by Cara McKenna
I knocked on the heavy oak door of his office, and it opened shortly.
“Good morning, Miss Coffey.”
“Good morning, Doctor.” We’d never been formally introduced, so we shook. He cut an impressive figure, tall and rigid, with authoritative, extra-white streaks at his temples. His shake was firm.
“Come on in and I’ll give you the rundown.”
His office was far tidier than Dennis’s, lined with books and books and more books.
He said that a psychiatric intern and I would be in on the interview. I flushed with pride to hear I was being offered the same experience as a medical student. We weren’t to say anything, except to explain who we were, if the patient demanded to know. Other than that, we’d just observe, and take our best stabs at diagnosis and suggesting treatment once the interview was over.
“I know you’re only an LPN.” The way he said it, I knew Dr. Morris wasn’t trying to be a dick about it. Not like, I know you’re only a lowly LPN with some piddly certificate from a no-name technical college. More like, I know this is the deep end and you didn’t sign up for it. Don’t panic. “But Jenny said you’re looking to continue your education, so this might be a useful peek at what goes on, behind the scenes.”
“I’m sure it will be. Thanks for even inviting me, Dr. Morris.”
Jenny had told me once, toss the docs’ titles at them in conversation, any chance you find. It’s courtesy, of course, but it’s also currency. They can’t get enough of that, she’d said, like we were talking about dogs and belly scratching. Think of it as an investment in your career. Kiss a little doctoral ass, and it’ll pay off when you need an emergency consult someday. Let them think you worship that white coat. It must have been working for Jenny. She was a regular puppeteer when she wanted something for the ward and its residents. Or for her colleagues, it would seem, if my invitation to sit in today was her doing.
“So.” Dr. Morris opened a folder on his desk, tapping the stack of forms with a pen. “Patient is thirty-two, long history of violence, multiple convictions. Drunk and disorderly, assault and battery, breaking and entering . . . Every unsavory ampersand combo you could want. Latest and most credible diagnosis lands him on the psychotic end of the schizoaffective rainbow, with some major and long-lasting mixed and manic episodes. Multiple voluntary drug treatment programs—for cocaine mainly, plus alcohol, and a botanical garden’s worth of cannabis, which never plays nice on that spectrum. Oh and meth, one conviction.”
I shivered at meth. The closest thing the human race currently had to a zombie plague.
His gaze zigzagged down the page. “Five voluntary programs, to be precise, and exactly zero completed. Not a finisher, shall we say. History of violence with treatment facility staff.” Dr. Morris smiled wanly at me like, Oh goody! Lucky us. “Bit of a pharma cocktail, both prescribed and recreational. Though his outbursts seem to have lessened greatly since he’s been treated as a schizoaffective case.”
“That’s good.”
“He was interviewed during an emergency hold following an assault, and the doc there wants him with us, instead of prison. Patient doesn’t relish either option, but who would?”
A knock came at the door behind me and Dr. Morris boomed, “Come in.” I swiveled as a gangly young African American guy in a white coat entered the room. He smiled at me and adjusted his glasses, and pulled over a second chair.
“Erin Coffey, this is Darius Flowers, my talented new victim from CMED. Coffey and Flowers,” he mused. “Charming. Darius, Erin’s one of our newer LPNs, with an eye on earning her BSN. She’ll be sitting in as well.”
We shook.
He rewound the spiel and briefed Darius about the incoming patient. We both nodded like babies watching a yo-yo, and I caught myself thinking, I could’ve been a med student. I was studious, and had managed strong grades even with all the drama I’d had going on through my certification, plus I had a pretty high tolerance for blood. All I was lacking was the huge wad of cash, and the nuts to cut the cord with my sister. I wouldn’t hold my breath.
“I think that’s enough of my yammering,” Dr. Morris announced, getting to his feet. “The admission interview will teach you more than this stack of papers ever could.” He shut the folder and we followed him out of his office, waiting as he locked it.
He led the way. I hardly spent any time on S1. It was mainly the psychiatrists’ domain, and while the nurses from the locked ward were often in and out, conferring about residents, orderlies and techs and junior staff like me received most of our information secondhand.
The first floor was nicer than S3. It seemed sunnier, with oak wainscoting and hardwood floors, not the speckled linoleum we had upstairs. Our footsteps were noisy, echoing with history.
Dr. Morris led us down a long hall, punctuated by doors with frosted windows, each boasting the name and credentials of one of the staff doctors. At the very end of the corridor was a windowless door with two plaques. The first read Admissions and the one below it, Vacant. Dr. Morris slid the bottom plaque from its brass runners, flipped it over, and put it back in place reading In Session. He keyed in a code and led us inside, leaving the door swung wide.
“Only S1 office without windows,” he told us, wheeling chairs over. “Normally we’re happy to give patients a view, minimize the confinement vibe, but in here we can’t afford too many distractions. Too much stimulation. No telling what shape folks are in when they get delivered.”
He arranged two chairs facing another two chairs, plus one more, off toward the corner. That was my seat. Part of me was a bit hurt, shunted to the sidelines, but another part didn’t envy Darius’s proximity to a new and unpredictable patient. Who the fifth body would be, I didn’t know. A police escort or security guard, likely.
Darius and I were both nervously eyeing the room, scanning the austere wood paneling, and like me, maybe he was getting an escape route plotted, in case things got intense.
Dr. Morris flipped the folder open on his crossed legs. “Don’t you two just tremble like fawns?” he teased, scanning a page. “No need to panic. The patient’s been detoxed to his previous doc’s satisfaction, and his paliperidone regimen seems to be working.”
I scanned my mental flashcards for the side effects—restlessness, tremors, tics—so I wouldn’t make the mistake of blaming them on his disorder, when and if Dr. Morris asked my opinion. Darius was surely doing the same, nodding with a blank expression as Dr. Morris outlined the patient’s meds situation.
Voices came from down the hall, but I was too far from the door to see who was approaching. A woman’s voice grew louder, then a face I recognized appeared—a senior nurse who spent most of her time on S1 but made the occasional appearance during hand-off.
“Ready for Mr. Paleckas?”
Dr. Morris smiled graciously, all his wryness dutifully packed away. Darius’s hand was frozen above a legal pad, pen hovering at the ready.
Two men entered. I barely noticed the first one, as the second was Kelly.
My nerves short-circuited, morphing from trepidation to that funny, pleasurable knot of misgiving I always got around him. I kicked it aside. Now was not the time for distraction.
Kelly waited for the patient to sit, then did the same, linking his fingers atop his belt buckle and looking blasé. I just bet he’d prefer to be standing, arms folded, but I supposed it wasn’t helpful to give the patient the impression he was being held and interrogated. Kelly and I shared the briefest eye contact, and if he was as surprised to see me as I was to see him, he didn’t let me know it.
The nurse briefed Dr. Morris on the patient’s latest vitals before taking her leave. She shut the door with a heavy, telling click, and Dr. Morris leaned forward to offer his hand. “I’m Dr. Robert Morris. You must be Lee Paleckas.”
Lee accepted the shake. He was medium height, wiry, and su
rprisingly attractive—charismatic, if not actually handsome. He looked a bit like Edward Norton, only . . . twitchier, and with an unhealthy milkiness to his complexion. A vampire Edward Norton, who could stand a few square meals. He was already dressed in Starling’s gray uniform, and it made him look undeniably like a convict. He even seemed to be wearing invisible cuffs, his hands now dangling limply from his wrists between his spread legs.
“Who’re these people?” Lee asked Dr. Morris, sounding more tired than suspicious.
“This is my intern, Darius, and one of our nursing staff, Erin. I’ve asked them to sit in on this chat, but all the same confidentiality applies.”
Lee sniffed and rolled his eyes, clearly annoyed to have an audience but seeming resigned to us. Resigned to this entire situation, maybe resigned to his whole damn life. I decided to channel my inner Kelly Robak and sit nice and still, blend into the furnishings until or unless my services were needed. I’d observe with my ears and eyes and intuition, and leave the obsessive scribbling to Darius.
Dr. Morris opened the interview with the basics, determining that Lee had grown up outside Louisville, Kentucky, in a broken home, had been getting into trouble since he could crawl, and had been paranoid and punchy for as long as he could remember.
“I just don’t trust people.”
My gaze shot reflexively to Kelly. His cold gray eyes settled on mine before I could look away. Which of us was accusing the other of distrust?
“And if I asked what your diagnosis is,” Dr. Morris said to Lee, “what would you say?”
“I’m bipolar. That’s what every shrink’s said about me since I was nineteen.”
“It was the hospital’s opinion that you may be what we call schizoaffective. And that’s a possibility I’d like to explore during your time here at Larkhaven.”
“Ain’t those the same thing?”
“Similar, but not the same.” Namely, not the same to the tune of psychosis. “You may also have a combination of the two.”
“Fuckin’ great. Lucky me.”
“In the last interview, you told your doctor you’ve heard voices. Is this a new phenomenon?”
He shook his head. “Nah. It’s just not something you want to advertise, you know? ’Less you’re looking to wind up in the nuthouse.” He cast his gaze around the room. “But it’s a little late for that, now ain’t it?”
“What do your voices say to you, Lee?”
He tensed for a moment, then slumped with a sigh, too worn down to bother resisting the conversation. “They don’t say things to me, exactly. But sometimes, if I’m talking to somebody and I don’t trust them . . . I’ll hear what they’re saying, with their mouth. Then I’ll hear like this echo of what they’re really thinking.”
“Okay.”
“I mean, I’m not stupid. I know it ain’t actual mind reading. But maybe some guy at a bar’ll say, ‘Did you catch the Lions game?’ But then I’ll get this echo, with his voice saying all fucked-up shit, sex shit sometimes, stuff this stranger wants to do to me.”
“That must be upsetting.”
Lee leaned back in his chair and gave Dr. Morris a leveling stare, one that said, loud and clear, Is that shit the best shrink line you got for me, Doc? And in that moment, I decided I liked Lee. I hoped he’d find his time at Larkhaven useful, and that I might be able to make his stay a little more pleasant.
“And your voices never tell you to do things?”
“Not really. Only if the person I’m talking to is thinking that. But nothing like you hear about, about demons and aliens. Just made-up whatcha-call-it. Telepathy.”
“Have you heard people’s thoughts for a long time?”
“Since I was a teenager, maybe?” That was in line with schizophrenia and schizoaffective disorder, for auditory hallucinations to begin manifesting in young adulthood.
“Did you believe you were hearing people’s real thoughts, all this time?”
“At first, yeah. I thought I was special. Like I had a superpower. Except it scared me, since nobody was ever thinking anything nice, nothing that ever made me feel anything but sick.”
As forthcoming as Lee was being, his affect was incredibly flat and dry, making it difficult to know if he was being open or just rattling off the same answers he’d given to a dozen doctors before. He also seemed tense, a bit jittery—but it felt like that was more physical than mental, a side effect of the antipsychotics.
“When did you first begin to suspect the voices might be coming from your own head?”
“I guess I was maybe twenty-one. I was visiting my grandma, and we watched this old movie. Black and white. I can’t remember what it was called, but it was about this chick that like, wakes up in a mental hospital.”
The Snake Pit, I thought. I’d watched it with my grandma, too, years before I wound up nursing her.
“The chick heard voices. Not like the way I did, but that was the first time I kinda got what people meant when they talked about ‘hearing stuff.’ I’d heard about crazy people having that, but for some reason, I never thought I was crazy. I thought I was special. That my brain was better than everybody else’s. Until I saw that movie. Then everything kind of went to shit, because back when I’d thought I was reading everybody’s thoughts . . . It sucked. I didn’t trust nobody, but I trusted myself. And my own brain. After I started thinking maybe I was crazy, then I didn’t trust anything. And I knew all that fucked-up shit I was hearing, that must be stuff I’d come up with. In my subconscious or whatever.”
“When did you first start experimenting with drugs?”
“Shit, I dunno. Fifteen? That’s when I started smoking pot, anyhow. I didn’t do nothin’ worse until I was in my twenties.”
“And is that around the time the voices started? When you started smoking pot?”
“Maybe, yeah. I never really liked it much—the weed. But after I got told I was bipolar, this one doctor mentioned, just like, in passing, how some people with that got benefits from smoking.”
Dr. Morris’s professional façade fell away for a moment, an exhalation of pure annoyance hissing from his nose. “I see.”
“So I smoked a lot, the last ten years. It was cheaper than seeing a shrink.”
“Pot has been shown to ease some symptoms of bipolar disorder. But it’s also been shown to exacerbate those on the schizoaffective spectrum. Did your trouble with the law begin during this period?”
“I was never a good kid, but it did get way worse after the pot, yeah. And the voices got louder. And nastier.”
The interview went on for another hour, a conversational trip down Lee’s crime-riddled memory lane. He didn’t withhold much of anything as far as I could tell, but his flatness made it difficult to get any handle on his temperament. And temperament was telling, just as much as these illuminating anecdotes.
But one thing was refreshingly clear—he was one of the most self-aware schizo patients I’d yet encountered. And that could be the difference between an institutionalized life and a manageable one.
After Dr. Morris had heard everything he cared to, he shook Lee’s hand, and opened the door, calling for the nurse. She appeared shortly, and she and Kelly escorted Lee down the hall. I’d nearly forgotten Kelly was there. He knew how to make himself inanimate when that was what a patient needed.
“I look forward to talking some more this afternoon,” Dr. Morris called after them, then bade Darius and me to stand. “Let’s take this back to my office.”
We followed him out the door, waiting as he slid the Vacant plaque in place. After a pit stop for coffee, we re-adjourned to his stately quarters.
“Well,” Dr. Morris said, crossing his legs and glancing between us. “What did we think of Mr. Paleckas?”
Mercifully, Darius went first. He gave a long account of his observations and de
tailed an impressive list of treatment suggestions, many points of which I wasn’t familiar with or hadn’t thought of. Suddenly the line between LPN and third-year medical student was crystal clear, and I felt deeply lame, standing on my side of it. I hoped Dr. Morris might not bother asking my opinions. I’d lost all faith in them.
He checked his watch. “I know you’ve got an appointment with Dr. Fenton,” he said to Darius. “I won’t keep you.”
“Thanks so much, Dr. Morris.”
“My pleasure. Excellent work.”
Darius left, and I got to my feet as well, poised to say my own thanks and escape back to S3, where I at least felt halfway qualified to exist.
“Not so fast, Miss Coffey. I’m dying for your analysis as well.” He linked his fingers atop Lee’s folder.
I sat heavily, weighed down by dread. My face felt warm, my hands like ice. “Well . . .”
He smiled. “Just tell me what you think. Unlike poor Darius, my opinions won’t be making it back to your academic advisor.”
“Well, I kind of thought . . . I can’t tell yet. The paliperidone seems like it’s made him all flat. And tense. I’m sure the other doctor knows what they’re doing, but I kind of wish I could meet him on a lower dosage. It didn’t seem possible to get a real read on his personality, with the meds in the way.” A luxury we didn’t have, and I damn well knew it. Dr. Morris probably thought I was making up excuses to avoid offering my own treatment strategy, or that I didn’t have one. Which I didn’t. “Sorry. I’m not comfortable recommending a course of action if I don’t know what his . . . what his baseline personality is. I’m way too new at this to be able to separate the side effects from his normal affectations.”
“Can I share with you my own perceptions, Miss Coffey?”
“Of course.”
“Every patient who arrives here—every person you pass on the street, for that matter—is a complex recipe. Perfectly unique but mixed from a set number of ingredients.”
“Okay.”