Admitted from outside facility, Lincoln County State Prison
Chief Complaint: Danger to self and others
History of Present Illness: Mr. Denton is a former family medicine physician with no known personal or family history of mental illness. According to the patient’s daughter, Mr. Denton went on a six month humanitarian mission to South America last year. When he returned, Mr. Denton—a lifelong atheist—began regularly attending church services. When questioned about his sudden change of faith, Mr. Denton was said to reply only that he was “preparing.” Approximately six months ago, there was an acute change in Mr. Denton’s personality. He became paranoid and spoke obsessively about “The Eleventh Plague.” Despite concerns of both family and colleagues, Mr. Denton continued to see patients in his clinic. Indeed, it is noted that in the final weeks leading up to his arrest, the former Dr. Denton was seeing upwards of fifty patients per day, often remaining in the office after hours and holding appointments on weekends. It wasn’t until later that it was discovered the doctor had been soliciting patients to bring themselves and their children in to the office for “urgent treatment.”
Using the panic surrounding the current Simian Flu epidemic to his advantage, the former Dr. Denton administered injections—which he described to patients as a new, more effective vaccine—to nearly two thousand individuals, including hundreds of children. It is still unknown precisely what Mr. Denton injected into his victims, only that after several weeks, a subset of his patients became acutely ill and died.
Among the victims were Mr. Denton’s wife, Cecilia; their son, Nicholas; and his granddaughter, Lily.
Deemed unfit to stand trial by the courts, he was remanded to our care.
Objective: Patient is a Caucasian male in no acute distress.
Physical Exam: Heart, lung, abdomen, and neuro exams all within normal limits
Labs: CBC, BMP, Urine - within normal limits
Tox Screen - Negative
Medications: None
Family History: Noncontributory
Assessment: Patient is a 42-year-old male admitted for homicidal tendencies and delusions.
Plan: Enroll in Project Handbasket.
***
Informed Consent form for Subject #314-69-4245
Part I: Information Sheet
INTRODUCTION: My name is Dr. Harper, and I work for Shady Acres Neuropsychiatric Institute. I am doing research on the effects of life after death on the behavior of subsequently revived individuals and its application as a rehabilitation tool. I am going to give you information regarding Project Handbasket as you are now a participant in this research. There may be some words you do not understand. Please feel free to ask questions as we proceed through the information, and I will answer your questions on a need-to-know basis.
PURPOSE OF RESEARCH: Violent crime has been a problem for as long as man has roamed the earth. Various modes of punishment and rehabilitation have been implemented over the centuries; however, few—if any—have resulted in long-term behavioral changes, and recidivism rates remain high. The purpose of this research is to determine if short-term exposure to the afterlife is superior to traditional sentencing penalties in achieving and maintaining reformation in serial offenders.
TYPE OF INTERVENTION: This research will involve a series of sessions during which a single infusion of potassium chloride will be administered intravenously (IV) into your arm, followed by a period of brief observation, resuscitation, and appropriate clinical follow up.
PARTICIPANT SELECTION: All patients remanded to the Shady Acres Neuropsychiatric Institute by the courts are eligible to participate.
VOLUNTARY PARTICIPATION: Your participation in this research is mandatory. You have no choice regarding the duration of enrollment in this study and may not withdraw at any time.
DESCRIPTION OF PROCESS: During the study you will make between one and seven visits to the research theatre.
On the first visit, baseline data will be obtained during a one-hour, pre-treatment interview and administration of psychometric testing. The interview will include questions regarding religious beliefs, past criminal offenses, the presence or absence of remorse, and intent to reoffend.
Following the interview, you will be secured to an operating table, and a single infusion of potassium chloride will be administered to you intravenously, resulting in arrhythmia and subsequent cardiac arrest. You will remain clinically dead for a period of no less than ninety seconds.
During this time, your soul will exit your body and you will experience an eternity of suffering, torment, and despair at the hands of Hell’s minions. Unfortunately we cannot accurately predict the nature of your particular encounter with the afterlife; however, participants from pilot studies have reported the following:
- A limitless void, “red as death and cold as sin”
- Repeated consumption by a yellow, eyeless serpent
- Drowning in a vat of liquid fire
- Pursuit by “The Devourer in the Mist”
After the ninety-second interval has elapsed, resuscitation techniques will be employed, including but not limited to: manual chest compressions, defibrillation, and the administration of pharmacologic agents, e.g. epinephrine, calcium, insulin, diuretics, and antiarrhythmics. These agents, when used in combination, will counter the effects of the potassium chloride, allowing for reversal of the death state and the subsequent return of your soul to the confines of its earthly body.
Post-therapeutic evaluation will include a complete medical examination, three (3) one-on-one follow up visits with a study psychiatrist to record your experiences and assess your mental status, and administration of follow up psychometric testing.
SIDE EFFECTS: Potential side effects include: sleep disturbances, insomnia, persistent nightmares, hallucinations (both auditory and visual), seizures, and short-term memory loss.
RISKS: As with any therapy, there are risks to undergoing treatment. Known risks associated with the above-described intervention include:
· Infection at the IV site
· Broken ribs
· Irreversible psychosis
· Increased incidence of developing suicidal tendencies
· Coma
· Permanent death and disability
·
BENEFITS & REIMBURSEMENT: While you may experience no direct benefits, others will benefit from your participation, in that a successful trial will decrease the recidivism rate of violent offenders, making society safer for everyone in the long term. All medical and living expenses incurred during the interventional and subsequent observational periods will be provided at no cost.
CONFIDENTIALITY: By participating in this research, you are undergoing an intervention unfamiliar and unavailable to other patients within the Shady Acres facility. While many patients are aware that experimental therapies are under investigation, we do not share the identity of any participants with other patients. However, due to the nature of your crimes, law enforcement officials, judges, lawyers, and victims or their surviving families may be made aware of your participation status as one of the conditions of your release.
RIGHT TO REFUSE OR WITHDRAW: As stated above, participation in Project Handbasket is mandatory. At no point will you be permitted to withdraw from the study.
PART II: Certificate of Consent
I have read the above information. I have had the opportunity to ask questions about it and all questions I have asked have been answered to my satisfaction. I consent voluntarily to participate in this research.
Print Name of Participant N/A
Signature of Participant N/A
I have witnessed the accurate reading of the above information to the participant, and the participant has had the opportunity to ask questions. I confirm that the participant has given consent.
Print name of witness Jacqueline Harper, MD
Signature of witness Jacqueline Harper, MD
Date March 4, 2017
***
03/05/2017
S: Patient reports he did not sleep last night. Refused meals both last night and this morning. No other overnight events.
O: Mental Status Exam: Patient is alert and oriented.
Affect: flat.
Mood: “defeated.”
Thought Process/Content: Linear without evidence of delusions, hallucinations, suicidal or homicidal ideation.
Vital signs within normal limits.
No acute distress.
A/P: Patient is a 42-year-old male with a non-specified psychotic disorder on experimental protocol. Proceed with experimental treatment 1/7 scheduled for this afternoon.
***
03/05/2017 Subject #314-69-4245 Pre-treatment Interview - Transcript
JH: This is Dr. Harper. Today is March 5, 2017. The time is 08:35. This is Mr. Denton’s pretreatment interview. How are you feeling this morning, Mr. Denton?
GD: (inaudible)
JH: Do you know why you are here?
GD: I failed.
JH: That’s an interesting perspective. Can you describe your failure?
GD: You understand, don’t you? We’re both doctors. It’s our job to prevent illness and death.
JH: Yes, but Mr. Denton, you didn’t prevent illness and death. You inflicted them.
GD: If you could save a million people by killing a thousand, would you do it?
JH: Mr. Denton, this isn’t a sophomore ethics class.
GD: How about a billion? How about the entire world?
JH: Mr. Denton—
GD: I’ll change the context. Triage. Right? In an emergency you save the ones you can, sacrificing some so that others can live. You understand that, right? Of course you do. He knew I understood it, too. I think that’s why he chose me.
JH: Who chose you? For what?
GD: What? Nothing. It doesn’t matter. You wouldn’t believe me anyway. I’m crazy, right? That’s why I’m here.
JH: You’re here, Mr. Denton, because you have been deemed mentally ill and unfit to stand trial for your crimes.
GD: Was Copernicus crazy? Or Pasteur? Or Mendel? They knew things no other man knew. The Bible says, “You will know the truth, and the truth will set you free.” I know the truth, and now I’m a prisoner to it.
JH: Can you tell me about this truth? Or about the one who chose you and for what purpose?
GD: I could, but it would only lead to more death.
JH: Is that a threat, Mr. Denton?
GD: No. I’m sorry.
JH: Very well, we’ll leave this discussion for another time. As we discussed yesterday, you will be receiving an experimental therapy to treat your illness. Later today you will undergo the first of seven treatments, but before that can happen, I need to ask you a few questions so that we might better understand your response to the treatment. First question: On a scale of 1-10, one being not at all and ten being definitely, if you were to be released today, how likely would you be to resume killing?
GD: Ten.
JH: I see. Question two: On a scale of 1-10, one being none and ten being extreme, how much remorse do you feel regarding your crimes?
GD: Ten. I didn’t want to hurt anybody. One. I did what I had to do. Ten. It wasn’t enough.
JH: So, ten?
GD: (inaudible)
JH: Very well. Last question: In your own words, how would you describe your religious beliefs?
GD: There is no God.
JH: Really? It’s my understanding that over the past year you spent a significant amount of time in church, and not five minutes ago, you were quoting Bible verses.
GD: There is no God.
JH: Very well. What about a higher power other than God. Do you believe in that?
GD: (inaudible)
JH: Mr. Denton, are you all right? You look pale. Would you like a glass of water?
GD: (inaudible)
JH: Are you sure?
GD: (inaudible)
JH: Very well. Let me know if you change your mind. I’m sorry? Would you please repeat yourself?
GD: Belief is irrelevant.
JH: It’s relevant to the data analysis. The presence or absence of religious beliefs is a standard question we ask all study participants.
GD: I’m not talking about your study.
JH: What then?
GD: You’ll see.
***
Treatment Note: Subject #314-69-4245 Session 1/7
Date: 03/05/17
Procedure start time: 13:07:00
Procedure end time: 13:14:37
Total time elapsed: 00:07:37
Total dead time: 00:02:27
Complications: None
Subject comments: “The angles are wrong.”
***
03/07/2017 Subject #314-69-4245 Post-treatment Interview #1 - Transcript
JH: This is Dr. Harper. Today is March 7, 2017. The time is 16:07, and this is the first of three post-treatment interviews with Mr. Denton. He has completed one of seven treatments. How are you feeling today, Mr. Denton?
GD: I’m tired.
JH: You didn’t sleep last night.
GD: I did not.
JH: Would you like me to prescribe something to help you sleep?
GD: I would not.
JH: Very well, but insomnia is a common side effect of the therapy, and I’d be happy to prescribe something if you change your mind. Now. Can you tell me about your experience on Sunday?
GD: I was murdered.
JH: How did it feel?
GD: It didn’t feel like anything.
JH: What did you experience following the injection?
GD: (inaudible)
JH: No sight or sounds? No conscious thought?
GD: Not conscious. Dreaming thoughts. Dead and dreaming.
JH: You thought you were dreaming?
GD: Not I.
JH: What then do you mean by “dreaming thoughts?”
GD: He showed me.
JH: Who showed you? What did you see?
GD: The Eleventh Plague.
JH: Can you describe it?
GD: Undying death returns in the absence of sacrifice.
JH: What kind of sacrifice?
GD: The kind that comes before eleven.
***
Treatment Note: Subject #314-69-4245 Session 2/7
Date: 03/12/17
Procedure start time: 15:00:00
Procedure end time: 15:24:44
Total time elapsed: 00:24:44
Total dead time: 00:06:51
Complications: Sedative required following resuscitation.
Subject comments: Uncontrolled laughter for 15 minutes prior to sedation.
***
03/13/17
S: Patient reports poor sleep and nightmares. Decreased appetite. No overnight events.
O: Mental Status Exam: Patient is alert, but only oriented to self. He is unable to correctly identify the date and when asked where he is, the patient is overcome by seemingly uncontrolled bouts of laughter.
Affect: irritable.
Mood: inconsistent.
Thought Process/Content: Tangential with delusions and obsessive discussion of a coming plague.
Vital signs are within normal limits.
Other than bouts of inappropriate laughter, the patient appears to be in no acute distress.
A/P: 42-year-old male with an unspecified psychotic disorder on experimental protocol.
Begin risperidone for psychotic symptoms
Begin zolpidem for sleep
Continue experimental protocol as scheduled.
***
03/14/2017 Subject #314-69-4245 Post-treatment Interview #1 - Transcript
JH: This is Dr. Harper. Today is March 14, 2017. The time is 11:15, and this is the first of three post-treatment interviews with Mr. Denton. He has completed two of seven treatments. How are you feeling today, Mr. Denton?
GD: [laughter]
JH: I understand you’ve been having nightmares. Would you like to discuss th
e content of your dreams?
GD: My dreams are not my own.
JH: Whose dreams are they?
GD: [laughter]
JH: Mr. Denton, please sit down.
GD: [laughter]
JH: Sit down, or I’ll be forced to—
GD: [laughter]
JH: Security!
GD: [laughter]
***
03/16/2017 Subject #314-69-4245 Post-treatment Interview #2 - Transcript
JH: This is Dr. Harper. Today is March 16, 2017. The time is 12:55, and this is the second of three post-treatment interviews with Mr. Denton. He has completed two of seven treatments. How are you feeling today, Mr. Denton?
GD: I’d like to go home now.
JH: I’m afraid it will be several months before the decision of whether or not you are well enough to return home can be made. I’d like to talk about your last treatment. There were some unexpected side effects, though I’m pleased to see they seem to have resolved. Tell me about Sunday’s session.
A Lonely and Curious Country Page 7