Part 3:
Anyway, let’s get back to the story so we can get it over with. I last left off with Nessie’s suicide, and how it shocked so many people.
Frankly, it should have. Even though I’d only been a resident at the hospital a short time, I knew the loss of a nurse like Nessie would be felt for years to come.
However, at the time, her death only gave me a thought that, in retrospect, I’m rather ashamed to admit. This could be my chance. It was obvious that they’d need someone new to give “Joe” his medicine, and the odds were long that any of the established nurses would be willing after what had just happened. Being a resident, who everyone would assume was too naive to know what he was getting into, I could volunteer for the job, and maybe get some covert therapy in with the mysterious patient. Then, if it went well, I could offer to maybe review his case. I immediately resolved to offer to work into the night to bolster goodwill, and then use that as cover to make this request.
Once the reporters and cops had cleared off, and the hospital’s operation had returned at least slightly to normal, I followed exactly this course of action. As I expected, the attending physician was quite grateful to have another hand on deck for the night shift, now that Nessie was gone. However, the instant I broached the subject of bringing “Joe” his medication in Nessie’s absence, all trace of his previous good humor evaporated.
“Hasn’t anyone told you about that patient?” he asked.
I confirmed that they had.
“Did you know that he was the last patient Nessie saw before she...died?” he asked. There was a slight hesitation in his voice that I could tell masked a quiver.
I said I’d heard rumors, but nothing definite.
“You do realize that there’s only a handful of people who ever go into his room, right?”
I said yes, and that because the number was so small, I’d assumed there was some sort of special permission required to enter. The attending physician started laughing.
“Son, it’s nice you care so much for procedure, but it’s all I can do to keep track of the patients here, let alone other doctors. You could’ve gone in anytime you liked. But only a few people are willing to do it, because they care about this hospital’s reputation and realize we can’t be seen to neglect any patient, no matter how…difficult. But you’re a damn resident. You just got started here, and I’m guessing you won’t stay. What’s your angle?”
I told him I didn’t have one, but had honestly just wanted to help. That made him laugh even harder.
“Listen, kid, I may not have graduated from a hotshot medical school like you, but I’m not stupid. You’re overqualified to work here. You’re at the most shaky point in your career. And yet, instead of asking to consult on a patient, or do anything else, you’re asking to do something a nurse usually does. You’ve got an angle, and I want to know what it is.”
There wasn’t any way to stonewall my way out of this, and I figured it was better to look foolish than dishonest. I told him honestly that I wanted to try my hand at therapy with Joe. To my surprise, he didn’t look angry, and he didn’t laugh at me. He just looked tired and sad.
“I thought as much. You wouldn’t if you’d seen his file.”
I considered telling him I had, but decided against it, telling him that I thought I could learn what might be wrong with Joe through careful observation. That did make him laugh, but it was more a bitter exhalation than anything else.
“Trust me, son, observation won’t help you. We’ve been observing him for over 20 years and we still can’t figure out what’s wrong with him; we just know we need to keep it locked up.”
He leaned back in his chair and sighed expansively.
“I should reprimand you for trying to lie your way into therapy with a patient. Hell, I should probably consider firing you. I’d do just that if you were the normal sort of resident we get. But like I said, you’re overqualified, and from what the other doctors tell me, you’re managing to carry almost a full caseload despite being just out of medical school. So I’m not going to reprimand you. Or fire you. But therapy with that...thing is out of my hands. If you want to get access to him or his file, we need to take you to someone more senior. Much more senior. And if you’re lucky, your request will be denied. So. Are you sure you want this?”
Without hesitation, I nodded. He sighed again, stood up from his chair, and beckoned me to follow him. I did.
It took me until we got to the elevator to realize that he wasn’t blowing smoke when he’d said he was taking me to someone more senior, because as soon as we got in, he punched in the number for the very top floor, which was where most of the executive offices were located. But it was only when I saw the nameplate on the office door he guided me to that I realized what was about to happen.
He was taking me to see Dr. G-----, the Chief of Medicine, herself.
A few smart knocks on the door by my guide were all that was necessary for Dr. G----- to open it and look up at him expectantly.
“Yes, what is it, Bruce?” she asked, in a voice as clipped and precise as her immaculately tailored skirt suit. My guide motioned to me.
“Rose, meet Parker H-----,” he said. “He’s one of our residents, and he’s just been to see me about conducting therapy on you-know-who. I told him we’d need to get you to approve it.”
Dr. G----- turned her eyes on me and I got the distinct impression that she was unimpressed by what she saw.
“Thank you, Bruce,” she said, not turning her eyes away from mine. “I’ll take it from here.”
She motioned me into her office mutely and I walked in, taking one of the soft leather armchairs that sat before her desk. Dr. G----- sat opposite me, her eyes once more returning to my face, as if determined to peel it back and read my mind.
It impressed me at this point that Dr. G----- looked like the last woman I’d ever have expected to have come into her post as a psychiatrist. I could not imagine this woman empathetically coaxing painful memories from damaged people. She didn’t even look like she knew what empathy was.
More than that, her entire affect was as cold and intimidating as most psychiatrists’ are warm and soothing. Judging by the dates on the file I’d seen, she had to be at least in her early 50’s, but she didn’t look a day over 40, with shoulder-length auburn hair, piercing green eyes and a round but slightly pinched face. I also noted that she was very tall -- taller than me with the help of the pair of businesslike black heels she was wearing -- and rail thin with a body that looked more like it belonged on an Olympic athlete than a doctor. If I’d been older, I probably would have found her attractive, but as it was, her hawklike stare only had the effect of making me aware how painfully young and inexperienced I was. It was like being X-Rayed by a very judgmental machine.
After a few moments of considering me, she finally spoke.
“So let’s start with the questions you’re least likely to fuck up first. You just started here after graduating from medical school?”
I said I had.
“Which medical school?”
I told her. She raised her eyebrows.
“And why would a graduate of someplace like that want to work here?”
I explained about my fiance. Her expression softened a bit, but she still looked at me suspiciously.
“And you are actually in residence to become a psychiatrist, yes?”
I said I was. She gave a brisk nod and considered me for a few more moments before speaking again.
“So why do you want to attempt therapy on an incurable patient?”
“Well,” I said, “I’m not so sure he’s incurable.”
“How would you know? Have you spoken to him?”
“No.”
“Have you seen his file?”
“No,” I said just as quickly, yet something I said must’ve given away the lie, because she glared at me.
“Try the truth next time, or this meeting’s over.”
I swallowed. “Fine,” I said. “Yes.”
“Better,” she said. “So if you read that and still want to work with him, you must have a diagnosis in mind. Care to enlighten me as to what you saw that the rest of us missed after twenty years of looking?”
It was a trap, and I knew I had to be diplomatic in answering it.
“I don’t think you missed anything,” I said quickly, “But the file says he was last treated in the 90’s. The DSM’s been revised since then, as you know.”
“Stop patronizing me and get to the point.”
I swallowed. “I think your first diagnosis might have been right and we might just be dealing with a very, very sophisticated sociopath. More sophisticated than we knew they could get in the 80’s. There’s obviously also sadistic personality disorder, and he may have some sort of psychological progeria which makes him seem more adult. The oddest thing is his ability to induce delusions in those around him, which is rare, but possible. Alternately, I think you might also want to test if he has some sort of disorder with how he mirrors people’s emotions--”
She put up a hand to stop me. “Wrong,” she said. “I don’t blame you for trying, but still wrong. And to be fair, you couldn’t have gotten the answer right anyway. You haven’t seen the file.”
I quirked an eyebrow. “Didn’t you just make me confess that I had?” I asked.
“What you’ve seen isn’t the full file. I’m not stupid. I know people find a way to game the records system every few years and look at what’s down there. So rather than remove his file intentionally, I just left an incomplete amount of documents in, knowing they’d scare off almost anyone who got access out of curiosity. What you’ve seen is what I wanted you to see. Nothing more.”
I blinked stupidly. “How much more is there?” I asked.
She reached into a drawer in her desk and pulled out another file and two small, rectangular boxes. She waved them in the air briefly, then put them back in her desk.
“Not much more,” she said smoothly. “The remaining documents are just a bit more hands on and technical than what you’ve seen. And then, of course, there are the two audiotapes. Which, speaking of those, that’s how I knew you were lying. Because anytime someone requests those file numbers, our records clerks all know to drop me a note. They don’t know why to do it, but I gather you can figure it out.”
“The only way someone would know the numbers is if they’d seen the file,” I said dejectedly. She nodded smugly.
“Which means that I knew you’d seen it before you even walked in here.”
She leaned back in her chair and gave me another satisfied, piercing look. I wondered if this was how mice felt when being stared down by a cat.
“So,” she said briskly. “Since we’ve established that I am the one in this room who has access to the greater share of knowledge, tell me, aside from assuming we were too stupid to see something just because it wasn’t in the DSM yet, or haven’t considered that he suffers from a cocktail of rare disorders that anyone would’ve ruled out after 20 years…why should I let you get close to a patient who I’ve sealed off from the rest of the staff? And please, assume my reasons are intelligent this time. I know something about being the smartest person in a place like this.”
She jerked her head at the wall, and her Medical School diploma caught my eye. It was from one of the few schools ranked above my own. I swallowed.
“I…” I paused to collect my thoughts. “I suppose it’s pointless just to ask what those reasons actually are?”
“I’m glad you asked,” she said, and, to my surprise, she smiled. “Let’s assume it’s pointless for now, but I credit you for asking a question instead of rushing to try to answer this time. That’s one mark in your favor. However, I’d like to you to try to guess the answer, and if it’s insightful enough, perhaps I’ll tell you.”
I considered. When I next spoke, it was slowly and deliberately.
“Well,” I said, “there’s a couple of things that don’t quite make sense about how he’s treated, and I’m going to assume those are by design, so let me see if I can start there and work my way up.”
She didn’t say anything, but she didn’t stop smiling either. I was either on the right track, or so spectacularly wrong it was funny. Well, no point second guessing myself with no conclusive information. I pressed on.
“Let’s start with the fact that the doctor who brought me to you said that anyone can talk to him if they want to, but nobody actually does,” I said. “And yet, I got dragged up to see you just because I told somebody I wanted to attempt therapy with him. Theoretically, therapy can involve nothing but talking to someone, but if anyone’s allowed to talk to him, then that must mean that you think he needs something other than talk therapy, or at least on top of it. Something that requires hospital resources beyond just a doctor’s time.”
“You’re on the wrong track,” she said, rolling her eyes. Fighting the urge to wince, I started again.
“Alright, so maybe you don’t need more than just talk therapy to treat him,” I said, speaking more slowly this time as I tried to work the puzzle out. “And anyway, you still discourage talking to him so heavily that I’m betting there’s something dangerous about even doing that. But even if he’s fine in small doses, someone randomly talking to a patient doesn’t mean therapy. I can walk up to a catatonic patient and start talking to him, but that doesn’t make him my patient. I’m not responsible for him just because I’ve tried talking to him. But if I formally take him on as a patient, then I’ve got a lot more responsibility both for his treatment, and for making sure it doesn’t go wrong. Maybe his family could sue us if we did something really wrong. On the other hand…”
She was starting to interrupt, which meant that my last four words probably sounded more panicky than they should have, but they had the desired effect. She shut her mouth and continued listening. I exhaled slowly.
“On the other hand,” I continued, “you already think he’s incurable, so I’m guessing other doctors have tried everything they can with him and he hasn’t been removed from your custody yet, so worries about his family being dissatisfied must not be a factor. Which means there’s someone else you’re protecting.”
All at once, a bolt of realization hit me. “There must be! Because there’s a note in his file from the last Chief of Medicine to you saying that even if his family stopped paying, he should be kept here at the hospital’s expense in order to protect the outside world from him. But that still doesn’t explain why you’d be so anxious about preventing doctors from taking him on as a patient. We’re supposed to handle things that most people can’t, after all.”
Words were tumbling out now, and I doubt she could have stopped me if she’d wanted to. But she showed no sign of wanting to. If anything, she looked almost proud.
“Unless the problem is even more dangerous for us,” I went on excitedly, “which isn’t a normal problem to have with a psych patient, but it’s pretty normal if you’re dealing with someone who’s under quarantine for a highly contagious disease. Those people really are kept off-limits except to people who follow the proper procedures to treat them safely because of the increased risk from prolonged exposure. Just being in the same room as an Ebola patient for a few minutes doesn’t guarantee you’ll get infected, but spending hours trying to treat them without proper procedure is practically a death sentence.
“Similarly, judging by the way you’ve set everything up, talking to this patient for a few minutes probably doesn’t put anyone in danger. But I saw what happened to his last nurse. She was exposed to him every night, and ended up committing suicide. Which means you’re worried about us taking him on as a patient because it means prolonged exposure, which we’re more at risk from him driving us to do something like what she did.”
I stopped suddenly, and felt a creeping chill run over me. “Dr. G-----, if there were others who treated him…um…can I ask what happened to them?”
She lifted her hands and clapped slowly.
“Now that’s a question I can answer,” she said softly, and I had to repress a double take. Her voice was no longer sharp, but instead sounded suddenly vulnerable and mournful.
Slowly, she reached into her desk, pulled out the same thick file, opened it, and began to read.
“Dr. A------ obviously did the initial diagnosis, or attempted it, anyway,” she said. “But you probably noticed the four year gap after that. Well, believe it or not, we didn’t leave him completely alone during that time. People did try to treat him. In fact…”
She swallowed hard. “I was the first. As soon as I finished my residency, Dr. A------ sent me to try it, thinking I was smarter than everyone else in this place, and could work it out. And he was right. I was smarter. But that didn’t stop me from trying to swallow a bottle of pills from the nurse’s office just four months into treating Joe. After that, Dr. A------ removed me and placed me on mandatory paid psychological leave so that I could get therapy to recover from the experience. I spent a few more months in a private clinic before returning, and I was never assigned to interact with him again. After me, his next doctor spent a year trying to treat him. That ended when the doctor in question stopped showing up to work. He was found two days later when we filed a missing person’s report. The police discovered him hiding in his house, suffering from what I gather must’ve been the after-effects of a psychotic break. I say ‘I gather’ because the instant they entered his house, he ran at them with a knife and was promptly shot to death.”
She paused, gave me a significant look, and went on. “His next doctor also lasted only six months before she went catatonic and had to be institutionalized here. I would say you might have treated her without knowing it, only she somehow managed to get hold of something sharp and slit her throat with it about a month before you started. In any case, after her, we assigned someone a bit tougher to work on his case. He had a military background and came to us from a hospital for the criminally insane. He lasted eighteen months before he sent us a one sentence resignation letter and put a bullet through his own brain.”
She reached the end of the page and heaved a very deep sigh. “After that, Thomas -- Dr. A------, I mean -- decided to take on the case himself. And to his credit, he actually survived the experience. However, he still refused to attempt further treatment after eight months. And when resigned as Chief of Medicine a few years later, he made sure his severance contract carried a stipulation that every Chief of Medicine after him would sign an agreement promising not to assign anyone to Joe’s case who they don’t personally interview for suitability first. Like all my predecessors, I have complied, and refused to assign Joe a doctor without one of these screenings. Because you’re right. His madness is contagious. I’ve seen it destroy my colleagues, and even the man who mentored and groomed me for the job I hold today. And it almost destroyed me.”
Her eyes met mine, and for a moment, I saw something behind the cold, sharp woman she’d been. I saw a crushed, angry young doctor, who’d thought herself brilliant just as I did, only to watch helplessly as one patient ruined her life, and the lives of those around her.
“What does he do to people, Dr. G-----?” I asked softly. “If his madness is so contagious, I’d like to know what I should be afraid of. Maybe I can guard against it.”
Her eyebrows shot up, and a bitter smile came over her face.
“I’m afraid I can’t answer that, Parker,” she said. “Unfortunately, that’s only a question you can answer, and you’ve earned the right, much as I hate the idea of putting anyone else in danger. But you’ve shown enough brains that maybe you might be able to do something with him. So let me ask you – what do you fear most?”
“Um.” I tried to think, but nothing that came to mind seemed like something I feared most. “I…I don’t know?”
“Sorry, that won’t do,” she said. “If you’re going to attempt therapy with him, you need to know the answer to that question first. It’s your first line of defense. In fact, if you treat him, it’s mine, too, because if I don’t know the answer to that question, I’ll have no idea what might be stalking my ward after your first therapy session with him. Try again. Take your time.”
An acute chill ran up my back. “You mean he can just tell whatever—“
“Just. Answer. The question.”
That was as close to a “yes” to my unspoken question as it could get. So I thought. I thought for several minutes, in complete silence, with Dr. G----- never doing anything to interrupt me. She seemed as fascinated by the answer to come as I was stumped. I thought of all the usual answers, of course – drowning, insects, fire – but one thing kept forcing itself back to my mind: The image of Marty paddling frantically against the stream as it sucked him under. There was only one answer I could give.
“I’m most afraid of not being able to protect the people I care about,” I said, finally. “I’m most afraid of being helpless to save someone.”
Dr. G----- raised her eyebrows with genuine surprise.
“Interesting,” she said. “And just now, is there anyone on my staff who you care about so much it would hurt you if they dropped dead? Don’t bother being polite.”
Feeling chagrined despite her last instruction, I shook my head. She nodded.
“I thought not,” she said. “See that you don’t develop any such attachments anytime soon.”
Without saying anything else, she pulled a blank sheet of paper from her desk, scribbled something on it, signed her name, and handed it to me.
“As of now, you are Joe’s new doctor,” she said. “I will reassign you if you ask me to, on one condition. You must make an appointment with me, and tell me exactly what he did that made you decide you were not fit to continue as his physician, in the most exacting detail you can.”
She reached into her drawer and pulled out the two audiotapes and shoved them into my hands along with the remaining file.
“Oh, and Parker?” she said, meeting my eyes. “Try not to kill yourself first.”
To say that the doctor who’d brought me to see Dr. G----- was surprised when I walked into his office and showed him the piece of paper is a gross understatement. He looked so shocked and horrified that you’d think he’d seen a close relative murdered. Nevertheless, he was as good as his word, and he added Joe to my list of patients with no complaints, other than the customary warning not to let any other duties I had fall behind because of this new case. Then, as soon as he’d finished the paperwork, he gave me a very tired look.
“I’m guessing you don’t need help finding his room?” he asked with more than a little irony.
I shook my head.
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Otis Jiry