by Barbara Ebel
Table of Contents
DEADLY DELUSIONS
Copyright © 2016 by Barbara Ebel, M.D.
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
Chapter 29
Chapter 30
Chapter 31
Chapter 32
From the Author
DEADLY DELUSIONS
by Barbara Ebel, M.D.
Book Two of the Dr. Annabel Tilson Novels
Book One: Dead Still
Book Two: Deadly Delusions
Book Three: Desperate to Die
Book Four: Death Grip
Book Five: Downright Dead
Book Six: Dangerous Doctor
Copyright © 2016 by Barbara Ebel, M.D.
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
Paperback ISBN-13: 978-0-9977225-1-2
eBook ISBN-13: 978-0-9977225-2-9
This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.
Chapter 1
Third-year medical student, Annabel Tilson, couldn’t wait to dive into studying her patients’ thoughts and behavior for the next month. She doubted that psychiatry would end up being her career field of choice but she was smart enough to recognize it would be a vital component of her clinical experience. The beauty of a psychiatry rotation was that no matter what specialty she chose later to practice, the time spent now would make her understand any or all of her patients better in the future.
The team had met for the first time that morning and her attending physician, Selina Keeton, echoed her thoughts. “You will contemplate patients with surgical or medical problems better,” she said, “by understanding the basics of psychiatry. It is the only specialty which will help you examine the psychological and social dimensions of their illness.”
Now Annabel hurried after her attending like a naïve young student again at the bottom of a hierarchy. She had only completed one third-year medical school clinical rotation so far – surgery. And like before, there was once again a resident and an attending above her; but this time there was only one other student with her - Bob Palmer. They had been on the previous rotation together. She considered him a good friend and a likeable guy but he liked her more than any romantic fondness she felt for him.
Annabel and Dr. Keeton hurried along a first floor corridor linking the hospital to the psychiatric emergency evaluation center in the building next door.
“As I told you and Dr. Palmer today,” Dr. Keeton said, her voice husky and quick, “the night-call duty for students doing psychiatry is lenient. You both will be expected to work only a few evening and weekend shifts in the center we’re going to now. That’s a sleep-saver for a four-week rotation.”
“It’s going to seem like a vacation from general surgery,” Annabel said.
Looking at Annabel, Dr. Keeton stopped short. “You may think you’re going to get a break but matters dealing with the mind can be taxing. Psychiatry’s a brain drain.”
“I’m sorry. I didn’t mean it the way it sounded.”
“Well, you must mean well,” Dr. Keeton responded. “Your enthusiasm to go see a patient with me … although you’re done for the day … is duly noted.”
Annabel gave her a timid smile and pushed her hair behind an ear while Dr. Keeton scanned Annabel up and down, noting her short white student jacket and what she wore underneath: a pale yellow top with a circular collar and a pair of belted beige pants.
“And by the way,” Dr. Keeton continued, “I didn’t mention this before since it affects you more than Dr. Palmer and our resident, Dr. Washington. Female students and residents, in particular, need to be extra careful about dressing professionally on psychiatry. Tight or flashy clothes or evident cleavage can be misinterpreted by confused or mentally unstable patients.”
Annabel nodded as they began walking again at a crisp pace. She thought about her attending’s appearance: sharp and bold. The woman, she guessed, was around forty-two years old and she had straight platinum blonde hair; a blunt cut snipped straight across at her jawline. Her eyes were green like a cat’s and she practiced what she preached. Her long doctor’s coat was starch ironed and almost closed with a matching navy blouse and pants underneath. Her shoes were practical yet stylish, and flat, which let her zoom around faster.
They came to heavy-looking double doors and Dr. Keeton pushed a number key code into the security box on the wall. “When you come over here from the hospital,” she said, “just use the intercom and let them know who you are.”
They approached the atrium from the side hallway. A middle-aged woman sat at the reception desk and a security officer stood by the main entrance. Two uniformed police men stood off to the side looking out the window.
“I’m Dr. Keeton, the psychiatrist in charge,” she said as she approached them.
“Officer Banks and Lowe here,” the taller one, Banks, said.
“At least one of you looks familiar,” she said. “So who did you both bring me?”
“A 23-year-old man picked up for aggressive behavior and disorderly conduct,” Lowe said.
Annabel stood next to Dr. Keeton and wondered about the men in blue. Were psychiatrist and police interactions common? Psychiatry must be more complicated than she thought.
“They called us to a movie theater,” Lowe said, “where the late afternoon current blockbuster film was in progress. You know, one of those superhero movies where the lead actor wears an outfit adherent to his skin and he’s been gymnized for a year.”
“Gymnized?” Annabel blurted.
“Yeah,” Lowe said. “You know, where Hollywood hires a team of nutritionists, coaches, and muscle builders to turn some scrawny actor into a young Arnold Schwarzenegger.”
“So what happened?” Dr Keeton asked.
“The manager told us there was a man inside,” Lowe said, peeling his eyes off of Annabel, “in front of the screen. Gesticulating his arms and hands and shouting. He thought the flamboyant characters were demons ready to pop out and do evil things to the audience.”
“When we walked into the dark theater and down the aisle,” Banks added, “between irate and scared movie watchers, this guy flew his arms over his head.” Banks pointed upwards but then wrapped his fingers back around his belt.
“Over the blaring loud speakers,” he said, “we could hear his shouting more clearly as we approached. Yelling things like ‘I’m here to protect you all from these serpents crawling out of the screen. They’re coming. Watch the floor. They’re slithering into your seats and will choke the life out of you!’”
Banks frowned and shook his head. “That’s about it, Doc. You can handle this one.
They put him back there.” He nodded his head towards the door behind the counter.
Dr. Keeton narrowed her eyes. “Did he have any belongings with him?”
“No. Not a thing,” Banks said, “except for a wallet in his back pocket.”
After Annabel listened with a stunned expression, Lowe asked her, “Are you a student?”
Annabel nodded affirmatively. “I figured,” he said. “You have a dazed look about you. Fresh out of the crib and into the playground. The reason Dr. Keeton asked about what he carried is whether or not he possessed any type of weapon. And I don’t mean just a traditional weapon like a gun, but anything his bizarre mind could conjure up to attack or fight someone.”
“Scary,” Annabel said. “I wonder if the poor viewers in the theater worried about that.”
“Anything else you can tell me?” Dr. Keeton asked them.
“No. We’re finished,” Officer Banks said. “I have paperwork here for you to sign.” He stepped over to the counter where Selina read and signed what he gave her.
“His name is Victor Blake,” Lowe added.
“The manager hasn’t told us yet if he’s going to file charges,” Banks said. “So we’ll be in touch.”
“Thank you, officers,” Dr. Keeton said. “I always appreciate the fine job you all do. I’ll dig to the bottom of Mr. Blake’s problems.”
-----
Behind the foyer of the building, a man wearing scrubs handed Dr. Keeton a chart. Annabel looked around while her attending checked the notes the staff logged in about Mr. Blake: insurance information, vital signs, and what the patient reported – why he was there.
As a psychiatric emergency center, it resembled a hybrid between a regular ER admitting area and a comfortable office. The two pictures on the wall were of a peaceful lake and in the corner was a large fake palm tree.
Annabel followed Dr. Keeton to the patient’s door and they entered to find Victor Blake pacing the width of the room and making sharp turns. He talked with a hurried speech so she had difficulty understanding him. She looked for a spot to sit as there were several options and crossed over the course he walked in the middle of the room; she sat down against the far wall.
“Mr. Blake,” Selina said while not taking her eyes off of him, “I am Dr. Keeton. I’ll be back in a minute.” She shot a glance over at Annabel. “Dr. Tilson, please step outside with me for a moment.”
Annabel gulped, wondering why they needed to leave. Outside, Dr. Keeton distanced herself from the patient’s door. “I am sorry. I neglected to tell you some other basics before your first emergency patient encounter.”
Annabel twisted her hands. She felt honored yet a little nervous that a faculty attending called her out alone.
“On psychiatry, don’t ever do again what you just did.”
Annabel’s heart sped up. What had she done wrong?
“Of paramount importance to rotating students is for them to keep safe at all times. Never, ever, situate yourself so that the patient is between you and the door!”
Dr. Keeton said it with such emphasis, Annabel knew she would also ‘never ever’ forget it. “Okay,” she said, realizing some patients could be considered dangerous. “I will tell the other student, Bob, as well. We are friends and we do a good job of sharing information.”
“I will consider it done then. And another point: on future rotations or if you end up practicing another specialty, it’s not uncommon to shake your patient’s hand when you walk in the room. Consider this the only rotation where you should never do that.”
“I’ll be sure to remember. Thank you for telling me.”
Dr. Keeton patted Annabel’s arm and leaned in just a bit. “And both you and Dr. Palmer are inexperienced so please adhere to the suggestions which both Dr. Washington and I make. If either of you feel uncomfortable in a particular situation, we need to talk about it.” She raised her eyebrows and let Annabel think about that.
“Tomorrow tell your student friend, Dr. Palmer, all three of my rules about student safety.”
Dr. Keeton smiled. “Your psych experience will be similar to what you did in your surgery rotation. You are to pick up new patients and follow their daily progress throughout the course of their admission to the hospital. Since you have been interested enough to stay over and watch this encounter with Mr. Blake, he can be your patient. But we’ll talk about the psychiatry H&P, or history and physical, tomorrow.”
Annabel ran her right fingers through the waves in her hair all the way to the base of her neck. “I have heard about the psychiatry H&P being different than medical or surgical ones. I do hope I live up to your expectations.”
“You must own up to your own standards, too, and set your sights high. Now, let’s go find out what Victor Blake is all about.”
-----
Inside the room, Annabel did not make the same mistake again. Sure enough, there was a plastic chair right inside the door to the left and she sat down. Dr. Keeton took a few steps to another one towards the right, more in the middle of the room, but continued to stand in a relaxed manner. Unlike a typical ER room, the room was slightly larger with more options to sit; an examination table was present if needed.
Never before had Annabel been in such close quarters with an individual as curious and eccentric as the jockey-sized twenty-three-year-old Victor Blake. Running down one forearm, he wore a ragged scar and, on the other, he sported an eagle tattoo. The gray cotton shorts he wore were baggy and his legs stuck out like hairy wooden toothpicks; on his cut-off T-shirt, a brown stain ran through the name of a tree cutting service. For a cool day in late October, he was underdressed
“Mr. Blake, I will reintroduce myself,” Selina said. “I’m Dr. Keeton and this is a medical student, Dr. Tilson. You may sit down if you’d like. Can you explain to me what happened in the movie theater?”
Mr. Blake backed into a chair, sat for a moment, but bounced right back up. “The voices told me to go there. The two of them said I was worthless and yelled at me to see that movie today. Outer space people and snakes and villains are in it and they want to kill the heroes.”
Victor’s beady little eyes stopped their constant movement and settled momentarily on Annabel. She shuddered and then felt relieved when he looked back at Selina.
“One voice told me to crush the big black snakes but the other voice told me to leave them alone and slaughter the people in the room to get them out of the way.”
“Are they talking to you right now?” Dr. Keeton asked.
He looked at her skeptically although his flat affect didn’t change. “Of course.”
“Do you, or do those voices, want to hurt you or us?”
“No.”
“Then what are they telling you?”
“One of them told me you are not who you say you are.” He pointed to Annabel. “And she’s a spy who’s going to blow up the building.”
Annabel gripped her knee. She wished he stood a football field away.
“I’m going to ask you a few simple questions, Mr. Blake, but you try to answer them and not the voices in your head. Okay?” She wore an effective expression assuring Victor that she was only focused on him.
He continued his nervous pacing, uncomfortable in his surroundings, as he shot Selina a glance. “All right,” he mumbled.
“Are you working or going to school?”
“Maybe working.”
“Maybe?”
“I kind of dropped out.”
“Why?”
“That guy I cut trees with is not who he says he is.”
“What have you been doing since then?”
“I’m in my safe room a lot.”
“Where is that?”
“My mother’s. I live in the whole finished basement. But my voices argue with each other. One says she’s not my mother.”
“I see.” Selina sat tall, her feet crossed at the ankles. “Do you drink any alcohol?”
He shook his head.
“Do you
take any drugs?”
“No. When I smoked marijuana, my voices wouldn’t talk to me so much.”
“You don’t use it anymore?”
“I don’t have extra money these days to buy it.”
“I see. Has any doctor put you on any medicines?”
“No. I don’t see any doctors.” His pacing slowed almost to a stop and he stopped in front of Annabel. “You don’t talk,” he said. “What are you doing here?”
“Dr. Tilson is a younger doctor in-training,” Dr. Keeton said. “She’s going to help me take care of you. I am admitting you to the hospital – to a special area where we can have routine talks - until we make those voices in your head go away. Is that agreeable to you?”
He frowned at Annabel but grimaced more when he turned back to Selina. Dr. Keeton let a silence fall on the room and she waited for his answer.
“I guess so. If I can go to bed soon.”
“Are you tired, Mr. Blake?”
“Yes. I’m pretty tired. Even my voices are saying they want to go to sleep.”
“I’m going to go do what’s necessary so you can get some sleep tonight. Dr. Tilson and I will be in to see you tomorrow morning.”
When they left the room, Dr. Keeton turned promptly to Annabel. “Welcome to psychiatry. You’re dismissed and we’ll meet sharp at 8 a.m. tomorrow across the way in the hospital ward.”
“Thank you for letting me come along,” Annabel said. “Is there always so much verbal judo?”
Dr. Keeton smiled. “Quite often.”
“Good night,” she said.
As Annabel took off her short white student doctor’s coat and headed to her SUV, dusk settled over the evening sky. She thought about the progression of her first day. It had been nerve-racking to be in the same room with her interesting, yet scary, new patient. Her attending, however, had remained cool, calm, and collected. But she wondered … was Victor Blake and his ‘craziness’ a blessing to her education or a problem patient for her to tolerate?
By the time she arrived home to her apartment – the third floor rental of a converted house - she craved a good night’s sleep like Mr. Blake. And before shutting her eyes she confirmed to herself what she had already suspected: psychiatry was indeed an intriguing field.