by Barbara Ebel
“Bob, what can you tell us about what happened?” Lowe asked.
“I guess it’s like he said,” Bob said. “I left him here for a second because I forgot his chart from inside. Mr. Wells, along with his information, were going over to the psychiatry ward for admission and suicide precautions.”
Lowe frowned. Selina had stood up and listened attentively.
“I guess he took care of that himself,” Lowe said.
“Officers,” Selina said, “if you are finished with the student, I’m going to let him go home.”
“That’s fine with us,” Banks replied. “And, Dr. Keeton, we’ll be busy calling this incident in and with gathering more information for our reports,” he said as his eyes lingered over her. “Besides what’s going on here this afternoon, I asked your female student something today; she may talk to you about it soon. We hope you consider it.”
Selina nodded, not knowing what he meant. She patted Bob’s elbow. “You’re dismissed for the day; we’ll talk tomorrow. The last thing I want from you is a PTSD from the shock of this.”
Bob felt little relief and stepped away towards the hospital corridor to fetch his things. Through the large glass windows, he noticed other vehicles pulling into the lot. The media had arrived to seek out a story for the evening news.
-----
Annabel waited like any other patient in the dermatologist’s waiting room. Appointments ran behind today and she wondered why. It wasn’t as if the physician had to run across the way like an ob/gyn doctor and deliver a baby between office hours. She opened her book bag and worked on the perfect time-killer: her psychiatry work-in-progress report on Victor Blake and schizophrenia. Every day she entered her thoughts and patient updates; each day she realized the importance to this method. She understood and reflected on his disease and its progressive treatment much better by doing daily entries. She would also save herself the aggravation of putting together the report at the end of the rotation like cramming for a test. The department, she believed, cleverly required student papers and she was going to make sure hers was an educational experience. She looked forward to the next group therapy session of the schizophrenic patients for additional material; Victor seemed amenable to his new disease partners, too.
A ding sounded on Annabel’s iPhone. Wondering if it was her Saturday boat-date guy, she immediately took a glance. It was Bob.
Something awful has happened. Can I meet you?
She stared at the message. How strange. He should still be at the psychiatry building and what could be so terrible?
I’m still at my doctor’s appointment.
With little delay, another message appeared.
How about in an hour? At café up the street from your place?
Okay, she responded. I’ll text … if running later than that.
Annabel muted her phone and closed her notebook when they called her back to the room. When the doctor came in, she examined the back of Annabel’s arm as well as her back, shoulders, and neck.
“It still looks good,” the dermatologist said, “including the little non-cancerous area on your neck. I’ll see you within a year when I’ll do a whole body skin check.” With a warm smile, she added, “Good thing the malignant melanoma was discovered and removed early. With these good results, go on with your medical training and don’t worry about a recurrence at all.”
“Thanks,” Annabel said. “I’ll try to heed your advice.”
-----
Annabel drove straight home and found a decent parking space. Instead of unloading her things in her apartment, she walked to the corner café. A bell jingled when she opened the door to the woody, wholesome room that tantalized the senses with a full-bodied coffee aroma. Bob sat on the bench running the length of the wall. His elbows were planted on the table and his hands held a mug. She went over and placed her things on the floor and eyed him with a slight smile. He furrowed his brow and put down the coffee.
“Hey,” she said, realizing he didn’t seem his normal self. “Coffee is bound to keep me up tonight but I’ll join you anyway and be right back.” She ordered a mocha at the counter and a scone, still fresh from the morning.
“The worst, most dreadful thing happened after you left,” Bob said when she returned.
She knew whatever he was talking about must be serious. He did not ask her first about her dermatology appointment. He, of all people, knew of her recent scare with cancer; not asking was not like him at all.
“What, Bob? Don’t keep me in suspense.”
“The depressed patient I told you about … he shot himself.”
“What? You’re kidding.” But he wasn’t joking and she knew it. He wore no jovial facial expression and his hand trembled. How could the patient have shot himself in a medical facility?
Bob shook his head. “No, it’s not a joke, he said as if reading her mind. “Annabel, it’s all my fault.”
“This isn’t making any sense. Would you please tell me what happened?”
“Dr. Keeton put this man, Mr. Wells, on suicide precautions and we were admitting him. She placed her trust in incompetent me; she asked if I’d escort him to the lobby so they could walk him over. I took him out but forgot his chart. So like an idiot, I left him there, and went back. He pulled the guard’s gun away from him and shot himself in the head.”
Annabel gasped. Even without being there, she envisioned the whole thing. The event couldn’t be more devastating and she couldn’t imagine the fall out. Bob lowered his head in shame as his lips began to quiver.
“I don’t know what to say. Right there in the atrium?”
He nodded. “He was so depressed. He wanted to commit suicide. It’s all my fault. He would still be alive this minute except for my brainless mistake.”
“But, Bob …”
“And the shooting … his head. It was awful. I’m going to have nightmares.”
Annabel sighed and ramped up the courage to straighten him out. “Listen to me. Knock it off right now. I bet Dr. Keeton is going to tell you the same thing. A certain percentage of suicidal patients end up succeeding no matter who or what intervenes to stop them. You did not pull the trigger. You were his advocate, not his demise.”
She slid her hand over to his, gave it a squeeze, and then let go. “You helped drag me out of a hell-hole on the surgery rotation and everything you told me was spot-on. You must likewise recognize that I am telling you the truth. Take my objectivity of the situation to heart.”
“But the repercussions are going to be huge, most of all for Dr. Keeton.”
“Bob, we can attest to the fact that she can handle herself.”
He finally gave her eye contact. “You can’t believe how nice she was. She didn’t want me there any more … viewing the whole bloody scene. She thoughtfully asked me to leave to protect me.”
“She is incredible. When I grow up, I want to be just like her.”
Bob stirred his coffee. “And it gets worse. When I left, the paramedics had arrived, the two cops, and the media.”
Annabel’s eyes widened. “But the patient was gone, wasn’t he?”
“One-hundred percent. Annabel, I hear what you’re saying to me, but I don’t know if I’ll ever get over this.”
-----
Annabel walked into her apartment an hour later; she put down her things and leaned over the counter to stream news on her iPhone. She found spotty updates of the day’s events and soon the local coverage played footage of the emergency psychiatric building from prior in the day. EMS shuttled a patient out of the lobby over to the hospital, the stretcher draped with a white sheet. A reporter asked questions of Officer Banks while Dustin Lowe stood nearby.
After Banks finished answering her few brief questions, the reporter turned to the camera. “A tragic end to a patient’s death wish,” she said. “He certainly did not get the preventive help which the family sought by coming here.”
Annabel cringed. Any situation can be spun to fit anyone’s viewpoin
t, she realized. But Bob was correct. She hoped Dr. Keeton and her student colleague and good friend would not have to face too much criticism.
Although she needed to get to bed soon, she put working on her rotation paper aside and opened her primary textbook. Time to buckle down, she thought, and read through the entire chapter on bipolar disorder. She always liked to skim a section first and then go back and really study it. Thinking about her patient who had it, however, wasn’t easy and it would be rough facing Noah Goodman again. He reminded her of the uncertainty of being a med student and his treatment by the team could be paramount to his maintaining his spot in the first year’s class. Would he even be able to complete this term doing the only dissection of a cadaver in his career, unless he were to go into forensic pathology? The more she read, the more thoughts kept popping into her head about the bizarre situations her and Bob had already encountered on the rotation.
When Annabel finished a once-go-through of manic bipolar disorder, she unplugged her cell phone and skimmed Findar. Not to chat again with her boat guy, Jerry, but to see what other profiles may have popped up. No one suited her. She closed down and went to sleep thinking of her one-and-only prior chief resident, Robby Burk.
-----
Annabel first saw her patients in the morning before the team met to discuss the day and do rounds. First she went through Mr. Blake’s chart and noticed Dr. Washington had increased his risperidone the day before to 8 mgs a day. She remembered Dr. Keeton mentioning that as the upper therapeutic dosage as she walked into his room.
“Mr. Blake,” she said, “good morning.”
Victor grimaced. His arms went up in a wild gesture, as if shooting a bow and arrow at the floor in front of her.
Startled, she jumped back. “What are you doing?” she said when she collected her wits.
“They told me to do it.”
“Who told you to do what?”
“The voices in my head. They said a snake was on its way to get you. I planned on protecting you just in case. But I know one isn’t in here because I haven’t been seeing them.”
Annabel calmly sat down by the door. “Victor, this is important. You are not seeing any snakes or other living things in your room, are you?”
“No. Maybe not since yesterday or the day before.”
“Does that make you more comfortable?”
He nodded.
“But those voices are still talking to each other, or to you, in your head?”
“A little bit. At least they are not jamming up my air waves like before.”
“Do you mean you hear them less?”
“Maybe yes. I am getting to think more without them interrupting me.”
“I am happy for you. We need to continue to make progress. Okay?”
“All right,” he said with a flat affect. “When can I be with those other people again?”
“Do you mean the therapy patients like you?”
“Yes,” he answered as he finally sat down.
“In a few days.”
He moved his head back and forth as if rocking to music; he must enjoy group dynamics with his own peers, she thought.
“We’ll see you shortly on rounds,” Annabel added and left to look through Noah Goodman’s chart.
A few nurses’ notes had been added since Noah’s admission and she read them all. Each of the health care shifts mentioned how much he could talk. One of them scribbled, ‘it’s endless.’
As Annabel entered his room, she braced herself for any surprise behavior; being shot at with an imaginary bow and arrow was enough for one day. Her patient saw her right away as he stood tall after touching his toes. He was doing some kind of exercise routine.
Annabel never got to ‘good morning.’ He was quicker on the draw than she was.
“It’s you,” Noah said. “One of the ladies that talked to me yesterday.” He resumed waving his arms down to the floor.
At least someone, or his roommate, had brought him back less colorful clothes, Annabel thought. He wore blue jeans and a regular T-shirt but still had circles under his eyes.
“My presence means a lot to you, I’m sure,” he said. “After all, I’m a medical student, and a guy, and good looking, and have a great body, and I study a lot, and someday I’m going to be a famous doctor who transplants organs from around the world. People will come from continents and oceans and mountains when they learn about me.”
Annabel smiled to herself. This aspect of his diagnosis had not been apparent so much yesterday but she had read about it last night. His self-esteem was bigger than an Olympic stadium full of gold medalists.
Noah stopped for a moment, thumped his chest with pride, and then resumed.
“My medical textbooks will become world famous. One of them will be called ‘Learning Everything’ by Dr. Goodman. You know that New York Times bestseller list won’t have any other book as number one for a whole year!”
Annabel crossed her legs like Dr. Keeton and Noah was easily distracted.
“You have pretty legs,” he said. “I can come over there and we can get it on. You don’t get to make it with a famous doctor very often, I bet.”
His pressured speech made Annabel wish she had a remote control switch to turn him off. Plus, she didn’t like where he was going with this.
“Mr. Goodman,” she said firmly. “It’s time I get in a word edgewise!”
Chapter 10
“Are you feeling any better this morning?” Annabel asked Bob when she entered the lounge and joined him in the kitchenette.
He answered with a grimace, reached for a second mug, and poured her coffee.
She decided right then to keep her eye on him for a few days. To make sure he did what he’s supposed to and not fall behind with his patients or with clinical responsibilities. Yesterday’s situation would blow over but, in the interim, he couldn’t blow off getting through the course.
“Have you seen your patients yet,” she asked.
“Yes. All seen and, luckily, they are accounted for.” He took a sip and made another gloomy face.
“Did you begin writing your psychiatry report yet which is due at the end of the rotation? Or decided on the patient and diagnosis you’re going to use?”
“No. I’m getting behind on starting it. I have had no psychotic patients like you, so I’ve been dragging my feet.”
“I understand you lost your new patient yesterday, but those circumstances are one in a million. You possess the fodder to write an exceptional piece on depression and it’s ultimate bad outcome. You can write from your heart about the time you spent with him and the soulful insight he gave you into depression. Write in current statistics about depression and suicide, the warning signs, the loss to society, the need for psychiatric intervention and suicide precaution. I could go on and on. Most importantly to you, writing on this topic would be extremely therapeutic.”
Bob rubbed his chin. “But I think the department wants a piece on a live patient in our care.”
“The whole point is the educational experience; to make us better doctors. That case would be perfect. All you have to do is run it by Dr. Keeton. And if you won’t, I will.”
“Feisty this morning, aren’t you?”
She shrugged her shoulders and stirred creamer into her coffee.
“Okay. I can’t think clearly right now. We’ll ask her.”
“You can do it then.”
Selina and Joshua both walked in. “Good morning, students,” she said. “When you come over, would either of you mind lugging a cup of coffee for me?” She sat at the table and took out her patient list and a pen.
Annabel obliged and set a mug next to her right arm.
“Thank you,” she said. “I would have done the same if our positions were flipped.” Every platinum hair was in place and today she wore matching jewelry. Silver-stoned earrings mirrored the gems set in a silver bracelet on her wrist. Her long white coat was crisper than a snappy bag of Doritos.
“F
irst off,” Dr. Keeton said, “has everyone already seen their patients?” They nodded and she added, “Any emergencies we need to attend to? Otherwise we’ll spend a bit more time here first.”
All three of them countered with a “no.”
“Dr. Tilson, are you aware of what happened yesterday afternoon?”
“Yes,” she said.
“I’m sorry,” Bob blurted out, sitting next to her. “My apology pales in comparison to the loss of Mr. Wells’ life, but I need to say it again. I cannot begin to describe the guilt I’m feeling.”
“Dr. Washington,” she said, “please go close the door so we are not distracted. I ordered something but it should take a few minutes to get here.” Joshua did as she requested and resumed sitting next to Bob.
“We are going to talk about this first,” she said, “and Annabel will benefit as well. The sooner you hear my spiel and let it take root in your head, the more you should shrink away from letting guilt grow like kudzu.”
Bob frowned. He deserved his guilt and wasn’t open to her trying to change his mind.
“First of all, every day in this country there are about 117 suicides but for every one that’s successful there are twenty-five attempts. That’s a harrowing statistic. Our Eugene Wells was the classic individual to carry it out. Three and a half times more men die this way than women, the rate is higher in middle-aged men, and seven out of ten of them are done by white males. Almost fifty percent of them are done with firearms, too. Like our patient.”
Like Bob, Annabel had no idea the numbers were so high. Thank goodness most attempts fail, she thought.
“Patients in the process of being admitted or early in their admission are in the highest-risk periods.”
“Which is why …,” Bob interrupted.
“Just wait until I finish,” Selina said softly. “So, once they are admitted, they are on 15-minute checks or 1:1 observation and still some of them succeed. One hospital study reported that 78% of them had denied suicidal ideation before they did it.”
She gazed at each one of them. “The bottom line is that sometimes, no matter what we do to prevent it, patients successfully pull off suicide right under our noses.”