The Patient

by Jasper DeWitt

  But the thing is, Rose, the things Joe was trying to remind Frank of? They were all nightmares Frank had as a child. He said it was like the monster in those nightmares had been whispering to him all night, saying how much he missed chasing him, and catching him, and eating him.

  It sounded outlandish. How would a boy that young know what a 40-year-old orderly used to dream about? So I listened to the tape. And I can’t come to any other conclusion but that he imagined it. I didn’t hear a sound, and the microphone was turned all the way up. What’s more, Joe was restrained all the way on the other side of the room, so if he was making a sound loud enough for Frank to hear, the mic would’ve picked it up. I don’t think he could’ve avoided that unless he was whispering right into Frank’s ear, which is obviously impossible.

  Even weirder, after a bit, I was able to hear Frank breathing very loudly. And his breathing patterns weren’t normal. It sounded like he was hyperventilating. Like he was having a panic attack, in fact. But I listened to it over and over again, and there were no other sounds. At all. So I have no idea what Frank’s talking about.

  I now know for sure, after this session and the one I had with Joe that we can’t cure him. It’ll take a better doctor than me to figure him out, and good luck finding one who’ll be willing to come work in this shithole. Maybe he’ll die in here. But there’s nothing we can do.

  Rose, you’re going to be medical director one day. We both know it. We’ve discussed it at length. I know you think this is your fault. I know you’ll be tempted to keep trying new things with him. Don’t. Just keep him here at his parents’ expense and feed them whatever story you have to. They’re rich enough to afford a lifetime of care. Even if they somehow go broke, find room in the budget. I couldn’t have it on my conscience if I knew I’d had him in my care and he somehow got out to cause trouble in the real world with whatever he has just because we failed. Promise me, Rose.

  —Thomas

  After this letter, there was only an official document stating that all therapy with Joe would stop. He would have his own room, but at the price of being kept restrained in it twenty-four hours a day, seven days a week. Only a select few orderlies would be allowed in to change his sheets and deliver his meals, and only the most experienced nurse would be given the task of administering medication to him. All staff would be encouraged to stay away from him. He would not be referred to except by the extremely nondescript shortened name, so that anyone wanting to find out more information wouldn’t know where to start. It was, in brief, everything that I’d observed since arriving at my new workplace.

  Even so, if I’d been intrigued before, I was hooked now. Here lay the possibility of discovering a previously undocumented disorder—not merely a permutation of something already in the DSM, but something entirely new! And I had patient zero under this hospital’s roof. My choice of residency began to seem almost an act of God. There was just one thing to do now: listen to the audiotapes I’d seen referenced in the records.

  I immediately went back to the records clerk and showed him the numbers for the tapes, expecting to get them fairly quickly. However, to my surprise, after he’d typed in the numbers on his computer, he furrowed his brow in confusion and then walked back into the records room without a word. Some ten minutes later, he returned looking even more confused.

  “There’s nothing under those numbers, doc,” he said. “Never has been. You sure you wrote them down right?”

  I was quite certain I had, and anyway, I couldn’t risk another trip that could alert him to which file I’d been looking at. Besides, if they had ever been there, it would make sense that they might have been destroyed or removed given their connection to the hospital’s biggest problem patient. I faked a tired grin and shook my head at the records clerk.

  “Someone’s played a joke on me,” I said. “Sorry for wasting your time.”

  I walked out of the records office and discreetly left the hospital. Knowing I would need time to think about what I’d just read, I decided to stop at a coffee shop before heading back home. While there, I began to jot down my own makeshift notes, so as to keep what I had read fresh in my mind for later analysis. These notes have formed the basis for my re-creation of the file in the preceding pages.

  It was obvious that Joe had started with some sort of empathy-based disorder, which perhaps had been worsened by the concussion he sustained at the hands of his first roommate. Had he merely been a nasty little kid who pushed people’s buttons at random, it would’ve been easy to diagnose him as a textbook case of antisocial personality disorder.

  But the thing is, Joe’s empathy problems seemed to run in different and equally extreme directions. His emotional empathy—that is, the ability to feel what other people were feeling—was obviously nonexistent if he’d been making people kill themselves and trying to rape a boy before he even knew what rape was. But his cognitive empathy—the ability to recognize what others were feeling—must’ve been unbelievable. Almost superhuman. Not only could he spot another person’s insecurities, but he could predict with perfect accuracy how to exploit them in order to cause maximum distress. It was the kind of skill I’d have expected to see in a trained CIA interrogator, not something spontaneously developed by a young child.

  More puzzling still had been his apparent shift in tactics right after his disastrous encounter with his first roommate. Prior to that, the numerous therapy records all indicated that his preferred approach was to induce feelings of anger or self-hatred in his victims. Yet immediately afterward, as if his modus operandi had changed, he’d switched to inducing fear so extreme it would trigger a fight-or-flight response. Why this sudden shift in approach? What had happened to change his symptoms? And who’s to say it was even him who’d triggered those feelings of fear in the first place? What about the fact that the orderly’s recording of his encounter with Joe revealed only silence?

  That night, probably because of the reference to the orderly’s negative experience, one of my childhood nightmares resurfaced. I wouldn’t ordinarily go into it since it raises terrible memories for me, but it’s relevant to what happened later, so I’d better explain.

  My mother was sent to the hospital for paranoid schizophrenia when I was ten. My father had put her there after the night he’d woken to find her bending over the kitchen table with the sharpest knife we owned buried clean through her wrist, muttering about demon insects that the devil had put in her ears to make her hear the screams of the damned. She thought that cutting herself would make the insects bleed out of her and she’d stop hearing the voices. I wasn’t aware of any of this at the time. My dad told me that he’d made damn sure I was out of the house whenever Mom had an episode, which, in retrospect, explains why he was so cool about letting me constantly go to sleepovers at my friends’ houses. But even at that age, I knew something was wrong, and I wasn’t surprised when I woke one morning to find my dad at the kitchen table, stern and sad as he explained to me that my mother had to go away.

  But, obviously, I missed my mom and started begging my dad to take me to see her. For the longest time, he refused, but eventually he relented and took me to St. Christina’s, the hospital where Mom had ended up. That one visit nearly broke me, and it completely quenched any desire I had to see my mother again.

  To give you some context, St. Christina’s is one of those poor, urban hospitals that has always been underfunded and which suffers from reports of patient abuse right up to the present day. In the eyes of the local government, it was effectively a dumping ground for human trash, and the city I came from doesn’t spend much time worrying about the comfort of those it sees as garbage.

  Fortunately, my dad was gainfully employed and could afford to keep my mother from pushing a cart down a street and screaming at random passersby, but only just. So St. Christina’s was our one option. Being a kid, I didn’t understand that some hospitals were better than others. Until that visit.

  My mother was housed in a small side building
where the most financially strapped patients were kept, and long before I got to her room, I knew I categorically did not belong there. The place was held behind two heavy, ugly, gray doors, and they opened with a buzz that sounded like it had been calculated to disrupt the human mind before you entered. The lobby, meanwhile, was little more than a grimy cube, with chairs that even bedbugs wouldn’t deign to touch.

  Some of the patients, each clad in identical filthy hospital gowns, wandered freely in the surrounding halls, throwing jackrabbit stares and subterranean-sounding mutters at the sane visitors. Even at ten, I could feel the rage and fright in those eyes, which seemed to scream in their sockets. Why are you here, among the damned, you poor dumbass child? Didn’t your momma tell you this is no place for you?

  But my momma was one of the damned. I found that out as soon as we got to her room and the orderly opened the door. In that moment, I was hit with the overpowering smell of urine and blood, and even the orderly covered his nose in reflexive disgust before shouting for his peers. Not knowing that something was wrong, I pattered into the room.

  My mother was crouched against the wall, her gown soaked in a slowly spreading pool of her own urine. Clutched in her hand was a small, makeshift shiv that she’d stuck halfway into her wrist, from which bright red blood was weeping. Momma must’ve felt my eyes on her, because she turned toward me as I stared, and her mouth split into a smile so wide I was surprised her cheeks didn’t split open. An ugly, blackish-purple bruise marred her forehead, probably from banging her head against the wall.

  “Parker, child,” she murmured. “Come help me with this. The damn maggots won’t crawl out of me, baby.”

  I had no idea what to say. I had no idea even what to think. I stood there and stared at the abomination that had once been my mother. Seeing my expression, which must’ve been blazing with shock and revulsion, my mother’s face fell, and she dropped the shiv. Her wrist still pouring blood, she raised her face to the ceiling and let out an animal howl that slowly devolved into peals of laughter. Or sobs. I honestly couldn’t tell which. Then, slowly, she began to crawl toward me, the blood from her wrist joining with the urine on the floor to form a hideous puce broth around her. Some part of her must have remembered she was a mother, and that her child was afraid, because she began to croon a lullaby softly, in a voice hoarse with months of misery.

  “Hush-a-bye, baby, on the tree tops,” she rasped. “When the wind blows, the cradle will rock. When the bough breaks, the cradle will f-f-faaaaalll . . .”

  There was the sound of heavy footfalls behind me, and two orderlies rushed past, one of them holding a syringe in his hand. She was still singing—and laughing—as they seized her and shoved her onto the bed.

  “When the bough breaks, the cradle will fall!” she shrieked. “And down will come ba—”

  The syringe had gone in, and she went quiet. I turned and ran, into the open arms of my father, who held me as I wept with primal, uncomprehending terror.

  You need to know this because you must understand that this was the day I decided to become a psychiatrist. And not just any psychiatrist, but one who would never treat any patient as disposable, no matter how hopeless or unlovable they seemed.

  Which brings me back to the nightmare I had after reading Joe’s file. One of the least surprising effects of a traumatic experience is having bad dreams about that experience afterward, particularly when your brain is as underdeveloped as mine was during that fateful encounter with my mom. As you can probably tell from reading this, I still grapple with the feeling that I have an obligation to help any and every person who has been left to suffer from their own mental illness, simply because some part of me still questions whether it was my fault that my mother went insane in the first place. True, blaming myself like that is irrational, but kids—and adults who are still processing childhood trauma—don’t blame themselves simply out of a secret desire for self-hatred. They blame themselves so they can feel in control of what seems like an impossible situation, because the only way to feel like they can process it is to reclaim their agency, even by blaming themselves for something they have no control over.

  I like to think that as I have gotten older, I have grown more capable of dealing with the trauma of that experience without feeling the need to hold myself to an impossible standard in order to feel in control. But that wasn’t true at first, which is probably where the nightmare I’m about to describe came in.

  In the dream, everything began just as it had in real life. I walked into St. Christina’s and took a seat in the dismal waiting room. Only there was no one there besides me. In fact, in the dream, I somehow knew the entire building was empty except for me. And it. The thing I called my mother.

  I could feel its presence in the building without even seeing or hearing it. That awful, traumatic wrongness vibrated in every inch of wall, chair, and ratty carpet I could see. And even though I would have given anything to stand up and run away from it, and out of that miserable, crumbling monument to the personal hells of broken souls, what I wanted to do and what the dream let me do were completely different things. So instead of running, I felt myself stand as if bewitched and walk slowly, step by step, across the stained gray linoleum floor to the room that housed my mother.

  Even before I got there, I could hear her laughing. A high, keening, mirthless cackle of the damned that made the walls seem to literally contract around me like the walls of a boa constrictor’s stomach. The closer I got to its room, the more desperately I fought to turn away, and the more I fought, the faster the dream forced me to approach. As I reached the doorway beyond which the hell of my own childhood trauma was gibbering, the smell of piss and blood blew into my nostrils and choked off my air, even as the dream forced me, with implacable, merciless force, to look at the cause of the sounds and smells.

  My mother was, as she had been in real life, crouched against the wall of her—its—lair, its dirty hospital gown soaked to the skin beneath the waist from the slowly spreading pool of urine underneath it. As I entered the cell, it sensed my presence and raised its leering face to mine.

  And this is where my subconscious managed to somehow transform the already terrible details of that memory into the true, hallucinogenic stuff of nightmares. My mother’s smile was not merely wide and manic—it was so wide that her cheeks had split, revealing bleeding gums that leaked their hideous scarlet effluvia down onto her chin and gown. Her arms were not merely sliced open in brutal, jagged cuts from the shiv; the wounds festered and crawled with maggots. And where my actual mother had appeared tall only by comparison to my childlike frame, the nightmare mother was so tall that she couldn’t stand upright in the cell but loomed over me as she bent against the ceiling, a spider already gushing with the blood of the traumatized fly in its web.

  Then it screamed. Normally, I was saved from hearing much of this because I would scream in response and wake myself up. But for whatever reason, the night after I found Joe’s file, my mind would not let my throat form the necessary sound. Instead, I was forced to choke out terrified, rasping noises as that endless perdition-laced howl reverberated through every chamber of my ears. How long this went on I couldn’t say, as dream time eludes the most strict clock, but the mental distress I felt was so acute that it may as well have been hours.

  Yet this was not the only terrible surprise that my subconscious mind had in store for me. There was one more fresh horror. As I watched the nightmare mother shriek at me, the mire beneath its feet suddenly began to bubble as if boiling over. Then, suddenly, from within the depths of that feculent, squalid pond, a pair of feelers shot out and wrapped themselves with dreadful tightness around my mother. The feelers looked to be made of tangled black hair and bloodstained leather, but they moved and jerked like tentacles attached to some awful subterranean horror. As they dragged the nightmare mother to her knees and into the muck below, she began to shrink, her wounds healed, and her face assumed the look of frustrated love that my mother—my real mot
her—had worn as she tried to comfort me.

  “Oh, my darling boy,” my mother crooned. “My sweet baby . . .”

  The dream permitted no attempt at aid from me. Instead, I was forced to watch as that awful pair of bristling feelers dragged my mother into what now looked like a lake of her own filth. When her head finally reached the surface, I heard a terrible sound: a burbling, hacking laugh echoing from beneath the pond that rang with increasingly deranged sadism as the feelers yanked the last remnants of my mother into its depths. Somehow, the sight made my brain release my throat, and I screamed out at her.

  “Mommy! Mommy! Come back! Mo—”

  “Parker! Parker!”

  I felt someone shaking me, and, just like that, the dream blinked out of my mind, and I found myself staring into the bleary, very frightened, and yet fiercely loving eyes of Jocelyn.

  March 18, 2008

  Hey, guys. Nice to see the reception growing. And thank you for your feedback. No, I can’t do anything for her anymore. My mother passed while I was still rather young, which further compounds my inability to help her. And she’s really not what this story is about. I just needed you to know that piece of my history.

  Fortunately, the dream didn’t recur that night, and I more or less forgot about it as I returned to the hospital. Having read the case file, I fully intended to see if there was some way I could get an audience with our mysterious problem patient. I was debating how to go over my supervisor’s head, since I knew he would slam the door on this. When he had given me his tour of the premises as part of my orientation, he deliberately did not even walk to Joe’s end of the hallway. When I asked him about it, he bit my head off and told me to mind my own patients and never interfere unsolicited with another psychiatrist’s work. “You can’t help everyone.” So I needed to find a justification for going over his head. But as I arrived at the hospital, a new distraction presented itself.