Chance and the summer of love

Early on, before it had become apparent just how acrimonious, costly, and downright mean spirited the divorce would become, Chance had thought to find a place in or near the Presidio, a small house perhaps, with a view of the water, the proximity of redwood and cedar. The fantasy was short lived. The good places were expensive and hard to come by though nothing in the city was cheap anymore, that other Summer of Love a long time gone.

He’d settled finally for a modest one-bedroom apartment with a shared basement garage at the edge of the Sunset from whose front-most windows he might on occasion glimpse the sea. The streets in his new neighborhood, though raked at a slight angle to run downward in the general direction of the Pacific Ocean, were uniformly flat and treeless, bordered by long lines of gaily painted stucco and wooden structures. On sunny days he found these streets infused with such light as he’d come to associate with the deserts of the Southwest, their hopeful pastels bleached of meaningful distinctions. On foggy days the colors were made impotent as well, barely distinguishable from the damp concrete sidewalks, the asphalt streets, or the pale, slate gray sky. Analogies he might have drawn with his own life appeared tiresome even to him.

What he’d taken as the decline of things in general had coincided with a particularly disturbing case. It was not a complicated case. There were no legal or medical puzzles to be solved. There were only the facts, which he had summarized as follows:

At the time of my evaluation Mariella Franko was 34 months post a head-on motor vehicle accident in which her 68-year-old father was killed in gruesome fashion. (In an effort to avoid a wayward dairy cow that had wandered into his lane, her father had collided with an oncoming delivery truck. He was decapitated. His head rested in the rear seat. Mariella remained trapped next to her father’s body till freed by the Jaws of Life. She remembers shouting ‘Daddy!’ many times while in the car.)

Review of emergency medical services indicates her Glasgow Coma Scale was 15 at the time of their arrival. Her chief complaint was listed as ‘My daddy… I want my daddy!’ She was medicated with intravenous fentanyl and transferred by ambulance to a CalStar helicopter that carried her to Stanford. Upon arrival, she was crying and asking for her father. No fractures or internal injuries were found. She was monitored overnight and sent home with plans for follow-up by a primary care physician.

A psychiatric evaluation done one month later describes anxiety, depression, startle reactions, spells of tachycardia, tachypnea, and perspiration together with intrusive thoughts of her father. It was noted that she had spent three months off work and attempted to distract herself by trying to watch television. Her social life had become very constricted, with severe withdrawal and isolation. She described a predominant state of hopelessness and lack of motivation. Ms Franko was found to be suffering from chronic post-traumatic stress disorder and major depression. A course of psychotherapy together with antidepressant medication was recommended.

Unfortunately, Ms Franko went on to receive neither psychotherapy nor pharmacotherapy and remained, at the time of my evaluation, anxious, depressed, and struggling to avoid any such thoughts, mental images, or feelings as might return her to the night of the accident. I agree that Ms Franko suffers from chronic post-traumatic stress disorder. She faced a life-threatening situation, believed she was going to die, was present at her father’s death, and was trapped in a vehicle with him under gruesome circumstances. The photographs I have been shown speak for themselves. It is unfortunate that a second psychiatric consultation was not obtained until more than 2 years had passed following the accident. And while her avoidance of mental health care professionals is understandable, it is exactly this avoidance to which health care providers should have responded…

Eldon J. Chance, MD

Associate Clinical Professor

Department of Psychiatry

UCSF School of Medicine

There was more to the report but that was the gist of the thing. Someone’s insurance company had retained him to evaluate the nat