A crowd had assembled around the main hospital entrance, including more than a few people whose cameras and microphones positively identified them as reporters. Immediately curious as to what was going on, I fought my way through the crowd, only to see a stretcher bearing a body bag being loaded into a police van. Worried, I scanned the crowd for any face I might recognize and spotted an orderly whom I’d seen working on the same ward as me. I fought my way over to him and asked what had happened.
“Nessie died.” His voice sounded hollow, as if he were a million miles away. “They’re saying she threw herself off the roof last night after making her rounds. No one knows why, but one of the patients says she did it after she’d finished . . . you know, with him.”
Now just as horrified as my counterpart, I reached out and gave him a stiff, one-armed hug, as if to reassure him that someone else felt the same thing he did. He didn’t react. Apparently, the shock was still too strong.
And just like that, my need to cure Joe became personal.
Note: The next update will take place on Friday. We’re getting closer to the stuff I find really difficult to talk about, so my writing pace is probably going to slow.
March 21, 2008
Oh, man, I knew I was throwing a grenade into this thread with that last post, but I didn’t expect this. For God’s sake, the mods stickied this post at the top of the forum! I never expected my little confessional to get that much attention, or that much love, and I can’t tell you all how much I appreciate it. I’ve also been more than a little amused reading all your attempts to diagnose Joe, even though none of you are even close to the truth. But reading your comments has made it easier to remember all the shit that other doctors ruled out, which in turn has made it easier to remember more details.
I haven’t even gotten to the bit that makes me doubt my sanity yet, and already the memories are making me feel like I have to drink more and more just to sit down and write. My wife’s worried about me, but once I told her what this was all about, she understood. She’s the only other one I’ve told, and whether out of love, or open-mindedness, she believes me. I’m still glad to see that so many of you do, too, and after the last part, some of you at least seem to be getting closer to the truth. I don’t think anyone could figure the whole thing out, though. Not now. You simply don’t have enough information.
Anyway, I left off with Nessie’s suicide and how it shocked so many people.
Frankly, it should have. Even though I’d been there only a short time, I knew the loss of a nurse like Nessie would be felt for years to come. Over the days that followed the dreadful event, it became obvious that the ward I worked on had trouble functioning at all when there was no Nessie around to carry most of the workload. The police didn’t help either, as they made a point of questioning every single member of staff, which slowed us down even more and raised a lot of uncomfortable suspicions about foul play. But, ultimately, the case was cleared as a suicide, and they finally left us alone.
For the sake of order on the ward, Dr. P—— was forced to step up and act more in control of the staff he theoretically already supervised. His aggressive new participation manifested as yelling at me to stop wasting my time on talk therapy with my patients, that’s what the group sessions were for, and just medicate them so they’d be quiet. A more easily cowed doctor probably would’ve just taken it, but I didn’t. Instead, I asked Dr. P—— to visit my patients if he thought my methods weren’t working, because otherwise, I’d make sure to put it in writing that he’d asked me to do something ineffective. He raged and stormed at this and called me something I won’t print here, but eventually, he relented, since he knew that the patients under my care had been receiving more targeted prescriptions and were benefiting from my more expansive attention.
“You’ve made your point,” he snarled. “But everyone has to pull more weight around here with Nessie dead. If your methods can’t accommodate that, then find someplace else to work.”
He wasn’t wrong about the “pulling more weight” thing, and damn my bravery, because I sent him an unsolicited memo detailing the extra patients and triage details I’d be willing to take on, to lighten his load. I named two additional patients suffering from severe depression and, more importantly, included the name “Joseph M——” on my list.
The next day, I arrived early, and seeing that I’d beaten Dr. P—— to the hospital, I slid the manila envelope carrying my list under his door. Two hours later, Dr. P—— arrived at the hospital, all bluster and discontent as usual, and without so much as acknowledging any other staff members, opened the door to his office and strode inside. There was the sound of crinkling paper, and I saw him hesitate slightly, then reach down for something at floor level. I walked away hastily and immersed myself in a proper task. Whatever Dr. P——’s reaction would be, I wanted to give him at least a few minutes before I had to bear the—
“Parker Goddamn H——!”
The sound of Dr. P——’s voice rang like a great husky bell. Oh boy, this was going to get interesting. I heard angry footfalls approach my office, and then Dr. P——’s face poked around my doorframe, scarlet with shock and anger.
“My office, wonder boy! Now!”
I stood up, willing myself to stay calm, and followed him, feeling sweat begin to form on my hands. I clenched them and sat down opposite Dr. P——’s desk, trying my best to give him a look of pure serenity.
Dr. P—— picked up my list of new patients and practically threw it across the desk at me.
“What is this?” he asked, stabbing the name “Joseph M——” with one fat finger. “What the hell is this?!”
I shrugged. “You asked me to carry a heavier load. I’m volunteering my energy.”
Dr. P——’s breathing sharpened from the effort to remain calm. “How did you get this name?” he asked slowly. “Who told you we had a patient with this name? Do you have any idea who this is?”
“Yes, I know who it is. I found out from Nessie.” Which was technically true.
Dr. P——’s eyes contracted into two angry lines. “Do you know anything about this patient?”
“Yes, and I want to treat him.”
“No! You don’t, and you fucking won’t. You don’t know anything about him. You just want to prove you’re King Shit of Fuck Mountain. Well, you have gone too goddamn far, Parker. Here’s what’s going to happen now. You will leave this office. You will never mention this again. Ever. Or I will personally make sure you are fucking fired and sent back to those Reaganomicals in New Haven with your tail between your legs, got it?!”
“That’s enough, Bruce.”
I jumped. The cool, razor-sharp voice that had come from the office doorway behind me belonged to none other than Dr. G——. Dr. P——, who had been leaning over his desk so as to menace me more effectively, suddenly went pale and fell backward into his chair.
“Rose,” he said. “What are you—I mean, always a pleasure to have you on the ward, but why—”
“Because I need to see someone,” Dr. G—— replied smoothly, sweeping into the office with regaliciness. “That is, if you’ve finished giving him a reason to file an HR complaint about you?”
“Oh,” said Dr. P——. “Well . . . I mean . . .”
“Out, Bruce.”
“I was just—”
“Words fail to express how much I don’t care. Out.”
“Wait . . . this . . . this is my office.”
“And I need your desk for a few minutes.”
Dr. P——, looking deflated, stood up and began to exit. However, as he did, something seemed to nag at him, and he turned to me with a look that seemed at once full of rage and pity.
“You dumb goddamn kid,” he snarled. “I’m trying to protect you. You’ve done good work here. I hate to admit it, but you have. Get away from this before it’s too—”
“Out, Bruce. Now.”
Dr. P—— gave me a last pained glance and exited his office. I was
left alone with Dr. G——, who crossed to Dr. P——’s desk and sat down, giving me a look of wary interest. As she sat, her eye caught my proposed list of new patients, and her mouth quirked into a grim smile as she read it.
I realize I’ve never described Dr. G——. Judging by the dates on the file I’d seen, she had to be at least in her early fifties, but she didn’t look a day over forty, with shoulder-length auburn hair, piercing green eyes, and a round but slightly pinched face. She was also very tall—taller than me with the help of the pair of businesslike black heels she was wearing—and rail thin, with a body that looked more like it belonged to an Olympic athlete than a doctor. If I’d been older, I probably would have found her attractive, but as it was, her hawklike stare only had the effect of making me aware of how painfully young and inexperienced I was. It was like being X-rayed by a very judgmental machine.
After a few moments of considering me, she spoke. “I suppose this was inevitable. So, tell me. Why do you want to attempt therapy on an incurable patient?”
“Well,” I said, “I’m not so sure he’s incurable.”
“How would you know? Have you spoken to him?”
“No.”
“Why not?”
I gaped at her. “I mean, I assumed that if I so much as tried, I’d be fired, what with everyone threatening me if I didn’t stay away.”
“Who threatened you?”
“Well . . . Dr. P——, as you can see. And Nessie.”
“Ah,” said Dr. G——. “Well, even if she took every other duty on herself, I can promise you that Nessie O’S—— did not have firing authority. You could have just taken the key and visited Joe whenever you liked.”
I blinked. “You mean there isn’t some special procedure?”
“Oh, to treat him, yes,” said Dr. G——. “But to simply walk into his room? No. I think some combination of fear of Bruce, fear of Nessie, and fear of the stories about Joe himself just keep most people away. Those that do go in rarely stay for more than a few minutes unless they have to, and those that have to . . . well, you saw what happened to Nessie.”
“Yeah,” I said. “I did.”
She cocked her head at me. “And that doesn’t dissuade you? You’re not afraid of ending up the same way?”
“No,” I said. “If anything, what she did made it personal.”
“I see,” said Dr. G——. “Well, next question, then. You haven’t spoken to Joe. Have you seen his file?”
“No,” I said just as quickly, yet something I said must’ve given away the lie, because she glared at me.
“I have better things to do than listen to a junior physician lie to me. Try the truth next time, or this meeting’s over.
I swallowed. “Fine,” I said. “Yes.”
“Better. So if you read that and still want to work with him, you must have a diagnosis in mind. Care to enlighten me as to what you saw that the rest of us missed after twenty years of looking?”
It was a trap. “I don’t think you missed anything,” I said carefully. “But the file says he was last treated in the late ’70s. The DSM’s been revised since then, as you know.”
“Stop patronizing me and get to the point.”
Gulp. “I think your first diagnosis might have been right, and we might just be dealing with a very, very sophisticated sociopath. More sophisticated than we knew they could get in the ’70s. There’s obviously also sadistic personality disorder, and he may have some sort of psychological progeria, which makes him seem more adult. The oddest thing is his ability to induce delusions in those around him, which is rare, but possible. Alternately, I think you might also want to test if he has some sort of disorder with how he mirrors people’s emotions—”
She put up a hand to stop me. “Wrong. I don’t blame you for trying, but still wrong. And to be fair, you couldn’t have gotten the answer right anyway. You haven’t seen the file.”
I raised an eyebrow. “Didn’t you just make me confess that I had?”
“What you’ve seen isn’t the full file. I’m not stupid. I know people find a way to game the records system every few years and look at what’s down there. So rather than remove his file, I just left an incomplete set of documents there, knowing it would scare off almost anyone who got access out of curiosity. What you’ve seen is what I wanted you to see. Nothing more.”
I blinked stupidly. “How much more is there?”
“The remaining documents are a bit more hands-on and technical than what you’ve seen. And then, of course, there are the two audiotapes. Which, speaking of those, that’s how I knew you were lying. Because anytime someone requests those file numbers, our records clerks all know to drop me a note. They don’t know why to do it, but I’m sure you can figure it out.”
“The only way someone would know the numbers is if they’d seen the file,” I said dejectedly.
She nodded. “Which means that I knew you’d seen it before I walked in here.”
She leaned back in Dr. P——’s chair and gave me a satisfied, piercing look. I wondered if this was how a mouse felt when being stared down by a cat.
“So,” she said briskly, “since we’ve established that I am the one in this room who has access to the greater share of knowledge, tell me, aside from assuming we were too stupid to see something just because it wasn’t in the DSM yet or haven’t considered that he suffers from a cocktail of rare disorders that anyone would’ve ruled out after twenty years . . . why should I let you get close to a patient I’ve sealed off from the rest of the staff? And please, assume my reasons are intelligent this time.”
“I . . .” I paused to collect my thoughts. “I suppose it’s pointless just to ask what those reasons actually are?”
“No, I’m glad you would ask,” she said, and, to my surprise, she smiled. “Let’s assume it’s pointless for now, but I credit you for asking a question instead of rushing to try to answer this time. That’s one mark in your favor. However, I’d like you to try to guess the answer, and if it’s insightful enough, perhaps I’ll tell you.”
I considered. “Well, there are a couple of things that don’t quite make sense about how he’s treated. I’m going to assume those are by design, so let me see if I can start with that and work my way up.”
She didn’t say anything, but she also didn’t stop smiling. I was either on the right track or so spectacularly wrong it was funny.
“Let’s start with the fact that you tell me anyone can talk to him if they want to, but nobody actually does,” I said. “And yet, I told Dr. P—— I wanted to attempt therapy with Joe and he flipped out. Theoretically, therapy can involve nothing but talking to someone, but if anyone’s allowed to talk to him, then that must mean that you think he needs something other than talk therapy and medicine, or at least on top of that. Something that requires hospital resources beyond just a doctor’s time and prescription pad.”
“You’re on the wrong track,” she said, with a slight shake of her head. Fighting the urge to wince, I started again.
“All right, so maybe you don’t need more than just talk therapy and medicine to treat him,” I began, speaking more slowly this time as I tried to work out the puzzle. “And anyway, you still discourage talking to him so heavily that I’m betting there’s something dangerous about doing as little as that. But even if he’s fine in small doses, randomly talking to a patient doesn’t mean therapy. I can walk up to a catatonic patient and start talking to him, but that doesn’t make him my patient. I’m not responsible for him just because I’ve tried talking to him. But if I formally take him on as a patient, then I’ve got a lot more responsibility both for his treatment and for making sure it doesn’t go wrong. Maybe his family could sue us if we did something really wrong. On the other hand . . .”
She was starting to interrupt, which meant that my last four words probably sounded more panicky than they should have, but they had the desired effect. She shut her mouth and continued listening. I exhaled slowly.
“On the other hand,” I continued, “you already think he’s incurable, so I’m guessing other doctors have tried everything they can with him and he hasn’t been removed from your custody yet, so worries about his family being dissatisfied must not be a factor. Which means there’s someone else you’re protecting.”
All at once, a bolt of realization struck me. “There must be! Because there’s a note in his file from the last medical director to you saying that even if his family stopped paying, he should be kept here at the hospital’s expense in order to protect the outside world from him. But that still doesn’t explain why you’d be so anxious about preventing doctors from taking him on as a patient. We’re supposed to handle things that most people can’t.”
Words were tumbling out now, and I doubt she could have stopped me if she’d wanted to. But she showed no sign of wanting to. If anything, she looked almost proud.
“Unless the problem is even more dangerous for us,” I went on. “Which isn’t a normal problem to have with a psych patient, but it’s pretty normal if you’re dealing with someone who’s under quarantine for a highly contagious disease. Those patients really are kept off-limits except to people who follow the proper procedures for treating them safely because of the increased risk from prolonged exposure. Just being in the same room as an Ebola patient for a few minutes doesn’t guarantee you’ll get infected, but spending hours trying to treat them without proper procedures is practically a death sentence.
“Similarly, judging by the way you’ve set everything up, talking to this patient for a few minutes probably doesn’t put anyone in danger. But I saw what happened to Graham, the orderly, and to Nessie. She was exposed to him every night and ended up committing suicide. Which means you’re worried about us taking him on as a patient because it means prolonged exposure, which puts us more at risk of his driving us to do something like what she did.”
I stopped suddenly and felt a creeping chill run over me. “Dr. G——, if there were others who treated him . . . um . . . can I ask what happened to them?”
The Patient Page 4