The Patient

by Jasper DeWitt

  “I’m not joking, Nessie,” I said. “I really—”

  “Yes, you bloody well are joking, and that’s all you should ever be.” Her green eyes were livid now, but I could sense, looking at her, that she wasn’t angry at me. She looked like a bear who’d just pulled her cub out of danger. Gently, I put a hand on her arm.

  “I’m sorry, Nessie. I didn’t mean to scare you.”

  Her eyes softened, but it didn’t make her expression any better. Now she only looked haggard. She placed her hand on mine. “It’s not your fault, lad,” she said, her accent loosening as the fright faded from her features. “But you don’t have any bloody idea what you’re talking about, and it’s best you never find out.”

  “Why?” I asked softly. “What’s wrong with him?”

  Then, knowing she might not answer, I added, “Nessie, you know I’m too smart for my own good. I don’t like puzzles I can’t solve.”

  “That’s not my fault,” she said coldly, her eyes hardening again. “But fine, if it’ll stop you, I’ll tell you why. Because every time I have to bring medicine into . . . his room, I start to wonder if it wouldn’t be worth locking meself up in this ’ospital just to avoid ever ’aving to do it again. I barely sleep from the nightmares I get sometimes. So take my word for it, Parker, if ye’re as smart a lad as ye think ye are, ye’ll stay away from him. Otherwise, ye might end up in here with him. And none of us wants to see tha’.”

  I wish I could say her words weren’t in vain. But in reality, they only made my curiosity burn hotter, though suffice to say, this was the last time I openly discussed my ambition to cure the mystery patient with a member of staff. But now I had an even better reason: if I could cure him, Nessie and everyone else who had to deal with him would lose what sounded like the main source of misery in their lives. I had to find the records on him and see if I could come up with a diagnosis.

  Now, you might be wondering why I didn’t ask my boss about the patient and why I would ultimately resort to subterfuge to find the records. The structure of this hospital was such that I rarely saw the medical director who had hired me, Dr. G——. My day-to-day supervisor was a man named Dr. P——, and unfortunately, I knew after meeting him on my first day that we would butt heads. He was a harassed-looking, barrel-chested bear of a man with a shaved head and a beard so wild that it looked like it could have concealed the corpses of several small animals. His eyes, a pair of bored, piggish slits, emanated sourness so intractable that I doubt even winning the lottery would’ve made him happy. Initially, he verbally harassed me, but I figured out quickly that he was just throwing his weight around to assert his seniority. I later learned that he was profoundly lazy and barely functioned at his job—his approach to all patient care was to drug them ’til they were numb—which left me a tremendous amount of autonomy with my work. Fortunately, the dynamic he wanted was one in which I rarely talked to him, let alone sought his guidance, and no one needed to talk to him about me. As it was, he barely participated in standard team meetings—the near-daily briefings when all hands reviewed patient care plans. I hardly ever even saw him out of his office, where he seemed to hide in a morose funk.

  So, back to my hunt for Joe’s file. In order to get access to the file of a patient who’d been admitted before the year 2000, I’d need to ask the records clerk to retrieve the paper file using the patient’s last name as a reference point. This was because the hospital hadn’t digitized anything beyond patients’ names and dates of admission before the year 2000. Searching by first name or date of admission was theoretically possible, but I was told that unless I wanted the records clerks to kill me, I should avoid asking them to do this.

  Eventually, I hit on a solution opportunistically. I snuck a look at Nessie’s meds-and-duty roster during a rare moment when she left it unguarded. To my immense gratification, this document seemed to be the one place that listed Joe’s full name: Joseph E. M——.

  Hoping to avoid the gossipy weekday records clerk who was always snippy even when I needed to check records for legitimate reasons, I went in on a weekend when Jerry, a barely functional alcoholic, was working in the records room. He let me in, gave me directions on where to go, and slurred at me that I’d better “put the f—king files back” when I was done before slouching back in his chair.

  And then I had it. Joseph E. M—— had been first admitted in 1973 at the age of six, and he was marked as still in hospital custody. The file was so covered in dust that I doubted anyone had opened it in a decade and so thick that it looked like it might burst.

  But the clinical notes were still there, and in surprisingly good condition, along with a crude black-and-white photo of a fair-haired boy giving the camera a wide-eyed, feral stare. The image made me feel unsafe, just looking at it. Averting my eyes, I turned to the notes and started scanning them.

  As I read, I realized that the reports that Joe’s condition was undiagnosed had been misstating the truth. It wasn’t that there was no diagnosis. It was that there had been a couple but Joe’s symptoms seemed to mutate unpredictably. Most surprising of all, however, Joe had actually been discharged at one point, very early in his life in the mental health system, after staying only forty-eight hours in the hospital. Here are the full contents of the physician’s notes at the time:

  June 5, 1973

  Patient Joseph M—— is a six-year-old boy suffering from acute night terrors, including vivid hallucinations of some sort of creature that lives in the walls of his room and which emerges at night to frighten him. Joseph’s parents brought him in after one particularly violent episode in which his arms sustained significant contusions and abrasions. Patient claims it was from the creature’s claws. May indicate a proclivity for self-harm. Prescribed: 50 mg of Trazodone, along with some basic therapy.

  June 6, 1973

  The patient has been cooperative in therapy session. He suffers from acute entomophobia and possible audiovisual hallucinations. He experienced no sleep disturbances last night but explained that this was only because the monster “doesn’t live here.” However, when presented with the theory that the monster was a part of his own psyche, patient was very receptive, which suggests nothing more serious than normal childhood fears. Have suggested to parents that we monitor the patient for an additional 24 hours and possibly start him on a mild course of antipsychotics if we see further evidence of hallucinations. They were receptive.

  I almost laughed. It seemed ridiculous that such a brief set of entries would become the prelude to decades of horror. Nevertheless, I pressed on. The notes indicated that Joe was discharged after the additional twenty-four hours as promised. There was also a reference to an audiotape of Joe’s one therapy session, the number of which I was careful to write down in the notebook I’d brought with me.

  However, the doctor’s optimism after Joe’s first visit had obviously been misplaced, because Joe was back the next day, this time with a much more serious set of disorders. And this time, he was never discharged. The notes from his second admittance follow:

  June 8, 1973

  Patient Joseph M—— is a six-year-old boy previously admitted for night terrors. A course of sedatives and some rudimentary coping techniques were prescribed. Patient’s condition has since changed dramatically. No longer shows signs of previous entomophobia or possible hallucinations. Instead, patient seems to have regressed to a preverbal state.

  Patient additionally shows a high propensity toward violence and sadism. Patient has assaulted numerous members of staff and has had to be restrained. Despite relative youth, patient seems intuitively aware of which parts of the human body are most vulnerable or sensitive to pain. This may even be true on a strictly individual level. Patient kicked one older nurse in the shin, where she had recently had surgery. Nurse had to be removed in a wheelchair.

  Patient is no longer cooperative with therapy. Emits clicking and scratching noises instead of talking and is no longer capable of bipedal movement. He remains violent and ha
d to be restrained and removed after attempting to assault Dr. A——.

  June 9, 1973

  Patient’s condition has changed again. When nurse Ashley N—— told patient that he was “a bad little boy for kicking and punching so much,” patient suddenly became verbal. He proceeded to abuse Ms. N—— verbally, calling her “a long-nosed Christkiller,” a “dumb k—— bitch,” etc. Ms. N—— became acutely distressed and subsequently requested leave, citing traumatic memories triggered by patient’s insults.

  Patient’s targeted physical violence, verbal abuse, and antisocial behavior all suggest a form of antisocial personality disorder normally too sophisticated for someone his age. Specific personal insights on the part of patient not yet explainable.

  June 10, 1973

  Patient’s condition continues to deteriorate. When brought in for a review, patient made no attempt to engage but instead commenced verbally abusing psychiatrist. Referred to psychiatrist as a “f——king worthless drunk,” a “sexless cold fish,” and “bitch boy Tommy,” among others. These insults all correspond to personal attacks previously suffered by psychiatrist at moments of acute mental distress. Asked patient why he chose these insults. Patient refused to answer. Asked patient if anyone had called him anything like this. Patient refused to answer. Asked patient why he chose to verbally assault people this way. Patient said he had to, because he was “a bad little boy.” Asked patient if he could stop being a bad little boy. Patient asked what I thought. I asked patient what he thought. Patient refused to answer. Patient released from therapy. On a personal note, I wish only to comment that one therapy session with this boy made me more tempted to break my 20-year Alcoholics Anonymous pledge than any other experience I have had in that time. Consequently, I am asking that another psychiatrist take over this case.

  No entries on Joe’s treatment followed this one. Apparently, one session had been enough to make the writer give up in disgust. I shook my head. Even an understaffed hospital should put in more effort than this. Indeed, the only item from the same year was a curt note from the medical director ordering staff to keep Joe isolated from the rest of the population. For four years after that, there was nothing.

  March 15, 2008

  Whoa. I seriously didn’t expect my first post to get this much attention. I honestly expected you guys to think I was exaggerating. And, yeah, I know that’s been the response of some (I hear you, DrHouse1982), but the overall positivity of the response so far has truly floored me.

  I also underestimated how hard it would be to write all of this down, though the fact that all of you seem so ready to believe it, and even speculate about what was going on, is somewhat comforting. I have read your comments, and while I can tell you right now that none of you are even close to realizing just how fucked this patient was (you don’t have even half the story yet), it’s nice to see that people will take an account like this seriously. There might be hope after all.

  Anyway, where was I? Oh yeah, Joe’s file, and the fact that it basically went dark for four years.

  The file started up again in 1977. This time, sections of each entry had been redacted, with a note preceding it saying to see Dr. G—— for the unredacted file. It seemed that funding cuts forced the staff to make patients share rooms. As such, there was a note from the new medical director, Dr. A——, instructing staff to find roommates who seemed unlikely to trigger whatever Joe’s condition was.

  The staff evidently failed at this.

  The next memo that bore any content was also from Dr. A——, and was addressed to a Dr. G——, known to me as the medical director. It ran like this:

  December 14, 1977

  I don’t know whose idea it was to move Philip A—— into Joe’s room, but whoever it is, I want them fired. Putting a grown man with such serious anger issues in a room with a boy who’s got such a powerful need to push teople’s buttons was obviously not going to have positive results. So now it seems we have at least one patient whose family might press charges if they ever find out what their son has been through. I take it you’ve heard the stories already about Philip needing to be sedated before he could make good on his promise to “kill the little f—king monster.” I don’t know what this will do to Joe’s condition, but I can’t imagine it’ll be good.

  Apparently, Joe was transferred to a conventional hospital for a broken arm, bruised ribs, a concussion, and a fractured skull. After this first disaster, records indicated that when Joe returned, he was paired with someone closer to his age: an eight-year-old boy who’d been admitted for issues associated with his severe autism. This led to a much worse result.

  December 16, 1977

  Our insurer till not be happy if we get more incidents like the one with Will A——. The one bit of good news, I suppose, is that the autopsy shows no signs of foul play. Joe’s violent tendencies must’ve been toned down a bit. But even if the autopsy will probably absolve us of any blame, I worry that a good attorney will pick it apart in court. When was the last time an eight-year-old died of heart failure? Check with the nurse and pray we didn’t give till too strong a dose of something.

  Joe’s next roommate was a boy of six who’d been admitted with post-traumatic stress disorder resulting from his father’s sexual abuse. There was a note next to the new rooming arrangement instructing orderlies and nurses to periodically look in on the two because the boy had a tendency to become violent. As it happened, he was the one who benefited from this protection.

  December 18, 1977

  Patient Nathan I—— moved into joint room with patient Joseph M——. At 10 p.m., Nathan and Joe are locked in for lights-out. At 1:34 a.m., patient Nathan can be heard sobbing and screaming. At 1:36 a.m., orderly Byron R—— enters room to find Joe on top of Nathan, in the process of sexual assault. Patient Nathan is removed and patient Joe is restrained and placed in solitary confinement. Patient Nathan has sustained bruising, multiple bites, and slight rectal tearing. He was moved to another facility for medical treatment. Patient Joe will be kept in solitary confinement for a week. All staff will be reminded not to discuss sexual matters within earshot of underage patients. Termination of all orderlies except for orderly R—— is strongly suggested.

  The last roommate Joe had who was drawn from the general population of mental patients was a teenage meth addict who’d developed severe paranoid personality disorder, probably picked because he could have easily overpowered Joe if the boy tried to assault him. What’s more, as a further precaution against that sort of assault, the two were placed in a room where they could be permanently restrained, to stop them from hurting each other.

  However, this didn’t turn out any better.

  December 20, 1977

  Firstly, have someone look into getting us stronger straps for our beds. After what happened last night with Claude Y——, and everything else that’s happened this past week, we’re going to need to assure the public that nothing of the kind will happen again. Also, get the orderlies to go over the room one more time, because I am frankly incredulous at the explanation they’re giving us. I don’t care how paranoid Claude was; there’s nothing in that room that could scare him enough to make him chew through multiple leather straps and throw himself out the window. The straps would be hard enough, even with an average adrenaline rush. But to force open a barred window? There had to be something wrong with the bars, or the bed, or the window.

  One way or another, though, I mean to find out what that child is doing to make accidents like this happen. Assign any orderly you want to stay with him tomorrow night. Make sure the orderly has anything he needs to defend himself. Treat this as a case of a criminally insane patient, even though we can’t prove that much of anything’s happened beyond the Nathan incident. Oh, and get the orderly to take a tape recorder in. If that little bastard so much as breathes, I want it available for analysis.

  There was another record indicating where to find the audiotape that resulted from this order. I jotted its number dow
n as well. There was one final communication from Dr. A—— on the subject of Joe, and in it, I finally found at least a partial answer for why the staff so despaired of diagnosing and treating this particular patient. But unlike the previous documents, this wasn’t a memo. It was a handwritten note, apparently preserved by Dr. G——.

  Dear Rose,

  I just spoke to Frank. I think it’s fair to say he’s not going to be ready for work for at least a month, considering the state he’s in. And you know what? I’m actually going to let him have that time as paid sick leave, because it’s my fault he’s like that. Can’t punish someone for following your own orders. Mind you, if he’s not better by the time it’s over, we’ll have to keep him here.

  I’ve also come to a conclusion: Whatever Joe has, I’m sure we can’t cure it. I don’t even think we can diagnose it. It’s obviously not in the DSM. And given the effect he has on others, I’m starting to doubt that anyone could diagnose him.

  You know what? I’m getting ahead of myself. First, let’s talk about what Frank told me. He says that Joe just kept whispering to him the entire night. That’s it. Just whispering. But it wasn’t a child’s normal voice. Somehow the boy managed to make his voice go all guttural and hoarse, and he kept trying to remind Frank of things they’d done together—like he knew him from somewhere.