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© 2014-2018 Yara Zgheib All Rights Reserved


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On Pathological Daydreamers

March 26, 2015

‘ […] Oh, dream maker, you heart-breaker,

Wherever your going I’m going your way.


Two drifters off to see the world,

There’s such a lot of world to see.

We’re after the same rainbow’s end,

Waiting ’round the bend my Huckleberry friend,

Moon River and me.’


Moon River was composed by Johnny Mercer and Henry Mancini for the movie, ‘Breakfast at Tiffany’s.’ The song, which won an Academy Award and was later recorded five hundred times by other artists, is about two friends chasing a dream down a river. Some will say it is unlikely that Mercer and Mancini were actually referring to mon chéri and me when they composed it… in 1961, but we make it a point never to socialize with skeptics. Believe what you will, but Moon River is about us. You see…


© 2014-2015 Yara Zgheib All Rights Reserved


There was once a very lovely, very frightened young girl’ who thought she would never find someone to call home. One day, she met a boy who was smart and kind, and made her laugh. They married and drifted off to see the world.


The girl had always wanted to write stories, good stories. So one afternoon the boy sat next to her on their little grey couch to write one with her.


It took a few drafts, quite a few glasses of wine, and definitely more than an afternoon, but they finally wrote a story. A good one. That won an Honorable Mention in the Glimmer Train literary journal’s January 2015 Very Short Fiction Award. And boy did that make those two daydreamers proud.


It’s not quite the rainbow’s end mentioned in the song, but it is a beautiful milestone they wanted to share with you, dear reader. It's called: 


Diagnosis of a Pathological Daydreamer


The Emergency Department waiting room was full to burst when they wheeled her up to the counter, behind which an overwhelmed nurse was wiping pearls of sweat off her forehead and trying to bring the words on the sheet in front of her into focus. Seventeen hours into her shift and surrounded by wailing children and anxious mothers, drunks and paranoid schizophrenics, she was doing the best she could.


The girl on the stretcher was neither crying nor screaming, but as any ED nurse would know, that was not a good thing. She was unconscious and her vitals were unstable. Code red, this could not wait. Wheel her straight in and page the resident on call.


Identification?  None.
Relatives? Unknown.


Another Jane Doe.


Minutes later, a disheveled twenty-eight year old in light blue scrubs and a white lab coat with overstuffed pockets hurried in. His pager’s hysterical screech had jolted him out of an exhausted, uncomfortable slumber, but he knew the adrenaline pumping through his temple would soon have him well alert. He secured a white sheet of paper onto his clipboard and clicked his pen. Recognizing the queue, the paramedic started talking.


Twenty-four year old Caucasian female found wandering among speeding cars on the highway, asking for directions to the auction of the ruby slippers. No visible injuries or bruises. Delirious on approach, but calm and in no acute distress. Obvious disconnect with immediate surroundings.


No form of identification. No known medical history or available records. Observable distinguishing features: two small stars tattooed on the inside of left ring finger, birthmark in the shape of a wing above right collarbone…


The resident glanced up from his notes and looked at the patient for the first time. He was momentarily distraught by the girl’s red shoes. Why did they look so familiar?

The paramedic was still talking. Snapping back to attention, the resident interrupted him and turned to the nurse.


I need an oxygen mask, a cardiac monitor, and 1000 ml of IV normal saline. Basic labs, pan cultures, and a urine drug screen.


His instructions came out brisk and clear. The nurse reacted efficiently; she could follow his train of thought. The girl was delirious, but that was not an uncommon sight in the ED. More often than not, it was a sign of dehydration, alcohol intoxication, substance abuse… none of which, if confirmed, would speak highly of the soundness of Jane Doe’s judgment. But then again, the waiting room was full of irresponsible, inebriated adults behaving like children. The delirium could be a sign of infection, but in the absence of a fever the odds of that were slim. The resident had ordered pan cultures, but the nurse knew he was only being cautious. The situation was critical, as most cases in this department were, but he clearly did not expect any surprises.


Of course, that’s just the thing about surprises.


When the overwhelmed resident answered his page a second time the girl’s fever had gone up, and she was mumbling incoherently. Her heart rate and respiration had slowed, and the test results indicated an infection. His gut tightened like he had just missed a step on a flight of stairs.


Nurse, page the attending on call and have the crash cart on standby.


As he waited for the attending physician, the resident stared again at the girl’s red shoes. He pictured her putting them on earlier that night, just before she headed out the door. Perhaps she had bought them specifically for the … what was it again? The auction of the ruby slippers, the paramedic had said.


The uneasy feeling gnawed at him again. Why were those words so familiar?


He suddenly remembered; it was a movie his wife had insisted on making him watch, another lifetime ago. Ruby slippers with magical powers, heels clicking together, and something about flying. Or was it going home. He couldn’t remember; he had slept through most of it. But he did remember the lavender smell of her shampoo and the white dress she was wearing that day.


The attending on call burst into the room. He snatched the clipboard from the resident’s hand and began scanning his notes. On queue, the resident began his recitation:


Twenty-four year old female patient in a state of acute confusion and unstable vital signs. Fever, increasingly pronounced heartbeat irregularities, shallow respiration…


But the attending, who had leaned in to listen to the girl’s heartbeat, suddenly held up his hand to silence his junior. He stood motionless for a few seconds before shakily pulling the stethoscope out of his ears. When he finally spoke, his tone was nauseatingly detached.


Extended neck pointing skywards, dilated pupils, unfocused gaze… what we have here is a Pathological Daydreamer. Common symptoms include: incessant humming, tendency to step off sidewalks, gaze at stars, tear up to the sound love songs played after two am.


He sounded almost academic.


The Daydreamer Syndrome most often affects children and adolescents, though it can at times have a later onset. The younger the patient, the easier it is to misdiagnose, as symptoms are often dismissed by parents or guardians as childlike anomalies.


A Pathological Daydreamer will pour a tub of glitter on his head and expect to fly, or wander away to another city because a yellow brick road led him there. He will see shapes in clouds and poems in alphabet soup, spot every penny dropped on the sidewalks of Kansas City but walk straight into every lamp post and fire hydrant.


Daydreaming heightens the sensitivity of the patient’s heart to otherwise common elements we are all exposed to in the real world: loss, suffering, heartache, injustice. Symptoms include chest pain, dizziness, nausea, and insomnia. The chest pain is often described as a heavy weight pressed against the heart.


Daydreaming can be treated by gradually hardening the fibrous pericardium:[1] restricted exposure to certain music, movies, and literature; a thorough rehabilitation of the patient’s thoughts; and a reevaluation of the patient’s sentimental relationships.


Early diagnosis and a comprehensive treatment can stifle Daydreaming early on, but undetected and untreated, the syndrome can rapidly degenerate into a fatal pathological state. If the heart is sensitized to the point that it can no longer withstand any contact with the real world, then the damage is irreversible; Daydreaming has metastasized. The slightest infection will cause the heartbreak you are witnessing here.


There is nothing we can do. Free up this bed.


Just before he left, he added, almost humanly:


She cannot feel the pain.


But the young man was not listening. He was thinking of another pair of red shoes and another young girl, who smelled of lavender and floated off a rooftop in her favorite white dress, another lifetime ago.


© 2014-2015 Yara Zgheib All Rights Reserved


[1] Outermost layer of the heart’s protective membrane.

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