Worse still, the whole affair cast Nessie’s suicide in an entirely new light: That kindly old woman must’ve known what was going on. How could she not, having been Joe’s nurse since he was a child? He was probably the closest thing to a son she’d had, and yet there she was, being asked to torture him with medication, captivity, and gaslighting for more than three decades. It was no surprise that she didn’t want anyone else working on him; she must have thought she was the only one who would even think of being kind to him. And maybe Dr. G—— and Dr. P—— let her go on doing it because they thought she couldn’t tear herself away from the hospital that had been her home for so long. But it appeared to have been too much even for her, and she’d killed herself out of guilt. Which explained why she tried to warn everyone, even people she trusted, away from Joe so they wouldn’t have to suffer the same guilt.
And all because one cruel woman had been simply too arrogant and too ambitious to handle being given a dud case for her first assignment.
Even so, on some level, I felt relieved. This was a horror story all right, but at least it seemed like it probably had a human monster. And if Dr. G—— was the monster I suspected, then I vowed that by the time this was over, I was going to put a stake through her heart.
March 27, 2008
All right, if you all have read this far, you don’t need me to treat you with kid gloves and summarize where we are. You know we left off with me having my first session with a supposedly incurable patient, only to discover that he might actually be sane. Let’s move on, and quickly.
Going back to the hospital the next day was, as you might expect, a fairly tense experience. Now that I was beginning to suspect that I would have to openly defy the medical director herself at my first real job after so many years of training, much of what had been routine suddenly seemed sinister. I studied the behavior of the various therapists in our morning-team patient care meeting. I reconsidered every new prescription I had thought to write, wondering if I was going to be scapegoated for any negative reactions. I watched the nurses rotating through their duties.
Once I started looking for patterns, it became excruciatingly obvious that I was being followed by two orderlies, the titans of the hospital. One, Marvin, was a baldheaded, pale behemoth at least six feet five inches tall whose hospital uniform stretched across his expansive chest and his tattoo-sleeved arms. The other, Hank, was a dreadlocked black colossus who was almost as vast as Marvin was tall and looked like he could squat twice his weight without breaking a sweat. They would’ve been noticeable even to an unobservant person, but to me, their constant lurking presence screamed malevolence. Not that they were obvious in their reconnaissance. No, they had enough wits to appear to be working whenever I spied them, whether it was checking a patient’s chart or carrying mountains of supplies into the closets. In the beginning, it was only disquieting, but over the following days, I found myself deeply unsettled. Dr. G—— had appeared positive about my taking on Joe, so putting me under surveillance seemed contrary and left me suspicious of her.
OK, so back to my treatment for Joe. Psychodynamic therapy, or talk therapy, as we often call it, usually involves one to two visits per week. At this point, I was concerned about getting a head start with him and covering a lot of background quickly. With my heavier workload, I had a lot to balance, but as I was coming off my residency—everyone knows doctors are sleep-deprived and overworked in those early years—I was up to handling it. All of which is to say, I was right back in his room for another session the day after I listened to those tapes.
I found Joe lounging on his bed, a half-finished game of solitaire in front of him. I have to admit, I was relieved to see this. If he was as sane as he claimed, it would have been cruel even for the most unethical doctors not to give him some form of entertainment.
He was looking at me with the same crooked grin he’d worn the previous day. “Hey there, doc,” he said. “Nice seeing you again. I guess I didn’t scare you off the first time after all.”
I gave him a polite smile. “Hello, Joe.”
Joe pulled himself into a cross-legged position on his bed and pointed to a folding chair in the corner. “Well, don’t stand on my account. Sit down.”
I pulled the chair into the center of the room, facing Joe, and made myself comfortable. “So, I read your full file last night.”
“Oh yeah?” He raised his eyebrows. “And? How much of a dangerous nutcase do they say I am?”
“I think you know the answer to that, Joe.”
His expression darkened. “Yeah, I do. The question is, do you believe it?”
“I don’t know what to believe. I can tell your previous doctors weren’t exactly paragons of medical efficacy, but there’s much that just doesn’t make sense.”
“Oh yeah? Well, I’ve got all day, doc,” Joe said quietly, before reaching down and shifting a few cards from pile to pile. “Why don’t you ask away?”
“OK,” I said. “Say you’re telling the truth. Say you are being kept here just so the hospital can keep billing your parents. Your parents really wouldn’t care if they knew that?”
Joe snorted. “Of course they wouldn’t. My parents are very rich and only cared about me when I made them look good by being the perfect little boy. Once they figured out I wasn’t like them, they probably thought locking me away here was worth it just to keep the neighbors from talking.”
“What makes you so sure?” I asked. “Isn’t it possible they just don’t know you’re being kept as a revenue stream for the hospital? That they believe you really need help?”
Joe’s laugh was harsh. “Don’t be an idiot. They wouldn’t care either way.”
“What makes you say that?”
Joe, who was in the middle of shifting cards between piles again, stopped and glared up at me. His voice was level, and yet every syllable was pregnant with hurt. “If my parents gave a shit about me, why haven’t they visited me?”
I kept my expression bland, so as not to antagonize him or seem to be taking the bait. “Everyone’s encouraged to stay away from you, Joe, even the doctors. It’s not a stretch to think they might believe the same things we’re told.”
“It’s not like I’m asking for them to waltz in with a knitted sweater every Christmas. But who said they couldn’t at least come to look in through the window in my door once in nearly thirty fucking years? Or check to see who’s treating me? None of the doctors I’ve had in this hellhole have ever mentioned them asking about me. I’ve asked the few people who come in here, orderlies and whatnot, directly, and they’ve all said no one from the outside comes looking for me. Face it, doc, they left me here to rot. They don’t care where I am, so long as it’s not with them.”
I must not have looked sufficiently convinced or else I’d touched a nerve, because his frustration gathered energy. “Let me tell you a story, doc, and you’ll see what heartless shitheels my parents are.
“When I was five, just a year before they decided to get rid of me, I met a stray cat out in the woods on my family’s estate. But she wasn’t like just any stray cat. She was friendly and tame and would let me pet her and even hold her. I called her Fiberwood Flower, or Fiber for short, because my dad had made his fortune in textiles, so I used to hear him use the phrase ‘fiberwood.’ And she was pretty, so calling her a flower seemed appropriate. I was a kid, y’know, so just mixing words together seemed fine. Well, eventually, she stopped hiding in the woods and started coming onto my family’s estate to visit me. I’d leave out scraps for her, from food I didn’t eat, and we sort of got close. That is, until my parents found out.”
His fist clenched. “My dad was allergic to cats. And as soon as he knew I’d been sneaking one onto the estate, he was furious. I tried to tell them I’d be good and wouldn’t let her upset him, and that she was a nice cat, and my friend, but my dad didn’t care. He marched right out of the house over to where Fiber was sitting. Well, she was used to people being friendly, so of course she didn
’t run. I wish she had, though. Because when he got to her, he picked her up and dropkicked her into the fucking woods before telling me if I ever got near her again, he’d do the same to me. Then he took a switch to me before he locked me in my room. I never saw her again.” He paused, looking down at the cards. Then he raised his head and gazed at me. “Oh, and you are probably wondering where my mother was while I was screaming and crying in the garden having my naked back whipped.”
He paused. Whatever his hesitation, he seemed uncomfortable with what he was about to share.
“My mother was telling my dad to stop because, she said, ‘the neighbors might hear.’ And my dad rounded on her. ‘The neighbors will talk? Joseph snuck a cat onto our property, Martha. A fucking cat. You know what I get like around them. You want me to die, Martha? You want me to fucking die just so the neighbors won’t talk?’ Then he hit her in the face so hard she fell over. She never stood up to him again after that. And even though the beating I got was bad, seeing her with her eye swollen and black-and-blue for the next week or so was worse. Every time I think about why I’m here, I remember her walking around with her eye like that. I think she blamed me, and frankly, I kinda blame myself for being so stupid. I still dream of her glaring at me through that black eye, and sometimes when I wake up, I think my being here is punishment for putting my mom through that. I know, it’s a dumb thing to think, but when you’re a kid desperate to be loved, you’ll believe anything is your fault if it’ll make your parents love you again. Too bad that’s impossible for me.”
It was a stomach-churning story. I kept my eyes level with his and said, “I believe you.”
And Joe’s expression altered startlingly; he looked up at me with a smile that radiated relief.
April 3, 2008
So don’t take this the wrong way, but I’ve never seen so many comments that both call me stupid and beg me for more information in the same place. Mixed signals, eh? Nah, I get it. This story is pretty damn cinematic, and I guess your comments about my judgment just reflect how much you’re into the story. You sound like a horror film audience yelling at the babysitter not to go down into the basement! Well, too bad, what’s done is done. Here’s what happened next.
The sympathy I felt for Joe after hearing his heart-wrenching story stayed with me long after I exited his room on that fateful second day of our interactions. In fact, it permanently affected how I related to my job. Where once I had seen my decision to work at CSA as merely an abstract attempt to save patients who were considered disposable, as my mother once had been, now my decision to stay became acutely personal. Joe needed me, either to prove he was sane, as I now thought was almost certainly the case, or to root out whatever traces of latent insanity had lodged themselves in the brain of this lonely, abused pariah. Yes, even the most kind-hearted doctor has a duty to treat the utterances of mental patients with some degree of skepticism, but the sheer clarity and emotional honesty in Joe’s description of the incident with Fiberwood Flower, the cat, suggested that it was either a very, very well-constructed delusion—which didn’t preclude it from bearing some tenuous connection to reality—or a genuine memory. Either way, I saw it as a signpost that might help me begin to plumb the depths of Joe’s mind.
Moreover, the story gave me a game plan for the month that I would spend evaluating Joe and determining whether or not I believed his story. Even if I couldn’t treat him for the fantastic disorders attributed to him in his file, he had other issues I could address. He was obviously suffering from depression, for example, and with good reason, and the abuse from his parents, not to mention whatever else had happened, had clearly made it difficult for him to trust people.
This obviously necessitated going back to look at his file, albeit with a more skeptical eye. While most of it now seemed to be a fabrication, I did notice a couple of details that whoever had written the reports hadn’t bothered to disguise. Perhaps most important was the fact that Joe had been committed by his guardians, which meant that, theoretically, since he was well over eighteen now, he should have been able to check himself out. I resolved to broach this at the next meeting we had.
Big mistake.
“Why not just walk out?” I asked as Joe and I played cards in his room during our second week of sessions. “If your parents really don’t care where you are, why not leave? You are considered a voluntary committal, and now you are legally an adult. You can leave against medical advice.”
“Did you even read my file?” he asked softly. The temperature in the room suddenly felt arctic.
“Yes. All of it. Why—”
“Then why are you asking me a question you know the answer to?”
“I . . . I’m not,” I said slowly. “Joe, if there’s something keeping you here, I don’t know anything about it.”
He sighed deeply. “I’ve been trying to leave since I turned eighteen. But who’d let me out if they saw what was in my file? Used to be they’d send in a new doctor every couple of years just to keep the trick going, and when the doctors got too scared, they started making shit up. Fuck. Gum, please.”
I had taken to carrying gum with me, since I expected he would want some when we met. I pulled out a stick and watched him furiously munch on it. Seeming a bit pacified, he went on.
“I almost thought I might get out back when Nessie was giving me my meds every night.”
I stared. “Nessie?” I asked, my mouth dry. “What did Nessie have to do with it?”
The look he gave me was laced with pity.
“So you knew Nessie,” he said sorrowfully. “Well, then tell me something, doc. Does Nessie seem the type to be a good jailer?”
I didn’t have to think about it. I shook my head. He smiled mournfully.
“Well, you’re right. She wasn’t,” he said. “She knew what they were doing, and it was killing her inside. At the same time, even I knew they couldn’t fire her, and she didn’t want to leave. It’s only because she was so attached to this place that I couldn’t get her to agree to spill the beans. That is, until the last night I saw her. You know, the one when she ‘committed suicide’?”
“You don’t mean to say . . .”
“That they killed her over it? No, I don’t,” he said. “Because I couldn’t prove it even if I did mean to say it. All the same, if I had any illusions about getting out, they died right before you showed up.”
The psychiatrist part of my brain screamed at me that this must be a product of Joe’s isolation, which might well have made him paranoid, even delusional about the prospect of escape. If it had been any other patient, that’s exactly what I would have told myself and not lost any sleep over it. But this case was already so strange that this explanation seemed almost laughably insufficient. Joe seemed so lucid about everything else that it was very difficult to imagine a delusion like this being buried beneath that facade. Besides, if it was a delusion, how to explain Nessie’s death? I’d seen her very shortly before her death. She had appeared tired, and unsure of herself, yes, but that was a long way from suicidal ideation. And anyway, on the off chance that Joe wasn’t paranoid, this would go well beyond the realm of medical malpractice, and into serious criminal conspiracy. I was frightened of what might happen if I tried to interfere, but I was even more determined that I wouldn’t be an accomplice. My time treating Joe had made me care about his well-being just as much as I would care about any other patient’s, if not more so.
All the same, it seemed utterly hopeless to think that I could do anything without breaking the law. If I went to the authorities—the police or the medical board—I’d probably end up committed myself for claiming that a thirty-year-long history of mental illness was the product of such an elaborate conspiracy, and all on the word of a mental patient with a terrifying list of injured, suicidal, or dead patients and staff in his file. If I resigned in protest, it’d just leave Joe at the mercy of someone with fewer scruples than I. And I knew with absolute certainty that under no circumstances would I becom
e a willing participant in this contemptibly inhuman treatment of a patient. I had gone into medicine to stop that sort of thing. I could, of course, go on treating Joe as I would a normal patient, try to be as kind to him as I suspected Nessie had been, and generally do my best to make his continued captivity as pleasant as possible. But even that kind of passive participation galled me. How many people had rationalized complicity in the cruel treatment of other “problem” patients, patients like my mother, thanks to the lure of a paycheck and an unwillingness to rock the boat?
The whole situation felt wrong, and my options had gone from bad to worse.
There was only one thing for it. I’d have to find a way to break him out in secret. If the attempt failed, I told myself, I had to hope the worst they would do is fire me. Sure, I could be banned from practicing medicine again if they pressed charges, but if Dr. G—— was vindictive enough to try that, at least I could take a stab at trying to expose the whole thing before she got her way, seeing as I wouldn’t have anything else to lose. And yes, I know what you are thinking, considering what had happened with Nessie. It was possible they could do worse, but surely I could find a way to protect myself?
The Patient Page 7
