it was pure torture.

My boss furrowed his brows.

"Why?"

Because I left Izuna. Because I started ignoring him. Because I hurt his feelings. Because I was terrible to him. Because I couldn't love him and thus I don't deserve medication. I don't deserve to feel well. It's not in this life for me.

"Because I was better."

"Was it the doctor's orders?" When I didn't answer, he sighed. "Sorry. As your boss, it's none of my business. But look." I didn't want to look. Nor hear. Nor think, nor feel, nor be. "Stopping your medication is irresponsible. I don't want to be part of you getting hospitalised again. Step up your game, or you'll have to find another job because if you deteriorate, it's not going to be on my watch."

I had drunk when I came home. The first time I had alcohol since that night on the bridge. This time, I'd had five glasses of wine and two shots of Fireball. I felt exactly the way I deserved. Better, in fact; I deserved much, much worse. But I wasn't going to get worse by just sitting here, pathetically in my bathroom.

I stood up, staggered to my door. I put my coat and shoes on, took my keys. I fell on the doors of the elevator outside, pressed the button, breathing heavily to prevent the next wave of nausea created within me; I had nothing left in my soul to throw up. Only emptiness. Once out, I was surprised to find it was completely dark. Just like last time. But the night wouldn't scare me. Just like it hadn't last time. 

Remember how you didn't have any clue how to get over the fence last time?

Well, this time would be different. This time, I would be aware. I would understand how I came to stand at the edge the last time.

I walked along the sidewalk, looking at the fence. It was much, much taller than I was. I felt myself starting to panic as I walked and walked, not finding any means to get through.

Relax. Relax, it's okay. There are other means. There are other means than jumping. The night won't scare me.

And then, about three quarters of the way to the other side, I saw it; a hole in the fence, large enough yet so subtle it was hardly visible. Relief washed over my heart like warm water, and before I had time to even decide what I should do, I climbed through.

The relief I felt was painful. Just like when you'd been tied up with a rope for a long time and was finally released just to realise the blood rushing back to your limbs was more painful than the rope itself, finally being free to jump was painful. Finally... Finally, I'd be free of this.

I didn't dare to wait this time. Last time, I had been so close. So. Close. There was no way I would let that happen again. I would-

And I heard it.

My heart that had dropped through the earth and out into space and was now the moon clenched so all blood was squeezed out of it, dying the moon red.

I heard it.

No...

Police sirens.

I hadn't heard them last time, too occupied with my thoughts, but this time, I did.

No!!!

My skin was dipped in the blue light of their sirens.

It's now or never.

"Bye, Izuna", I said out loud.

"NOOOOOOOOOOOOOOOOO!!!!!!"

It was the worst thing I had heard in my entire life.

Lifetimes worse than the voices in my own head.

Lightyears worse than Izuna's screams as he was belted and force-fed.

The scream was so heart-felt, it split my soul in two perfect bits with razor-sharp edges.

And he threw himself at me, and caught off guard as I was, I fell to the ground.

"WHAT ARE YOU DOING TO YOURSELF?! TOBIRAMA, WHY?! WHY WOULD YOU DO THAT?!"

His face was like that of an angel in the night, contorted in fear and shame and hurt as if displaying all of the emotions he'd never been able to display throughout his life all at once, just like my brain had tried to think all of the remaining thoughts of my potential life the last time I had stood on this bridge. He had a glow about him as if surrounded by a halo. If he'd been an angel without a halo, I would surely give him mine just to make sure he was allowed into heaven.

I heard the screeching wheels of the police vehicles, their sirens gratefully silent now but the blue lights burning my eyes.

I leaned my head back, closed my eyes.

I took Izuna's hand in both of mine.

Then, I screamed in pure despair of being alive.