Roy began to shake as his speech became more vehement. I found myself backing up slowly, but Cassie was unshaken. She moved in closer. "Alright," she said with a voice like a caress. "No mental status exam. What do you want to talk about?"
Roy spit on the floor. "Are you deaf? I don't want to talk." The tears returned to his eyes and he pushed himself up against the wall. A look of utter loss consumed him. I took my notes in a frantic attempt to draw attention away from myself. I felt unprepared to do this intake and was happy to let Cassie navigate the evaluation.
Cassie only smiled at him, “Why not? Do you have something else planned? Are you afraid?"
"I'm tired. You can't help me. I've already lost my soul."
"How did you lose your soul?"
"Stupid, aren't you? I killed my family."
"So there is no redemption for you? No therapy that can help."
"I sold my soul to the devil."
"What did you sell your soul for?"
"Nothing really. Just to see him. To feel powerful and different. Nothing."
"You don't think you can get it back? I could help you."
"It’s too late. He'll be comin' for me soon. He already took everyone I loved."
"So it was the devil that killed your family."
"No. I killed my family."
"Did the devil tell you to kill your family?"
"No, I summoned one of his legions."
"And he told you to kill your family."
"No."
"Why did you kill your family?"
There was only silence.
"Roy?"
Roy's eyes had fixated on the window. He had drawn his legs up to his chin again. "I told you I don't want to talk."
“I just want to help you, Roy. You aren’t going to be moved around anymore. No more lawyers. No more hospitals. This is it. This is home. Let me help you. Talk to me.”
She was met by silence. He turned and put his face in the corner. Cassie sat on the bed next to him, placing her hand on his shoulder. He moved away from her touch.
"Alright. We'll come back tomorrow."
Cassie gathered her papers up and touched Roy again, this time on his cheek, in a manner that was a little too intimate for my comfort. She smiled at him and he looked up at her as if she were the devil himself, ready to claim his prize.
“What do you think?" Cassie asked me.
"It’s funny how the nature of schizophrenia causes patients to focus on such religious dichotomies and fixate on things like the devil. It’s amazing how many people I've seen suffering from paranoid schizophrenia that have become obsessed with religion and sure the devil is after their soul in particular."
"Good and evil, the devil and God are a part of all of our collective unconscious. It isn’t particular to paranoid schizophrenics. We’re all afraid of those things in the shadows that we can’t see. It’s in every culture's mythology. Evil is always out there, in some form, seeking our souls. Crazy people just aren't as good at masking their fears."
"Crazy? Is that a DSM-IV diagnosis?"
"No, but I'm pretty sure it'll be in the DSM-V." Cassie laughed, flashing a particularly pretty smile.
"I'll be sure to put that in my next report."
"You don't question his diagnosis?" Cassie asked.
"Not at all. Even if I did, he’s been assessed by every psychiatrist and psychologist in the state of Alabama, and I doubt that you and I are the light in the darkness of false diagnoses, Cassie."
"He just seemed particularly lucid for a psychotic."
"Many psychotics have lucid moments, and he’s medicated."
Cassie shrugged. "You’re right. I should probably let you get back to your other work so you can get home on time."
"Thank you."
"Hey. Would you and your wife like to come over to dinner at my house next Friday?"
"Of course."
I thought about the invitation all day. In fact, it was all I could think about. It seemed very unlike Cassie. It was too normal. Ordinary colleagues invited each other over to potluck dinners and family night outs. They sat at chain restaurants with each other's spouses and talked about work and politics. They smiled across cocktails and sat in each other's living rooms laughing about particularly strange things that happened at work. Cassie wasn’t part of this culture. She dwelt in a society of her own. She was isolated and avoided staff luncheons and dinners out with the other psychologists of the team. She was an island and her invitations to me seemed like a strange ritual rather than any real reach for friendship. I enjoyed the ritual, but including Pria in it seemed disturbing.
Cassie and I went to lunch again that day. We ate at a little cafeteria that catered to Circe’s staff. She talked and I listened. I watched her smile. I watched the way the light caught her hair. Her eyes were sublime in the light. She had an opinion on everything. I didn’t need to comment. I enjoyed her fickle monologue. She leapt from topic to topic with a passion that I had never seen in a woman. She talked about history, psychology, politics, and patients with joy. She even reached out and touched my hand at one point. A tingling sensation went up my arm. Her hand was soft and cold.
Every day that week we had lunch. I stayed late listening to her talk, and occasionally, I said something myself. Sometimes I didn’t even listen to her. I found myself studying the shape of her calves or the texture of her blouse. I imagined she had to be a runner. Her legs looked as if they had been molded out of bronze. Sometimes we took lunch in the office. Eventually, she noticed my gaze and with her usual openness, she commented.
“Is there something crawling up my leg?” she asked.
“No, I was just wondering if you ran? You seem to be in good shape.”
“Yes. I’m in shape for a woman my age. I like to backpack and trek. I think that the only way you can know the true face of the divine is to seek out nature.”
“You climb?”
“I have. I did Mt. Ranier last summer.”
“Really? I used to love to hike and trek, but Pria has never been that into it.”
“That’s a shame. Passions shouldn’t go wasted.”
Our eyes met and I knew what we were doing. I knew why she talked to me more than the other interns. There was no mistaking the look in her eyes and there was no mistaking my physiological response to her look. I got up uncomfortably and fumbled with some papers. I made lame excuses and disappeared, trying to erase her impression on me.
I went with Katie to reality therapy that day as always, but my mind was somewhere else. Only three patients bothered to show up. Katie handed me the checklist of how they had been doing on their daily behavioral tasks, such as bathing, eating, and keeping their rooms clean. I handed the chart back to her without really seeing it.
Mr. Nicca sat in the corner, as always, muttering under his breath. Mr. Guiles stuck his tongue in and out of his mouth like a fat serpent and Mr. Fat sat in a chair that was clearly much too small for his girth.
"I heard that I could go to a group home next week,” Mr. Fat began.
"Who told you that?" Katie asked.
"Dr. Allen."
"I haven't heard anything about that. Did she tell you anything else?"
"Maybe. I think that she said I'm doing good. She said I'm real smart and that I'm doing good."
I grabbed Mr. Fat's chart from the stack and looked at the recent treatment notes. He was still considered too volatile for release into a less restrictive environment and there were no notes indicating that he had any contact with Dr. Allen.
"Why do you think she said these things to you?" I asked.
"Don't know. I think we're gonna get married when I leave."
"Fuckin' retard," Mr. Nicca spat from his corner.
"That is completely inappropriate," Katie said.
"He is. He thinks that the Fuckin' head doctor is gonna marry a fat, crazy patient. He's a retard."
"Mr. Nicca, you'll have to leave if you don't stop insulting other people!" Katie s
aid.
"I saw the devil last night and he says he's comin' for her next," Mr. Nicca said.
"Mr. Nicca, what did we discuss about the devil?" I asked.
"You said he didn't care about my loans or my car or that ho I married."
"No, that isn’t what I said. Can you remember what we said last Tuesday?"
"The devil ain't real. It's part of my craziness."
"And when you see him or you hear him talking to you, you have to close your eyes and tell yourself he isn't real."
"If he ain't real, why doesn't the medicine fix it?"
"Your illness is resistant to the meds. We are working on it. Until then you have to work with us. You can get a mental health worker to help you when he talks to you."
"Man, those bitches don't do shit. He’s gonna fuck that bitch next."
"Who are you talking about?" Katie asked.
"The devil is gonna fuck Dr. Allen."
"She took my money," Mr. Guiles said suddenly.
"What money?"
"My diamond money."
"OK," Katie said looking at her notes. "Let's move away from Dr. Allen and talk a little about everyone's daily checks and the progress you've been making on your goals."
"I took my shower every day," Mr. Fat said gleefully.
"Fat fuck ate six trays of food yesterday and was picking shit out of the garbage to eat." Mr. Nicca sneered at Mr. Fat.
"I think you need to focus on your problems," I said.
"Fuck you. I see you. I see you and her and the other one too, that fucking bitch with the bugs in her mouth and the black eyes and she'll come for both of you and he knows it."
I blinked. Somewhere in all the nonsense I heard a piece of my dream. He was talking about the creature from my dreams. He was talking about my demon and Cassie. I shivered underneath my jacket. Mr. Nicca smiled, revealing a set of horribly blackened teeth separated by huge gaps where teeth should have been. He started slamming his hand into the arm of the chair and rocking back and forth. He stood up suddenly and spit on me. I flinched.
"You think we's all crazy and you’re sane, but I see what you can't never see. I see you and her fuckin' in the dark and I know what you’re gonna wake. Jane told me. I know what this place is. This ain’t no hospital."
"Who's Jane?" I asked.
"She used to work over there, over there in the old buildin'. She's dead. The devil killed her."
"Sit down, Mr. Nicca, or I'm going to have to get a mental health worker in here to restrain you!" Katie was yelling, but I wanted to hear what Mr. Nicca was saying.
"You and me," Mr. Nicca said to me. "We are gonna dance with fire. You and me, we belong here. This is our fire. This place gonna take us." He threw a pen at Mr. Fat and ran out of the room.
Katie made a note on the chart and glanced briefly in my direction before she continued with group as if nothing at all had happened. I said very little else throughout group and left to finish my notes as quickly as possible.
I was sitting in the empty office staring at an unfinished report when Cassie entered. I couldn't explain why what Mr. Nicca had said bothered me, but I couldn't make it go away. Memories of my dreams danced before my eyes like an old movie that you couldn't turn off. His description was so close to my figment that it brought tears to my eyes. Cassie threw a book on my desk and brought me out of my trance.
"You look like you've seen a ghost," she said. "I hope I didn't miss him."
"No ghosts. Only more violent outbursts by Mr. Nicca. He spit in my eye."
"That means he really likes you," she said with a wide smile.
"Wonderful."
"Let's go see Roy again."
Roy was no better than the last time we went to see him. He was lying in his bed staring at nothing on the wall. He looked like he had showered and groomed himself, but there was a smell that filled the room. He didn't move or avert his gaze when we entered. He didn't acknowledge us at all.
"How are you doing today, Roy?" Cassie asked.
"Why do you have a shadow?" he asked.
"Shadow?"
"That dude that comes with you and takes notes. What is he, your pet?"
"I'm Dr. Black," I responded. "I'm an intern here. I'm trying to learn how to help people and I was hoping that you could help me."
"You want me to teach you to shrink heads?"
"No, I want to sit in with you and Dr. Allen and learn from you both, but only if you’re comfortable with this."
"I'm not comfortable with anything."
"What aren't you comfortable with? Maybe we can move things around to make the environment more welcoming," Cassie said.
"Set the building and yourself on fire and let me go."
"That sounds awful."
"Just set the building on fire. I'll burn with it."
"Fire is comfortable for you?"
"I might as well get used to it."
"Why?"
"I'm damned, dipshit. You write a lot but you don't listen."
"I'm listening. Why?"
"I killed my family! I took an axe and killed them. I bathed in their blood and drove away screaming. No matter how much I pray. No matter how many lives I save or good deeds I do, I can never repent enough to save myself from hell. The veil between our worlds waxes and wanes with the winter and the demons come with the autumn. They wait by the edge of the smoky glass waiting for us to call them, and if we call them they always come. He came for me. He came and took my body and together we did the . . . unspeakable. Now winter comes again and he has come to reclaim what’s his."
"Are you his?" Cassie asked.
"Get the fuck out! Take your puppy and get out!" Roy stood up and threw his pillow at me.
"I'll leave, but I'll be back without the puppy."
Cassie took me back to her office to finish my work. I grabbed her before she could leave. "I'm not your puppy," I told her. "And I won’t be treated like that again, especially in front of a patient. I'm going to finish these reports in the morning."
"Fine," she said and her voice lowered. She transformed. Her demeanor and the color of her eyes seemed to cloud over. She was like a breeze, a warning of an impending storm and I felt her actions long before they occurred. She stood on her tippie toes and kissed me. It was a peck, a caress. It was a hint of a kiss more than a kiss. Her skin barely brushed mine. Maybe it didn't touch mine at all, but that kiss set me on fire.
Andy and John were laughing and waiting by the car when I got there.
"What's so funny," I asked.
"One of those idiot psychiatrists tried to do CPR on a dead patient today," John laughed. "I know they went to med school, but they are not medical doctors."
"Really," I said with a chuckle.
"They called the code and he marched in and started without even checking his vitals," Andy bent over laughing. "And this is perfect, because this guy is the complete asshole of the acute ward. He ran the entire code, CPR and all and the guy had been dead for, like, ten minutes.
"I'm gonna miss it," John said.
"Miss it?" I asked.
"Yeah. I've loved working with Dr. Donalds. You'll enjoy it. Only one month until the switch."
We all got in the car. I moved Andy's papers off the front seat and sat down. I felt like a weight had been lifted from my shoulders. I had forgotten that I only had one month left until I would never see the chronic ward or Dr. Allen again. I breathed deeply and smiled broadly at Andy. She smiled back.
"You seem uncommonly happy. Did something happen?" she asked.
"No, I just hate work sometimes, and the change will be appreciated."
"I'm just glad it will be over soon. I've been getting some job offers and I can't wait to get a real job. There's this clinic in Louisiana, near the town where I grew up and they only work with women. Y’all should see it; it'll be perfect for me."
"Sounds great."
"What 'bout y’all, any jobs on the horizon?" Andy asked
"I wanna do some postdo
ctoral work. I want to stay in an academic setting,” John said, looking at me. I assumed he had already told Andy all of this. "I'm looking at UAB."
"My father was a partner in a practice in Foley," I said as I watched the road pass by me. "His partners said there was a place for me there."
"Private practice?" Andy shook her head. "I could never do that. Listen to the mundane problems of the average depressed middle class populous with insurance. When I went into psychology, I knew I had to make a real difference. This facility I'm looking at mostly works with sexually abused women. To me, that is making a difference, changing lives. I want to guide truly hurt people back to a safe place."
"You’re an idealist. I went into psychology because of my father. It’s only appropriate that I join the practice. I don't want to change the world like you do, Andy. I wouldn't even know where to begin."
"Start here. These people need us. Every patient here needs us."
I laughed. I couldn't imagine really helping any of the people on the chronic ward. I felt more like I was managing their care. I was helping the state find the least restrictive environment for them. I was trying to get them well enough to be passed on to someone else for all their real care. My mind drifted to Mr. Fat. Where do you begin to help someone who once tried to kill his mother over toast? How do you alter their world? How do you save them? The psychiatrists medicated them. The social workers desperately tried to scrape together any social support they might have, and we mostly watched and evaluated. Occasionally we taught them useful coping skills, but I had never changed anyone's life. In graduate school I had epiphanies and really reached clients, but Circe was like a stagnant pool; all I could do was stir it up.
The road passed before us quietly. It was easy to enter a trance on the silent, deserted road. Andy smiled at me, but there seemed to be nothing left to say. After a while, she said, “I really didn't like you to begin with, Eric. But underneath all the shit, I think you’re a decent guy. It isn't a bad thing to want to follow in your father's footsteps. You can't be all bad if you respect your father that much."
"Thanks. You aren't that bad either. I thought you talked too much when we first met, but after a few months of working with Cassie I need a friendly voice."
“Thanks, I think. Was that a compliment?”
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