When I turned I recognized him immediately. He had that wild cocaine look in his eyes. His fists were clenched. He’s a big guy, and it had taken several mental health technicians to restrain him the last time he was committed to the acute psychiatric unit. He also was HIV positive. In other words, he scared the hell out of me. The last thing I wanted to do was get into a fist fight with him, but I didn’t want to gun him down in the parking lot, either.
My response was automatic. “Hi,” I asked him. “You doing okay, man?”
He looked surprised, unclenched his fists, and said, “Yeah, Doc, I’m okay.” Then he turned and walked away—much to my relief. You just never know.
Cocaine dependency is a real bitch. The drug causes delusions, grandiosity, and paranoia, among other things. Officer Washington had escorted Arnold from his parent’s pool house to my office under special invitation of an Order of Protective Custody. He was an unkempt thirty-three-year-old white cocaine addict who was determined to manipulate his way out of this little inconvenience. Since he was broke, he had resorted to stealing money from his parents and taking anything of value that he could find to hock at a pawnshop. Chief in his mind was the fact that he owed money on the street, and those folks tend to get their money or else.
At any rate, he was telling me that nothing was wrong with him and that his family was plotting against him and that was why he was in the hospital. He was most convincing, since he believed what he was saying. I could tell he felt confident that he was presenting himself and his case quite well. I committed him. But I did give him a word of advice. “The next time you try to convince me how normal you are, don’t put your pants on backwards.” At which point he looked down to realize he had done just that. Then he threatened to sue me for kidnapping him.
He stabilized within a few days and was discharged. He later came by the office to apologize for his behavior and to let me know he had gotten into an outpatient treatment program. I never had to pick him up again.
BEDLAM
The Hospital of St. Mary of Bethlehem, known also as Beth-lem Hospital, was originally established as a sort of general hospital in London in the mid-1200s. It ultimately had its name shortened to Bedlam, at least in the vernacular. A few centuries later, it became a hospital for “lunatics,” and since then the word “bedlam” has been associated with insanity and confusion.
I’ve been to Bedlam—the one in East Baton Rouge Parish. When I go to psychiatric hospitals for commitment evaluations, things usually go smoothly. Usually. Of course the vast majority of these patients are in an acute psychiatric unit. I should stress the “acute” part.
As soon as I was ushered through the locked doors of the acute unit one summer afternoon in 2001, I knew this was not going to be the usual. A rather large male orderly informed me immediately that “elopement precautions” were in effect. That means someone is trying to escape and you better be careful when you open any door to the outside world. I suddenly went on full alert. Be careful here, Cataldie. If you are careless with door security, you may find yourself chasing a psychotic patient through the hallways. I could feel the tension on the unit, and it was bordering on chaos.
The orderly has taken on more the role of a bouncer these days. I was careful as I navigated my way down to the locked nurses’ station. It pays to be vigilant—one M.D. friend of mine ended up with a retinal detachment after a husky male patient cornered and pummeled him. I’ve been hit before. Sometimes you just do not see it coming.
I immediately sought sanctuary in the locked nurses’ station, where I could review the chart on the person I was there to evaluate. The nurses’ station is a safe haven, and it is brightly lit. All eyes—including mine—were on an unkempt female who was screaming through a hole in the glass barrier that encircles this station. Her red wig tilted to one side, the patient was yelling a string of obscenities at the nurse. It was as if we were under siege in a medieval fortress.
The patient, who seemed to be trying to squeeze her head through the small opening in the glass, had some white powder around her nostrils. Her anger was escalating. “You mother-fuckers! I’ll get you! You can’t do this to me!”
The head nurse, the only nurse on the floor with thirteen psychotic patients, mostly street people, seemed unruffled. She turned to me, acknowledged my existence, then went back to the chart before her. Without looking back up, she said in the matter-of-fact tone of an overworked psych nurse: “She’s a schizophrenic . . . refuses to take medication . . . we know her well . . . she’s a frequent flyer. One of her thuggy sons supposedly brought her some cocaine because she promised to tell him where her government check is . . . he supposedly held up his end of the bargain, she didn’t . . . I think he tried to fool her with talc powder . . . she may be crazy but she ain’t stupid . . . you know the drill . . . it’s the usual crap.”
Nurse Overworked turned her attention to the screaming patient. “Listen, please go back to your room or it’s seclusion for you. I don’t have time for this now.” Her tone was firm yet respectful. An iron hand in a velvet glove—very nice work.
This patient, Tomica, grunted another “Fuck you,” then mumbled her way down the hall. She was heading toward the dining area, oblivious to the fact that her wig was leaning perilously to one side, yet remarkably still on her head. She was definitely no stranger to the seclusion room, and the threat of being put there seemed to calm her rage somewhat. Boundaries do help, even primitive ones.
I searched through the chart rack for a flagged chart that would indicate that a person was here against their will. My mandate is to evaluate patients and determine if an involuntary admission was appropriate. If I think the person needs to be here under mental health law criteria, they stay. If not, they are released immediately.
I muttered to myself as I pulled the chart from the rack and stopped at the name. Tomica Johnston. Of course. I should have known.
I glance at Nurse O. Finally, she smiles. This was not a nice smile. It was a misery-loves-company smile. I tried to recover. “I don’t suppose you have two Tomica Johnstons here, do you?” Nurse O.’s smile widened.
I resigned myself to the fact with acknowledgment. “No? I didn’t think so. Is there anyone who can help me talk to her?”
Nurse O. still had that wry smile on her face. She pointed to a young female tech who was evidently serving as hall monitor for the patients. I did not know this young lady, who appeared to be about twenty-five years old. She had probably been through the thirty-hour training course, then thrown into the pit.
As I was sizing her up for the task ahead, she suddenly bolted down the patient corridor at warp speed. “Nurse, nurse, come quick,” she shouted. “Gerald, you stop that, you too old for that.”
Nurse O. shot out to the hall at Mach 1. She definitely came alive when there was an emergency. I was running with her. This particular emergency: sixty-one-year-old Gerald was getting oral sex from a new admission, Alicia. They were doing the deed right there in the dining room. Alicia was on a psychotic manic swing and Gerald was somewhat demented.
The staff broke up the lovers’ encounter. Gerald asked for a cigarette break and smiled. Alicia began shouting that she was going to have his baby.
Chaos is contagious, especially in a psychiatric unit. If psychotic patients perceive you have lost control or don’t know what to do, they become fearful and begin acting out. They are like children in that they rely on you to furnish boundaries, and then they test those boundaries.
Nurse O. was a veteran and she knew boundaries were necessary here. We both did. Alicia was shuffled down the hall and placed in a chair right in front of the nurses’ station. Nurse O. gave Alicia a stern look and commanded: “Stay right there in that chair.”
The young psych tech had taken to chastising both of them. “You should be ashamed of yourself. How people going to trust you around children?” Alicia started to sing, and would continue to do so for several hours, but she stayed in that chair.
N
urse O. returned to the nurses’ station to see if there were any doctor’s orders for medication to be given. There were none. She paged the on-call psychiatrist and waited. Her face was red and she was as flustered as a wet hen.
While Nurse O. fumed and waited for a return call, I elected to visit with Tomica in the hallway. It was a safety issue, hers and mine. I introduced myself and began to assess her understanding of her emergency commitment and the current situation.
She was semi-dressed in a hospital-issue gown. She had abandoned her hospital slippers in favor of her own tennis shoes—sans shoelaces. It is standard practice in acute units to take away shoelaces, which can be used for suicide by hanging. I noted that she had neglected her hygiene; there was a somewhat repugnant odor about the patient.
When she cocked her head sideways, I feared the worst for the red wig, but it stayed there, precariously perched on her head. “I know who you is. I seen you on TV with that dead baby. What you want with me? I ain’t dead.” There was a short pause. “Am I?” Another pause. “Is you the Devil?”
Never enter a psychotic patient’s delusions. When I was a medical student on the third floor of Charity Hospital of New Orleans back in 1972-73, I was assigned a patient in the acute unit. I let him get between me and the door—stupid. Then I began my canned medical-school interview. When I asked him about his current hallucinations, he told me the Devil was talking to him right then. Stupidly, I asked what the Devil was saying. Of course, the Devil was telling this giant to “have sex with you right now.” Interview over! Now how the hell do I get out of here?
“I’m going to tell the nurse to make sure you get double meal portions.” It worked.
With Tomica, I merely assured her I was the coroner, not the Devil, and that I was there because her family was concerned about her health. Of course that was the wrong thing to say, given the recent encounter she’d had with her son.
“They don’t care ’bout me.”
I countered that her momma cared, and she had no rebuttal to that. It is amazing to me how many people will calm down when I say that to them. “Can you get them to give me double portions on my plate? That nurse don’t like me.”
She tends to switch topics easily. I asked her why she thought that about the nurse.
“’Cause the voices tell me. They want me to get that bitch.”
There was little reason to continue. She is a known schizophrenic who is noncompliant with medication. She is experiencing command auditory hallucinations that tell her to hurt the nurse. She is acting out on those commands. I thanked her for her time but she was already distracted. She turned to her right and remarked, as if to her voices: “Shut up, bitch! Hey, Doc, I need a place to live! They gonna help me with that?”
I assured her that everyone was here to help her. She trotted off to the dining room for a snack.
I returned to the nurses’ station. Nurse O. had just convinced another psychotic patient to take his prescribed medication, albeit not without some urging. I looked at her and smiled. It was a smile of understanding between two veterans who have been in this trench before.
“Tomica gets to stay,” I said.
Nurse O. laughed. “Somehow I just knew you were going to say that.”
I changed the topic. “So, how are the lovebirds? Engaged yet? Are we invited?”
“Ha-ha. Not funny.” Her face softened a little and revealed a trace of doubt.
“You know, Doc, I think we’ve been in this business too damn long.” She regrouped and managed a smile. “How about a cup of coffee? It’s even fresh this time.”
That translates into: Hey, I need to hear a friendly voice. And I need to hear it from someone who knows what the hell goes on here. I’m frustrated, overwhelmed, short-staffed, and I’m worried about these patients who are under my care. I need someone I respect to tell me I’m not crazy and that I’m doing the right thing. This sucks and I’m feeling a little on the powerless side right now, but I’ll do my best. I just need a little affirmation from someone who gives a damn . . .
I smile back. I do, but I’m a little pressed for time. I have two more hospitals to go to.
“Sure, cup of coffee sounds good.”
SEVEN
Final Exit
Some specifics of this investigation have been modified for reasons of confidentiality. The names that are fictitious include: Chris L. Cashio, Vernon Gantz, Mrs. Gantz, and Clyde P. Arceneaux. There have been at least two suicides in Baton Rouge that showed similar aspects.
A WAY OUT
I love spring mornings in Baton Rouge. The sky is clear and the temperature is in the seventies. You can smell the azaleas blooming from almost anywhere. I was enjoying this particular morning in 2000 by having coffee and warm French doughnuts outside at Coffee Call. I love a slow cup of hot coffee, the newspaper, and time with DeAnn. We were sitting in the cast-iron chairs on the patio when my cell phone went off. I recognized the number as the office and announced, “Party over!”
Being coroner of East Baton Rouge Parish is a 24/7 job. De understood; she always does.
The office always rings the cell phone first, then home. De is more attuned to the home phone and I to the cell. When it rings I pretty much expect the worst. These things seem to happen in the wee hours of the morning. The end of a drinking spree, fights over who is going home with whom, drunks on the road, hookers getting desperate, abusers at the end of a cocaine run. The robberies are usually shortly after dark—time to hit the mom-and-pop store. At night, after the party—time to get in the car and run down a group of kids who dissed you at the party, thereby killing five of them and becoming a young mass murderer—one of my first cases. But . . . if it has to come, I prefer an early-morning call, which is less disruptive to my family life.
The worst time is family time, in part because it induces so much guilt. “Okay, Michael, this dead person is more important than you—bye now!” I hopped into the Green Hornet and sped to the scene. I wonder if Michael will consider it unusual for a family to go out to dinner in one car when he’s married and has his own family.
As I approached the residence, I noted that there was no press, only one detective unit, and only one marked car. Good sign. The house sat on a corner lot of an established neighborhood. The lawn was uniformly green and well groomed. The neighborhood had been developed in the 1950s, and many of the residents were originals and now senior citizens. It was picturesque and seemed so tranquil.
Detective Chris L. Cashio was waiting in the carport; after the usual amenities, he motioned to the door and in a rather flat tone said, “This is a weird one. I think it’s a suicide. Still—weird.”
The word “weird,” especially when uttered by a seasoned homicide detective, always bothers me and puts me on full alert. Approach with caution, Lou.
As I walked through the kitchen and living area I noted how neat and orderly everything was. Everything was clean and in its place. I followed Cashio’s lead as he motioned for me to go through the hall and into the bedroom.
Vernon F. Gantz, age sixty-seven, was lying on his back on his made up bed. His feet and arms were crossed as if he were taking a nap. A black garbage bag, industrial grade, was under his hips. Another black garbage bag enclosed his head. He was fully clothed and even wore shoes. His shoes were polished. He wore a blue dress shirt and casual black slacks. His body was cold to the touch and had full rigor. EMS was correct: he had been definitely dead for at least twelve hours.
A glance about the room revealed that everything seemed to be neat and orderly. The garbage bag was sealed at his neck with a “twist.” I split the bag open gingerly with my lockblade pocketknife so as to maintain the twist for evidence. Vernon’s face had a calm look, and his eyes were closed. There was no blood apparent and no evidence of trauma. Further examination revealed that the livor distribution—the reddish discoloration of the skin that forms in the dependent areas of the body due to the settling of blood—supported the fact that he had died in bed.
Cashio was still rather flat as he responded, “Not yet. Haven’t really looked that much. Thought I’d wait for you. If this is a suicide, it’s an open-and-shut case. Makes it easy on me. Looks pretty much like that one they had in the northern part of the parish a year or so ago, don’t it?”
I was somewhat surprised that Cashio knew about that. That particular suicide had been handled by the sheriff’s office and this one was under the city police jurisdiction. The departments rarely share information. “Yes,” I said, responding to the detective’s query, then paused, contemplated a moment, and added, “Yes it does, Detective, yes it does. So, let’s have a look-see at his choice of reading material.” I left the bedroom.
Cashio followed and continued: “I wasn’t at Seminole Street, but I heard there is some kind of book on how to kill yourself—kind of a Suicide for Dummies deal.”
I smiled to myself. Homicide detectives certainly have a way with words. But this seemed like an opportunity to “enlighten” the detective, so I did. “The name of the book is Final Exit.” It certainly is a “how-to” book on how to commit suicide. “And I’ll bet you money Gantz had knowledge of it.”
I walked into Mr. Gantz’s well-kept reading room and inventoried the area. Near his small reading table was a publication describing the techniques touted in Final Exit.
Detective Cashio seemed a little disconcerted, and, immediately thinking in the terms of his profession, he asked, “So anybody can buy this damn book you’re talking about? Kids can buy this crap!” Cashio certainly wasn’t detached at this point. Indeed, he had become quite animated. “Say, is there a way to get the guy who wrote this book on assisted suicide?”
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