by Ray Garton
“This is a bad day for a walk-in, Barb,” Teresa said, nodding at the group in the waiting room. “We’re full up and Dr. Reasoner has fallen behind schedule.”
“I can wait,” she said hopefully. Her eyebrows curved upward in the middle and wrinkled her forehead, and she looked on the verge of tears. Her hands fidgeted and her nails clacked on the countertop as she said, “Really, honey, I’m serious, I need to see him, I’m not feelin’ so good. I’m really not feelin’ good.”
“Is this an emergency? Maybe you should go to the ER.”
“Oh, no, they don’t know me there, not like Dr. Reasoner does.” Jitter, fidget, jerk—she looked like she had ants crawling under her skin.
“I know what you mean, but if you need attention—what’s wrong, Barb?”
“Well, I-I... I’m not sure, really, I’m just feeling... I don’t know, but I... it’s hard to describe because... well, I can’t think. I just can’t think straight.”
“Are you in pain? Are you feeling nauseated?”
“It’s nothing like that, it’s just a... a... a feeling.”
Teresa held in a groan. “A feeling?”
The door opened and Karen walked in with two white takeout bags. She crossed the waiting room and went through the door into the back.
Barb said, “I’m thinkin’ maybe it’s got something to do with my meds.”
“Which meds?” Teresa asked.
Karen came around behind the desk and set down the bags. “Lunch is served,” she said.
When she caught a whiff of the delicious aroma coming from the bags, Teresa’s stomach made a loud, unpleasant sound of hunger.
Barb took a deep breath and let it out explosively as she shifted her weight from foot to foot. She said, “My antidepressant. I had to stop taking it.” Her hands became more fidgety and made louder clicking sounds against the countertop.
“Does Dr. Myerson know you stopped?”
Karen spread napkins on the desk and took burritos and tacos out of the bags.
“She’s on vacation. I couldn’t get the pill no more. Nobody’d refill my prescription, they all said there was no more Paaxone.”
That rang a bell in Teresa’s mind. “You’re taking Paaxone?” she said. Everett had been complaining about the recent unavailability of the drug. He had a number of patients who were taking it.
Barb nodded with a jerky motion. “I took my last one a couple of days ago. Now I’m feeling... well, I just feel like... “ She sucked her lips between her teeth and bowed her head as tears tumbled down her cheeks. “I don’t know how to explain it,” she whispered. “It’s like... like... my thoughts hurt.”
Teresa wasn’t sure why, but she found that description very disturbing.
Karen placed a burrito in front of Teresa. Normally they went into the back to eat lunch, but someone had to stay at the front desk.
The Billy Joel song was followed by a couple of commercials.
Teresa said, “Look, Barb, maybe you should go to the ER. Would you like me to call an ambulance?”
She shook her head frantically, eyes tightly closed for a moment. “No, no, no, really, I need to see him, I need to see Dr. Reasoner.” She wiped the tears from her eyes and took a deep breath, tried to pull herself together. But she did not stop moving and fidgeting.
As Teresa sighed, the phone chirped. She looked down to see one of the lights on the console blinking. It was one of the secondary lines. “Just a second, Barb,” she said. She picked up. “Dr. Reasoner’s office.”
“Teresa? Falczek here.” He sounded tense and hoarse. “Is he available?”
“Well, he’s with a patient right now. Hold on just a second, Falczek.” She put him on hold, replaced the receiver, and looked up at Barb. “Tell you what, Barb. Take a seat and I’ll see what I can do. Do you feel well enough to wait a little bit?”
Barb’s hands fluttered and her mouth opened and closed a few times before she said, “Okay, yes, I-I can, I can do that, yes.”
Teresa watched as Barb crossed the waiting room unsteadily and went to the only empty chair. She sat down next to Mrs. Pardo and put the big straw bag in her lap. She wondered if Barb was drinking again. She watched as Barb fidgeted and shifted in her chair. She muttered to herself, then shook her head and released a loud, fluttering sigh. Then she opened her bag, stuffed a hand in and began rummaging around.
“Avalon” by Roxy Music began to play on the radio.
Teresa picked up the receiver again, hit a button on the console, and said, “Okay, Falczek.”
“Teresa, this is an emergency.”
He did not sound very well. “Are you all right?”
“I’ve been better. Seriously, this is important.”
“Just a second, Falczek.” She turned away from the receiver and looked over her shoulder at Karen. “Can you see if he’s available? Falczek says it’s an emergency.”
“Will do,” Karen said. “I’ve got to set up the next patient, anyway.” She went around the small counter to the left of the reception desk and down the hall.
As Teresa turned back to the phone, she glanced across the waiting room. Barb was hunched forward in her chair. She’d put her bag on the floor between her feet and was rummaging through it with both hands now, muttering with a quiet urgency, when she suddenly pulled something out and sat up straight.
“Falczek? Karen’s checking on him. Is everything okay?”
He sighed. “To be honest, no, everything is not okay. I just got back from Washington, D.C.”
“What were you doing there?”
Before Falczek could answer, the quiet music playing in the waiting room was interrupted by a series of staccato screams: “Ah! Ah! Ah! Ah!”
Teresa’s head jerked up reflexively. Barb was standing in front of her chair now and had turned toward Mrs. Pardo, her right arm extended stiffly and moving in an up and down motion. She held something in her hand and was striking Mrs. Pardo with it. The glow of the overhead fluorescent light was reflected in flashes on the blade of the large knife Barb clutched in her fist. Spatters of red splashed onto the pale yellow wall as Mrs. Pardo’s arms flew up protectively and she continued to cry out, “Ah! Ah! Ah! Ah!”
Then a woman in the room screamed.
“What’s that?” Falczek said. “What’s going on there?”
The phone fell from Teresa’s hand and clattered onto the desktop as more screams erupted in the room and an explosion of movement broke out among the patients waiting to be called.
The haunting voice of Brian Ferry continued to sing over the speakers as more of Mrs. Pardo’s blood slapped onto the wall.
4.
“You need to just slow down, okay?” Roger said. “And stop pacing, Eli. You’re making me nervous.”
But Eli did not stop pacing. He couldn’t. He felt like he’d been plugged into an enormous generator and energy was coursing through him, building up inside him with no outlet.
When he’d seen Eli at the door earlier, Roger had said, “Jesus, you look like you fell out of the back end of a sick horse. Have you eaten? I was about to fix some lunch.” Now they were in the spacious kitchen and Roger was making sandwiches at the counter while Eli paced behind him. “So, tell me more about these people you called.”
“They all said the same thing,” Eli said. “Paaxone became unavailable, the people taking it couldn’t get it anymore, and within about 48 hours, they snapped and did something terrible. They hurt or killed people, sometimes themselves, sometimes both.”
Roger went to the refrigerator and removed a large glass jar of pickles, put it on the counter with a heavy thunk, then turned to Eli and frowned. His head turned back and forth as he followed Eli’s course from one end of the kitchen to the other.
“But why did you call them in the first place?” Roger said. “I don’t understand why you woke up this morning and started calling total strangers. Isn’t that a little crazy?”
“It was something Everett said to me over lunch t
he other day,” Eli said. “He said he’d stopped prescribing antidepressants because of the side effects they can cause. Sometimes they make people behave violently, he said. And then he said, ‘Sometimes these side effects are caused by taking the drugs, sometimes by stopping them and creating severe withdrawal symptoms.’” He stopped pacing and turned to face Roger. “At the time, it kind of set off a little alarm somewhere in my head, but then the waitress came with our food and I got distracted. It kept coming back, though. Like when I heard the story about that guy who shot his wife and sons just the other night. When I heard he was being treated for mental problems, that little alarm went off in my head again. And the guy who attacked that woman and her little boy on Third Street Monday—it happened right in front of me. When I heard he’d been taking an antidepressant, that alarm went off again. And it kept going off. I began to understand that there was some kind of connection.”
Roger dipped his head forward and waved his hands around for a moment, saying, “Wait a second, hold it, hold it.” He leaned back against the counter, rested his hands on the edge, and looked at Eli. “Think about this, Eli. These are people who are struggling with mental illness. They’re being treated for it with medication and probably therapy. They have sudden violent outbursts. It seems to me the obvious cause here is the mental illness that’s being treated, not the drug treating it.”
Eli nodded, rapidly first, almost desperately, then he slowed it down, thinking, Don’t sound crazy, don’t sound crazy. “That’s what I thought at first, too,” he said. “But these people I’m telling you about—none of them had a history of violence. They suffered from things like depression and anxiety, some emotional problems, but they never exhibited violent behavior before. They started getting treatment, and some of them improved a little. But as soon as Paaxone disappeared from the market, they snapped.” He started pacing again, still feeling that build-up of energy inside, as if he were about to disappear in a white-hot explosion. “They went crazy. Attacked people, shot people, killed themselves. Behavior that was totally uncharacteristic, that they’d never exhibited before.”
“Still, Eli, what you’re suggesting is pretty—”
”I don’t have all the information yet,” Eli said, rubbing the back of his neck as he paced, “but I’m telling you, Roger, there’s something to this. Maybe I should... yeah, I should probably talk to Everett. He should know about this.”
“Look, Eli, why don’t you just try to relax for now and we’ll eat,” Roger said, turning back to the counter.
“Goddammit, Roger, don’t you get it?” Eli shouted as he stopped pacing and faced his friend with fists clenched at his sides.
Roger turned back to him with a flinch.
“I’m next,” Eli said.
Roger’s face became serious and his eyes narrowed slightly. “You’re serious about this, aren’t you?” he said quietly.
“You think?”
“Um, look... I know you don’t drink, but maybe this would be a good time to break that rule. Just a little. You really need to relax. How about just a few sips of whiskey? Or rum? I’ve got some good rum.”
Eli wondered if the trembling sensation he felt was visible to Roger. It moved through him in a wave, as if his very bones were shivering. “I’m not safe, Roger.”
Roger forced a smile and a chuckle. “Sure you are, Eli. You’re fine, nothing’s going to happen to you here, you just need to—”
”Dammit, will you listen to me?” Eli shouted as he grabbed the front of Roger’s shirt in his fists and pulled him close. He spoke through clenched teeth as he said, “I mean I’m not safe for others. I mean Chloe’s not safe. Hell, Roger, you’re not safe!”
Roger’s eyes widened in fear, and Eli thought, Ah, good, now I’m getting through to him. But on the very tail of that thought came: He’ll think you’re crazy, you don’t want him to think you’re crazy, he needs to take you seriously. Eli let go of Roger’s shirt and backed up two steps.
“Last night,” he said, “I... when I went to bed, I... it’s hard to describe, I had this feeling like... like everything around me was bad. Everything. I felt awful, Roger, really awful, and I just had this feeling, this certainty that I felt awful because of my environment, and when I went into the bedroom and saw Chloe sleeping, I thought it was her, I thought she was making me feel so bad, and I wanted to... I wanted to... Jesus Christ.” He spoke the last two words in a thick breath and turned away from Roger. He looked down at the floor, put a hand to each side of his head, and pressed hard, as if trying to hold his skull together. Each thought he had seemed to jitter through his brain like an electrical charge. It was an irritating sensation, almost painful. “I’m not safe, Roger,” he said. “I’m not safe to be around. I have to go away. Away from Chloe and you and... everybody. And I need some way to... stop myself. If necessary.”
Eli heard Roger gulp behind him, a loud, wet sound. Finally, Roger said, “I think you should see a doctor, Eli. Why don’t I take you to Everett’s office? Right now. Okay?”
“I... I should call Everett. I’m afraid to go see him. And I... I’m not sure why.”
“There’s nothing to be afraid of, Eli. You might feel afraid, but I’m not going to let anything bad happen, really. You need to see Everett. I’ll take you. Right now.”
Eli dropped his hands as he turned to Roger. “Can I borrow your gun?”
Roger pulled his head back with a jolt, as if Eli had taken a swing at him, and his mouth dropped open. “Whuh-what?”
“Your gun. You still have that .45, right? The one you keep in your closet?”
Roger laughed abruptly but his face showed no humor. “If you think I’m giving you a fucking gun, Eli, you’re nuts.”
“I have to go away, Roger, but I need some way to stop myself. If I need to, I mean. If I get really bad, if I’m tempted to... do something... well, I need to be able to... stop myself.”
Roger stared at him open-mouthed for a long moment, then held up his hands, palms out. “Okay, that’s it. No more of this talk.” He turned to the sink and washed his hands under the faucet. “We’re going to see Everett.”
“Do you still keep it in your closet?” Eli asked. “The gun?”
“Forget the fucking gun!” Roger snapped as he grabbed a dishtowel from a hook on the wall over the counter and began to dry his hands.
Eli did not give it any thought—suddenly, thinking was just too difficult. He knew only that he needed the gun. He stepped forward, lifted the heavy pickle jar off the counter, and raised it up over his head. Roger was still talking, saying something about getting in the car right now because he was taking Eli to see Everett. Before he finished drying his hands, Eli brought the jar down hard.
The pickles sloshed as the jar made a cracking sound against the back of Roger’s skull.
Roger’s legs collapsed beneath him and he made a grunting sound as he dropped heavily to his knees, clutching at the edge of the counter. He released a long, pained groan as he let go of the counter and slid down to the floor. He turned his head and looked up at Eli with heavy-lidded eyes. He tried to get up as he said something too garbled to make out.
He’s going to try to stop me, Eli thought. He doesn’t want me to get the gun.
Eli brought the jar down again.
Roger fell limp to the floor and did not move. Blood glistened in the hair on the back of his head.
“I’m sorry, Roger,” he said as he put the pickle jar back on the counter. “But I really need that gun.”
Eli left the kitchen, hoping Roger still kept the gun and ammunition in the same box in his closet.
5.
“Your blood glucose is too high, Chuck,” Everett said. “It’s 118, which means you’re pre-diabetic.”
Charles Douglas sat in the molded plastic chair facing Everett. He was a fifty-six-year-old carpenter who had been forced into early retirement three years ago by a back injury caused by falling off of a roof. During those three years, he’d become s
edentary, gained 65 pounds, and his light smoking habit had become a heavy one.
Everett sat on his wheeled stool with Chuck’s chart open before him. He lifted his eyes from the lab results and looked at his patient.
“This needs to be treated right away,” he said. “The treatment I strongly recommend to all my patients with this condition is not the most popular, but it’s by far the best and most effective. If you lose weight and stop smoking, the blood sugar will come down. Exercise will make a huge difference. It doesn’t have to be a whole lot, either. If you can just do something that will elevate your heart rate above—”
”Can’t you just give me a pill?” Chuck said with a shrug.
Everett sighed. It never fails, he thought. “Can’t you just give me a pill?” was one of the most frequently asked questions in his office. “I could do that, yes,” he said. “That’s certainly the most popular treatment, the one everyone asks for first. Not only for this particular condition but for most conditions. We’ve become extremely reliant on prescription drugs for everything, even things for which drugs are inappropriate. But a pill to lower your blood sugar will come with problems. Most drugs that bring down your blood sugar can make you gain weight, or at least make it more difficult to lose weight. Losing weight will definitely bring down the blood glucose level and make you healthier overall, but the pill could make you put on weight even as it brings down your blood sugar, and then you’ll become dependant on the pill. And there are other possible side effects that—”
A shrill scream cut through the usual quiet of the office so loudly that Everett jerked with a start and spun around on the stool to face the door. The first scream was followed by another, and another, and somewhere in the mix were loud, throaty cries of pain.
“‘Scuse me,” Everett said as he dove for the door. He stepped out of the room and turned right to see Karen standing frozen in the hall. She seemed to be in mid-stride, as if she’d been on her way to the exam room. “What’s going on?” Everett asked as he rushed by her.
The screams grew louder and more frantic. Someone cried, “Call 911!” while someone else shrieked, “No! No! My baby! No!”
