The Patient

by Jasper DeWitt

  She lifted her hands and clapped slowly. “Now that’s a question I can answer.” She spoke softly. Her voice was no longer sharp, but instead mournful. “For that, you’ll have to come with me.”

  She got up and left Dr. P——’s office at a brisk pace, not checking to see if I was following. I hustled out and caught up to her at the elevator. We rode in silence up to the top floor, then went into her office. After unlocking a drawer, she pulled out a thick manila file and opened it.

  “Dr. A—— obviously did the initial diagnosis, or attempted it, anyway,” she said. “But you probably noticed the four-year gap after that. Well, believe it or not, we didn’t leave Joe completely alone during that time. People did try to treat him. In fact . . .”

  She swallowed hard. “I was the first. I’d just started at the hospital myself, and Dr. A—— sent me to try it. I’d graduated at the top of my class, performed with excellence at my residency and fellowship, and psychiatric hospitals were better funded in those days, so they could afford the cream of the crop. You aren’t the only one often accused of being the smartest person in the room.”

  She glanced to her right, and I looked up and saw her degrees. MD and PhD. Veritas. Plus her residency at the best hospital in the country, a fellowship, and two separate board certifications. She was quite a diplomate.

  “Dr. A—— was right. I was the smartest person in the room. But that didn’t stop me from trying to swallow a bottle of pills from the nurse’s office just four months into treating Joe. After that, Dr. A—— removed me and placed me on mandatory paid psychological leave so that I could get therapy to recover from the experience. I spent a few more months in a private clinic before returning, and I was never assigned to interact with Joe again. After me, his next doctor spent a year trying to treat him. That ended when the doctor in question stopped showing up for work. He was found two days later when we filed a missing person’s report. The police discovered him hiding in his house, suffering from what I gather must’ve been the aftereffects of a psychotic break. I say ‘I gather’ because the instant they entered his house, he ran at them with a knife, giving them no choice but to shoot him to death.”

  She paused, gave me a significant look, and went on. “Joe’s next doctor lasted only six months before she went catatonic and had to be institutionalized here. I would say you might have treated her without knowing it, only she somehow managed to get hold of something sharp and slit her throat with it about a month before you started. In any case, after her, we assigned someone a bit tougher to work on Joe’s case. He had a military background and came to us from a hospital where he’d focused on the criminally insane. He lasted eighteen months before he sent us a one-sentence resignation letter and put a bullet through his brain.”

  She reached the end of the page and heaved a very deep sigh. “After that, Thomas, Dr. A——, I mean, decided to take on the case himself. And to his credit, he actually survived the experience. However, he still stopped treatment after eight months. And before he resigned as medical director a few years later, he joined the board so he could make sure every future medical director after him would sign an agreement promising not to assign anyone to Joe’s case without personally interviewing each one for suitability first. Like all my predecessors, I have complied and refused to assign Joe a doctor without one of these screenings. Because you’re right. His madness is contagious. I’ve seen it destroy my colleagues and even the man who mentored and groomed me for the job I hold today. And it almost destroyed me.”

  Her eyes met mine, and for a moment, I saw something behind the cold, sharp woman she’d been. I saw a crushed, angry young doctor who’d thought she was brilliant, just as I did, and who had been able only to watch helplessly as one patient ruined her life and the lives of those around her.

  “You’re screening me,” I said softly. She nodded.

  “What does he do to people, Dr. G——? If his madness is so contagious, I’d like to know what I should be afraid of. Maybe I can guard against it.”

  Her eyebrows shot up, and a bitter smile settled onto her lips.

  “I’m afraid I can’t answer that, Parker,” she said. “Unfortunately, that’s a question only you can answer, and you’ve earned the right, much as I hate the idea of putting anyone else in danger. But you’ve shown enough brains to suggest that maybe you might be able to do something with him. So let me ask you—what do you fear most?”

  “Um.” I tried to think, but nothing came to mind. “I . . . I don’t know?”

  “Sorry, that won’t do,” she said. “If you’re going to attempt therapy with him, you need to know the answer to that question before you do. It’s your first line of defense. In fact, if you treat him, it’s mine, too, because if I don’t know the answer to that question, I’ll have no idea what might be stalking my ward after your first therapy session with him. Try again. Take your time.”

  An acute chill ran up my back. “You mean he can just tell whatever—”

  “Just. Answer. The question.”

  That was as close to a yes as it could get. So I thought. I thought for several minutes, in complete silence, with Dr. G—— never doing anything to interrupt me. She seemed as fascinated by the answer to come as I was stumped. I thought of all the usual answers, of course—drowning, insects, fire—but one thing kept forcing itself back into my mind: the image of my mother in her hospital room. There was only one answer I could give.

  “I’m most afraid of not being able to protect the people I care about,” I said finally. “I’m most afraid of being helpless to save someone.”

  Dr. G—— raised her eyebrows in genuine surprise.

  “Interesting,” she said. “And just now, is there anyone on my staff you care about so much that it would hurt you if they dropped dead? Don’t bother being polite.”

  Feeling chagrined despite her last instruction, I shook my head. She nodded.

  “I thought not. You haven’t been here long enough, really,” she said. “See that you don’t develop any such attachments anytime soon.” Without saying anything else, she pulled a blank sheet of paper from her desk, scribbled something on it, signed her name, and handed it to me.

  “Take this to Dr. P——. As of now, you are Joe’s new doctor,” she said. “I will reassign you if you ask me to, on one condition. You must make an appointment with me and tell me, in the most exacting detail you can provide, what he did that made you decide you were not fit to continue as his physician.” She reached into her drawer, pulled out the two audiotapes, and shoved them into my hands along with the missing patient file.

  “Oh, and Parker? Try not to kill yourself first,” she said, meeting my eyes. “Now, find Bruce, wherever he’s sulking, and give him that note.”

  I found Dr. P—— sitting in one of the ward’s lobby chairs, looking both mutinous and terribly tired. As I approached his chair, he gave a dissatisfied grunt by way of acknowledgment but didn’t turn around.

  “What is it, wonder boy?” he asked. “You all done with your heart-to-heart with the boss? Here to clean out your desk?”

  I didn’t know how to react, so I just pushed the note over his shoulder. He took it, read it, and slumped over in his chair like a man who’d just gotten word that a close relative had been murdered. Then he turned to look at me, and for the first time, his expression was neither hostile nor angry. Instead, his eyes held only defeat and fear.

  “Well, I’ll be damned,” he breathed. “Rose must think you’re as smart as you do. Too bad. Because I know that you trying this makes you the dumbest and craziest motherfucker on this ward. Well, now we’ll find out exactly how dumb. Just make sure you don’t let your shiny new freak make you fall behind in your other duties. I expect you to hold to all parts of your proposal.”

  I nodded. “Of course. Is there anything else you wanted to talk about with my proposed new patient list and intake hours?”

  He gave a hollow laugh. “No, kid, no, I don’t. Now stop wasting my time
and go do something for your new charges. Even Joe.”

  He flashed me a wry, humorless smile. “I’m guessing you don’t need help finding his room?”

  No. I didn’t.

  March 24, 2008

  Whew. All right, this one I have to write quickly, otherwise I’ll never finish it. Gonna have a killer hangover, but fuck it. Getting this stuff down on paper is like chemotherapy for my soul. It fucking hurts, but it’s burning something worse out. No point putting it off either way, so let’s talk about my first meeting with Joe. And, yes, I’ve tried to write this exactly as I remember it, but I obviously didn’t have a tape recorder with me, so if I have to paraphrase a bit in places just so it doesn’t sound disjointed, I trust you’ll cut me some slack.

  Although its occupant was so feared and despised by the rest of the hospital staff, Joe’s room fulfilled very few horror clichés. True, it was at the end of a long hallway, giving anyone who was walking toward it plenty of time to reflect on what they were doing with presumably mounting dread, but I’m sure this was deliberate. Considering the contents of even his abridged file, keeping Joe so far away from other patients made sense, and since very few members of staff interacted with him, that was all the more reason to put him out of the way. And given the reference in his file to his family’s wealth, perhaps it was also an act of deference to them to give him one of the more spacious and well-lit rooms in the hospital, despite the frequent shortage of beds and space.

  Even so, if you think any of that diminished my apprehension when I took those first few steps down the hallway, you are gravely mistaken. Until this point, Joe had been only a distant intellectual puzzle, to be imagined and theorized over. But now I was officially his doctor. And although perhaps it was too late for common sense, I suddenly felt more than a little jittery about my first meeting with a patient whose death toll extended not only to other patients but even to those trained to face insanity without fear. The words of Dr. G——, Dr. P——, and, most of all, Nessie kept echoing through my head. By the time I reached his door, I half expected it to shock me when I inserted my staff key and pulled the knob. But nothing of the sort happened.

  For such a formidable patient, Joe did not give even the slightest impression of danger. He couldn’t have been more than five feet six and was about as thin as one could get without appearing underfed. A mop of unruly blond hair that looked as if it hadn’t been combed in years flopped around his face.

  He was sitting with his back to me in one of the cheap hospital chairs, and as he stood up and turned, I expected his face to carry some sort of unexpected terror. But even here, I was disappointed. His face was long, pale, and horsey, with a weak, drooping chin, high cheekbones, and slightly yellowed teeth. His pale blue eyes looked unfocused and almost as absent as those of some of the more catatonic patients I’d seen.

  We stood staring at each other for a few moments before I spoke.

  “Joe?” I said in my most professional tones. “I’m Dr. H——. Dr. G—— assigned me to do therapy with you, if that’s all right with you.”

  He didn’t say anything. He didn’t react at all.

  “If this is a bad time, I can come—”

  “You’re young.”

  His voice was reedy and low, and rasped as if he barely used it. It would have been slightly disconcerting if not for the thick sorrow in it, which only made him seem more pathetic.

  I nodded at him and gave him a small smile. “I am,” I said calmly. “Does that bother you?”

  He shrugged. “The others weren’t as young as you. Should I be impressed?”

  I blinked. “Impressed? By what?”

  “Well, you must’ve really pissed someone off to get sent in here at your age.”

  Without thinking, I smiled. I had braced myself for the worst when I entered this room. I had expected verbal abuse, taunting, recitations of disturbing fantasies, and possibly even attempts to act on them. The one thing I hadn’t expected was for Joe to crack a joke, let alone actually be funny.

  “You might be right about that, but why would that impress you?”

  Joe shrugged. “I’m impressed with anyone who irritates the staff here. To me, that makes you a kindred soul. Besides, whatever you did to make them give you me as a patient must’ve been really fucking bad.”

  His expression soured. “That, or she’s gotten even meaner in her old age. Or desperate.”

  “Who?”

  “You know who,” he said with a bitter smile. “Her. The one who keeps me locked up here. Why doesn’t she just cut my throat while she’s at it? I’d wager she’s done it to plenty of others.”

  “If you’re referring to Dr. G——, I—”

  “Oh, doctor, doctor, doctor,” Joe said softly. Then, without warning, he smacked the wall and gave a disgusted snort. “Well, she’s a shit doctor. Can’t heal a patient, so she locks me up with barely anyone to talk to for decades, then sends in a fresh face like you. Let me guess. You’re the brightest new doctor on the block, and they think maybe you, and only you, could heal me?”

  I shouldn’t have been surprised that he’d worked out what I’d thought were private details about me, but I was. My shock must’ve shown in my face, because he chuckled disdainfully.

  “It’s not like I had to be magic to figure it out,” he said. “That bitch would send someone in here for only one reason: Because she wants to fire them. You know I was probably in here when you were in diapers, and no one since then has had any idea what to do with me? She knows I’m not ‘curable,’ you realize. You’re just a sacrificial lamb who’ll give her something to report to my worthless fucking parents so they’ll keep sending money, and she can get rid of any bright, fresh faces who might make her look bad.”

  I was shocked. This wasn’t at all how I’d imagined the most feared patient in the hospital would act. He was bitter and frustrated, yes, but seemed remarkably lucid, even sane. Hardly fruit for twenty-plus years of confusion and terror, let alone remaining in hospital custody. What was more, his comments left a bad taste in my mouth and made me doubt what I’d been told. Could all the stories about him really be just an elaborate act to maintain such a reliable revenue stream for the hospital? I quirked an eyebrow.

  “Joe, you don’t think there’s anything wrong with you?”

  “How the fuck should I know?” Joe shot back. “As far as I can tell, it’s everyone else who goes insane around me! It’s happened so often I sometimes wonder if they’re doing it on purpose, just to make me go as fucking nuts as they are from anticipating what crazy-shit thing someone will do next.”

  He sounded too sincere to be lying, and despite everything I’d learned, I began to feel sorry for him. Still, some of the stories I’d heard had stuck with me enough to make me wary, so I didn’t reply immediately. Better to keep him talking.

  “Well, go ahead, get it over with,” he said with a bitter laugh. “I’m sure I’ve done something to drive you nuts without realizing it in the past few minutes.”

  I shook my head. “No.”

  “Well, glory halle-fucking-lujah. But I can see the gears turning in that bright young brain of yours. Go on, spit it out. What’s got you scrunching up your face like that?”

  I shrugged. “Honestly, I don’t know what to think, Joe. You don’t seem like a monster, but your file does have some troubling stuff in it.”

  “Oh yeah?” he sneered. “This should be good. Like what?”

  “Well,” I said, “I don’t think a normal person would try to rape a six-year-old boy on his first night sharing a room with him.”

  Joe snorted. “Is that what the file says happened with Nathan?”

  I had to repress a double take. Someone as remorselessly evil as Joe had been made out to be didn’t usually remember individual victims by name after this much time. They might remember the acts, but generally the victims were so dehumanized in their minds that names weren’t part of the package.

  “What did happen with Nathan, Joe?�
� I asked. “Why don’t you give me your side of the story?”

  He didn’t answer at first but kicked back on his bed in disgust. After a few moments of silence, he gave me an appraising look.

  “Before I tell you,” he said, “I’ve just got one question for you.”

  “Yes?”

  “Got any chewing gum?” He gave me an uneven grin. “I used to get it from Nessie. Keeps my mind occupied a bit. Relieves the boredom.”

  As it happens, I did have a very worn-out old pack of gum in one pocket. I scooped it out and handed him a stick. He took it, unwrapped it, and popped the whole thing into his mouth with obvious relish, then smiled crookedly at me again.

  “Thanks, doc,” he said. “I guess you might be all right.”

  I smiled back despite my confusion. “So . . . Nathan?”

  “Right, Nathan.” Joe chewed thoughtfully. “Well, I know this is what a lot of people say, but the thing is . . . he came on to me.”

  “I find that hard to believe, Joe. He was six. You were ten.”

  “Yeah yeah, I know, it’s too young,” Joe said angrily, waving my comment away as if it were a fly, “but do you think he knew that? His dad had been fucking him since he could walk. I think he just thought that was love. Anyway, he told me he couldn’t sleep unless someone ‘put it in him’ first and asked me to do it. Well, I was a kid, and I didn’t know any better. They don’t exactly give you the birds-and-bees talk in a place like this, y’know. So I did. But because I didn’t know what I was doing and didn’t have anything to make it go in easier, he started screaming. The orderlies were right outside, so I couldn’t exactly get off him. And do you think they were going to listen to me after what they thought they saw?”

  He rolled his eyes. “I shouldn’t complain, I guess, since at least I won’t die a virgin. Not how I’d have chosen to lose it, but we can’t have everything.”

  Although it went against my better judgment, I had to admit the story sounded plausible. Still, there was too much in that file for the contents to be nothing but misunderstandings. I pressed him further.