Silent Epidemic (Book 1 - Carol Freeman Series)

by Jill Province



  By Jill Province

  Copyright 2004 Jill Province

  Table of contents

  Prologue

  Chapter 1

  Chapter 2

  Chapter 3

  Chapter 4

  Chapter 5

  Chapter 6

  Chapter 7

  Chapter 8

  Chapter 9

  Chapter 10

  Chapter 11

  Chapter 12

  Chapter 13

  Chapter 14

  Chapter 15

  Chapter 16

  Chapter 17

  Chapter 18

  Chapter 19

  Chapter 20

  Chapter 21

  Chapter 22

  Chapter 23

  Chapter 24

  Chapter 25

  Chapter 26

  Chapter 27

  Chapter 28

  EPILOGUE

  Prologue

  The gurney blasted through the emergency room doors, while Robert Grady, M.D., straddled the lifeless patient, applying CPR.  Dr. Danny Evans rushed to the racing gurney and accompanied the crowded rolling table to the trauma room.

  “What have you got?" he yelled to the paramedics who had fallen behind so that doctors could take over the life saving process.

  “White female, approximately twenty-five, deep lacerations on both wrists, BP is eighty over sixty.” The paramedic ran the complete list of the patient’s vitals while the staff continued to work on the unconscious woman.  Her wrists had been sliced with great precision, with three perfectly executed cuts on her left side, and one on her right.  There had been an enormous amount of blood loss. 

  “Get her typed and bring in five units, now," Evans yelled. 

  “We’re losing her," Grady warned.  “Her pressure is dropping." 

  “V tack," a nurse announced as a high pitch sounded from a monitoring device.  The green flat line followed.  The woman’s shirt was ripped open.

  “Give me one fifty," Evans yelled. 

  “One fifty," the nurse confirmed.  

  “Clear."  Everyone moved from the patient, as the jolt forced the woman’s body to jump slightly.  The high pitch continued.  “Two hundred.  Clear."  Again, the body jumped.  The whining sound of the monitoring device was steady and deafening.  “Two fifty.  Clear."  The body defied the machine.  “We’re going in," Evans announced, as a nurse handed him a scalpel.  The woman’s chest was sliced and opened quickly, while Evans forced his will into the lifeless heart.  The rest of the hospital staff watched helplessly. 

  “She’s been down too long," Grady said, mostly to himself. 

  “Adrenaline," Evans ordered, ignoring his colleague’s prediction of doom.  The doctor continued to massage the woman’s heart, as the minutes ticked by.

  “She’s gone," Grady stated.  But Evans couldn’t let this woman go quite yet.  She was too young to have her life end there in the emergency room. 

  “Not on my watch," he yelled to the lifeless form, and continued to work on her while the rest of the staff stood back.  They were waiting for Dr. Danny Evans to draw his own obvious conclusion.

  The woman had been lying on her living room floor bleeding out for an hour before her roommate had found her and dialed 911.  Her long brown hair was caked with the blood that had seeped into the carpet.  The staff looked down on her sympathetically as her body lay, unmoving, but disposed to the will of her doctor.  She appeared to be at peace, as Evans forcefully worked to bring her back. 

  “She was so beautiful,” a nurse sighed.  Except for the slices on her wrists and the bloodstains, her body was flawless.  There were no other notable markings, except for a small butterfly tattoo on her left shoulder.

  “Do you want me to call it?”  Dr. Grady asked quietly.  Danny Evans ignored the suggestion, and continued his battle with death. 

  “Not on my watch," he repeated.  The staff stood by, sadly resolved. 

   

   

  Chapter 1

   

  Carolyn Freeman was a square-peg person, living in a round-hole world.  She viewed the conventional path that most considered to be a safe comfort zone with contempt.  The down side was that this had always kept her from being a part of the mainstream.  As a means of survival, Carol had always sought out other square pegs to associate with, keeping her from living in the isolated world of the “conformably challenged.”

  From the time she could assign words to her thoughts, Carol’s favorite word had always been “why.”  Carol questioned everything.  If something didn’t make sense, she would beat the problem to death, demanding an explanation or alternative solution.  And since the real world often made no sense, nor did it lend itself to alteration, Carol spent much of her time yelling at the rain.

  The incongruence of her reality had left her burned out after only five years in the counseling field.  The initial motivation – to seek out others like herself and make a difference in a troubled world – had not gone according to plan.  The promising world of the helping profession should have provided the best of the square-peg population.  A safety net devised of warm and accepting companions, who like herself, would plunge forward in an uncaring world working together to make it a better place.  Within a short time, however, she had found them to be crazier than the patients and more apathetic than the checkout staff at Wal-Mart.  The kind that asks, “How you are doing?” but never responds to the answer.  One finally learns that it is a rhetorical question.  Carol was surrounded by these people every day, yet she felt completely alone.

  The “troubled world” was a bottomless pit of need.  For every person she had managed to help elevate one-step higher, there were a thousand more needing something that was always out of her reach.  Her unyielding logic – that each problem had to have a solution – left her exhausted and frustrated at the end of each day. This unfortunate phenomenon had landed Carol more and more inside her own thoughts instead of listening to patients during counseling sessions.  She had become numb in a sense, and was finding it difficult to genuinely respond with anything like honest concern for their pain.  There was an immense amount of guilt that went along with the realization of her fading commitment.

   It was time to leave for the day, but Carol was on a mission.  Worn out from the drone of policies, procedures and the paper trail of bureaucracy, she continued to plunge forward in an effort to force a solution to a problem that was drowning her.  The small addiction department consisted of herself and one nurse.  The rest of her staff was comprised of part time workers who came and left with such frequency that Carol barely felt their presence at all.  This proposal would provide the proof she needed to support the blinding logic and cost effectiveness of increasing her staff. 

   She was punching numbers into a calculator when her phone rang.  Carol regarded the ringing beast with contempt and thought for the ten-millionth time about smashing it with the closest heavy object.

  “Yes?" she managed, trying to keep the obvious annoyance out her voice.

  “There is a family out in the waiting room to see you, and Carol...”

  “Yeah?” she sighed.

   “You better come see this.”  

  Carol hated these invasions.  There were too many of them, and not enough of herself left to care.  But Newberg Mental Health was the crisis center for Newberg County.  This meant that anytime someone landed in an extreme and overwhelming situation, there was no need for an appointment. A counselor would drop what they were doing to rescue them.  The policy on walk-ins was c
lear.  If the “invasion” fell under your department’s jurisdiction, someone from your group had to comply.  She looked at her half-written, long shot of a proposal after returning the beast’s head to its base.  The party waiting for her in the lobby would most likely be extremely intoxicated and demanding.  A small amount of inadvertent insults would usually be in the blend.  Carol didn’t think she could stand one more drunken tirade.  She hadn’t been sleeping very well and stopped to rub her eyes with her index fingers before dragging herself away from the safe quiet of her office.

  Once again, she was the quarterback.  All of the defensive line had left hours before.  Carol had approached the issue several times already with no success. 

  “The problem," she would say to the center director, Buck Spears, “is the size of the population we are supposed to be serving.”  Spears would nod and appear to be evaluating the dilemma.  “We have only two full-time people and the part time staff may as well be invisible."  Once again, she would receive the standard managerial dribble about budgets and the cost of benefits for full-time employees.  Carol would listen and quietly calculate the monetary losses from time spent training people who seemed to be in a revolving door of job opportunities.  These meetings would always end the same way, with Spears providing the great American motivational pep talk and Carol taking the bait.  ‘I just have to come up with a way to better organize these people,’ she would think, and go back to her office and the drawing board.

  Carol pulled herself out of her reverie and walked down the long hallway.  The carpet was faded and walls were in need of either fresh paint or a wrecking crew. When Carol opened the door to the waiting room, she had to bite her lip to keep from laughing.  Sitting in one corner of the room was the standard two parents and a young man who appeared to be in his late teens or early twenties.  He was tall and painfully thin, and the faded jeans and white tee shirt he wore hung on his small frame.  The oily, dark brown strands of hair that fell over his eyes were an indication that hygiene had not been on the top of his list of priorities.  The scene would have seemed completely normal, except the young man was also wearing a pointed hat made out of tin foil.  Carol looked over at the receptionist who had closed her sliding glass deflector shield, but was still visible through the glass.  The receptionist just shook her head.  Carol thought how nice it would be to have her own sliding glass deflector shield, but that was not an option for a quarterback.  Instead, she reluctantly invited the family to come inside.

  When the group was seated in her small office, Carol picked up the crisis clipboard and, with pen in hand, began the standard process.  This phase of the interview did not require too much thought. 

  “Okay, I just need some information before we begin," Carol interjected, trying not to convey her sense of monotony.  While the father provided all the vital information about the young man sitting between himself and his wife, the mother continued her argument with her son.  From the tone of the woman’s voice, it appeared as though this discussion had been going on for some time.

  “Please, honey," the mother pleaded.  “Just take off the hat.  You look ridiculous and it’s embarrassing." 

  “No,” said the young man in a flat, lifeless tone and continued to stare off into space.  That was all Carol needed to hear.  In that one syllable, she heard the empty, haunted sound of a schizophrenic.

  She completed the mundane form and set the clipboard aside.  

  “Carl," Carol said in a soothing voice, “can you help me understand what is troubling you today?”

  “No," Carl stated in the same monotone he had used with his mother.  

  Acknowledging the patient’s apparent absence, Carol turned to the family with an invitational look.  The father responded first.

  “Our son does not want ‘them’ to read his thoughts," the man stated wearily. 

  “It’s more than that, Bob,” the mother intervened.  

  Carol waited for the family to sort out their conflicting versions of Carl Banner’s dilemma.  

  “He’s not eating,” the mother continued, “and he has loud conversations with no one.”  

  Mr. Banner just nodded his agreement.  The man looked exhausted and beaten down as a result of his son’s new behaviors. 

  “Okay,” Carol said, regaining control of the interview. “When did you first notice these changes in him?” 

  “Two, no, maybe three weeks ago,” Mrs. Banner stated.

  “Was there anything significant happening at that time?”  Carol inquired.  Normal life stressors that most people consider to be difficult, but manageable, can be viewed as traumatic and life changing to others - especially if that person is already hanging on the edge. 

  “No,” the mother responded.  “He has always been a loner and he seems depressed a lot of the time, but he has never been like this.”  She attempted to put her arm around her son, while he pulled away from her grasp defiantly.  Mrs. Banner seemed used to Carl’s need for detachment and returned her attention to Carol.

  “Is he on any medications, or does he have a prior psychiatric diagnosis?" asked Carol.

  “No.  Carl has been a typical moody kid – nothing we couldn’t handle."  Every kid with a psychiatric problem was typical kid, where loving parents were concerned.

  She stopped writing to rub her tired eyes again.  The end of the day’s fatigue was taking over, and she refrained from any further digging.  Carl’s current presentation went way beyond teenage moodiness, and she had no doubt that an anti-psychotic medication would be in order. 

  “Has there been any drug or alcohol use?"  If Carl had engaged in any street drugs, she doubted that his parents would have known about it.  If he had been using a mind-altering substance, the aliens would have had a field day with Carl’s brain. 

  “My goodness, no," Mrs. Banner exclaimed, and tried to put her arm around her resistant son again.  Carl sat like a stone with his mother’s arm supporting his back and continued to sit in his chair with a vigilant eye out the window, guarding against any possible threat in the parking lot.

  Carol excused herself and went off to find someone from the large pool of the psychiatric department.  This was clearly not an addiction issue.  Tired and extremely annoyed at the continued dumping tactics of her co-workers, she approached the counselor’s break room.  A group was situated around the table discussing something that was obviously amusing, and Carol interrupted the laughter to ask if someone from “psych” could finish a crisis call on a nineteen-year-old psychotic male.  The group looked up and each one in turn began giving a series of excuses.  A few didn’t bother with providing a reason and simply left the room.  Carol, now feeling her blood pressure rise, squared off on the remaining counselor who had responded by returning to her magazine article.

  “Do you think you could tear yourself away from your end of the day break long enough to complete your department’s crisis call?”  Carol inquired while attempting to control her frustration.

  “I’ve already been here eight hours," the woman stated defensively, and left the room.  

  Carol’s blood was now boiling as she looked at the clock on the wall, and calculated her own ten-hour day.  Angry, she backtracked down the hall to her own office.  People’s pain and suffering often failed to conform to state workers schedules, and Carol had no choice but to complete what she had started.  There was no one to throw the ball to, and this was going to be a little more complicated than a raging drunk in need of detox.

  “Carl, do you want to tell me anything?”  Carol asked hopefully.

  “No," the young man stated again.  Carol wanted to throw some cold water in Carl’s face and ask him if he knew any other word besides no.  She mentally slapped her own wrist for taking her frustration out on a patient.  She knew that she did not do well with schizophrenics.  There was nothing there to work with.  At least in her own chosen specialty,
one could dig down and find a fighting spirit underneath the fog.  Here, there was no one home.  She forced herself to plunge ahead. 

  “Has Carl said anything to cause you concern about his safety, or anyone else’s?”  

  Both of Carl’s parents just looked at each other blankly.  

  “Has he threatened to hurt himself, or anyone else?”  Carol clarified. 

  “Oh no, of course not," the mother said.  “Carl is a good boy."  Carol’s most effective tool for hospitalization had just been removed.  She knew that he needed to be in a facility where he could be placed back on medication and monitored until his personal “demons” went away.  She was determined to get him there. 

  “Okay, I need to ask about insurance," Carol concluded.  The father wordlessly handed her a beaten looking card that had seen a lot of mileage.

  “Excuse me for just one more minute," Carol said, as she left the bewildered family once again and went off to the copy machine and a private phone.

  While Carol watched the copy machine swing back and forth, she worked to steady her emotions and dialed the number to Newberg Hospital.  “Intake, please," Carol said to the hospital operator.

  “One moment,” the voice answered, and Carol listened to a terrible digital version of ‘Hey Jude,’ by the Beatles.  It sounded like an electronic music box.  Carol cringed as she inspected the copy of Carl’s insurance card.  God, Medicaid!    

  “Intake,” a voice said, interrupting the Beatles unintended performance.

  “Hi, this is Carol Freeman from Newberg Mental Health," she began.  “I have a nineteen-year-old male with a possible history of depression.  He is currently presenting with paranoid ideation, audio hallucinations, and is unresponsive to questioning.”  Carol could hear the intake worker writing and waited.

  “Is he a danger to himself or anyone else?" the intake worker inquired.  Carol had anticipated this, but could not see a way around the question.

  “Not as far as is reported by his family,” Carol answered. 

  “It appears that Carl is not a threat to himself or anyone else.  He does not meet the criteria for admission."  The intake worker stated this as if reading the words from her policy and procedure manual.  During the familiar speech, Carol nodded her head back and forth in time with the words as she had done too many times before.  Carol gave the woman an empty “Thank you,” and hung up the phone.  I guess the only way Carl will be a danger to anyone is if he stops dodging the aliens, or whatever they are, and decides to start fighting back.  She shook her head in frustration.  The truth about hospitalization criteria was that it was a crock. Anyone psychotic enough to believe that they were being stalked or monitored by outside forces was capable of doing a multitude of interesting things, none of which would be considered rational choices, but all of which had the potential for very dangerous outcomes.