"That's really disappointing. I was hoping we could get some official help with all this."
"It doesn't appear to be on the horizon. I'm afraid we're stuck with Custer and Simes now that Sam's on the disabled list."
"Don't worry;" she said. "Sam Purdy plays hurt, and we have Sawyer. Don't forget Sawyer. I think she's resourceful. Oh, I almost forgot, she said she remembered the name of the guy who used to play chess all the time, and she thinks she may know how to find him."
"Chester," I said. "We used to call him Chester."
SEVENTEEN
Sawyer may have remembered Chester's name. What I recalled most clearly about him was that he needed a shower and a CARE package that included a gift set of Right Guard and a tube of Crest.
Chester arrived on the unit during the last few days of a glorious October, although the weather was cool and clear, his reality was suffering a sleet storm of manic delusions, the primary delusion that was driving Chester had to do with God's impending visit to a cemetery east of Denver, the cemetery, out near what once was Lowry Air Force Base, is an immense forested place called Fairmount. Chester was determined that it was his duty to free God from a terrestrial prison where He was confined inside one of the graves in the cemetery. Toward that end. Chester had spent the last few days prior to admission wandering the graveyard, examining headstones, looking for signs that would tell him in which particular grave God was trapped. Somehow. Chester came to the conclusion that God would be lurking beneath the headstone of a dead person whose surname contained the name of a chess piece.
At night, Chester intended to dig up the graves of the prime candidates whom he'd identified during his daily strolls, he would do this systematically until he managed to free God from his earthly confinement. Over the course of his two-night quest Chester uncovered the mortal remains of one Samantha King, one Beverly Knight, and one man named Theodore Rook who had died in ‘937 and whose loved ones had thought it fit to grace his headstone with a limerick of dubious taste.
Chester dug up no pawns.
The cops corralled Chester near dawn on the second night of his odyssey as he was meticulously clearing the sod from above Sylvester Bishop's boxed remains, the authorities brought him— Chester, not Sylvester— to the psych ER at the medical school, the admitting doc downstairs in the ER was a psychiatry resident named Sheldon Salgado, after a brief workup. Dr. Salgado assigned Chester a tentative bipolar diagnosis and told the charge nurse on Eight East that he suspected that her new admission had slept for no more than a few hours over the course of the entire last week.
The doc taking admissions on the Orange Team that night was Dr. Sawyer Sackett, after doing her own intake workup, and consulting with Susan Oliphant in rounds the next day. Sawyer introduced Chester to lithium carbonata and Haldol, after his psychosis began to abate in response to the medications, she introduced him to me.
Sawyer and I were well into our strange little romance by the time Chester was admitted to Eight East on Halloween weekend in ‘982. In the months since I'd met her. I'd expected our relationship to evolve along some predictable line into a semblance of a boyfriend-girlfriend thing or to disintegrate along some equally predictable path into oblivion.
It had done neither.
What it had done was prove the law of physics about every action causing an equal and opposite reaction. Each time I edged closer to Sawyer— asking her for one too many dates, encouraging her to choose me over work, wanting to spend a night together and actually seeing what she looked like in the morning— her work became more pressing, or her fears about our relationship being discovered suffered some acute swelling, and she would quickly move beyond arm's length until I took the requisite step back.
One night she kissed me good night and shooed me out the back door of her little Tudor to send me on my way home after an evening of sex that I thought had been particularly inspirational. Together we had spent two long hours discovering some sensual oasis that I was certain no human had ever visited before.
That's how naive I was.
To my back, as I retreated down the concrete steps into her yard, she murmured. "Don't become another of my obligations, Alan. Please."
Her tone had been soft and still freckled with the hoarseness of sex, but when I turned to see what expression was on her face, all I saw was the transient glint of kitchen light off her golden hair as the door met the jamb and the lock clicked shut. Through the gauze curtains I watched her turn away; enjoying one last glimpse of the curve of her breasts and the elegant profile of her neck.
I walked home slowly, trying to savor the afterglow of our lovemaking, trying to make it last, along the way; I decided that Sawyer's parting words to me had been plea, not warning.
In those days I was much more adept at fathoming the depths of others' psyches than I was at plumbing the reaches of my own. By the time I had stripped off my clothes and settled naked into my double bed. I had succeeded in reassuring myself that Sawyer had been pleading with me, she had not been pushing me away.
She was asking for my patience.
Before I slept. I didn't get very far in beginning to understand the genesis of her concerns.
And I didn't spend anywhere near enough time trying to read the tea leaves of their consequences.
And by ten o'clock the next morning, the psychology I was most fascinated by wasn't Sawyer's. Or my own.
It was that of this new patient of hers, whom we'd nicknamed Chester, she'd asked me to do a psychological testing battery on him.
Psychological testing has never been one of my clinical passions. In skilled, inspired hands, the results of the process can be a fascinating glimpse into shadowed recesses of the psyche. Properly interpreted, the insight gained about the patient can be both practical and clinically useful. But the administration, the process of testing, is always— always— tedious. Over the course of my graduate school years, at least three professors had spent hours of class time trying to convince me otherwise, but the reality is that formal psychological testing is a time-consuming, mind-numbing task that I would gladly leave to my colleagues.
That Monday near noon, Chester and I sat across from each other, a laminated table between us, in a small room in the occupational therapy center on one end of the inpatient unit. I tried to engage him in an initial interview. How had he ended up here? What was he feeling? What did he think about being on the unit? What were his goals during his stay? What about family? Friends?
Chester wasn't biting.
His answers demonstrated a limited repertoire that consisted primarily of wrinkled brows, shrugs, and an occasional "I'm afraid that I'm not interested in that particular subject." Already; I was getting the impression that the projective parts of this test battery, which require active participation from the patient, were going to be accomplished with record brevity. I took solace in that.
Earlier that morning at rounds, the staff had reported that Chester had spent most of his weekend huddled over a chessboard in the dayroom. So I asked, "I understand you enjoy chess?"
His eyes widened and he opened his mouth and exhaled. His breath wafted my way. It was so fetid I had to compose myself not to react, he said. "I do." with exaggerated gravity, as though he were stating a marital vow.
"Are you good?"
"Nineteen eighty-seven,” he said.
His response constituted either a loose association, a bad answer on a mental status exam question about what year it was, or some numerical fact about his chess skill that I was too ignorant to interpret.
Since his mental status had shown him oriented by three during a morning nursing assessment, I guessed either B or C.
To camouflage my ignorance, almost always a mistake with patients, and to keep him talking. I said. "Nineteen eighty-seven. Huh."
He shook his head and snorted through his nose, he scratched his scalp with his left hand and examined his fingernails to see what interesting residue had accumulated beneath them, he flicked a couple
of specimens onto the tabletop before saying. "You don't know what that means, do you, asshole?"
I sat back on my chair. I'd been on the inpatient unit for— what?— almost three months. In internship weeks, which accumulate like dog years, that made me a veteran, actually, it left me only a couple of months shy of being an expert. I didn't have to put up with this grief from a patient. I said, "I'm getting the impression that you might be having some difficulty with our roles."
"Which means what?"
"That your hostility might reflect the reality that you don't like the fact that you're the patient and I'm the doctor."
"Or perhaps my hostility reflects the fact that I'm being asked to genuflect before a knave."
"We have a lot of work to accomplish together. Do you think we can accomplish this task with some degrea of civility? I'm doing my best not to insult you. I expect the same from you."
"Is it so hard? Not insulting me?"
"That's not what I meant."
"Oh, I see. It's only what you said."
I took a deep breath. "I didn't schedule this time to argue with you. If we're unable to proceed now, we'll reschedule and do this another time. Is that what you prefer?"
"That seems to increase the probability of my spending additional time in this no-star hotel. If you simply admit you don't have a fucking clue about the game of kings, I'll be civil."
"Okay. I don't know what nineteen eighty-seven means. Does it refer to chess, or your chess skill?"
"Let's not talk about chess, the subject interests me only when the person I'm conversing with is fluent in the language."
By then. I was set up to administer the WAIS-R, the Revised version of Wechsler Adult Intelligence Scale, the most widely used IQ test of the time. I said, "As you wish. Why don't we talk about something more neutral, then? For instance," I said, and proceeded to dictate the precise wording of the first question of the Information subtest of the WAIS-R.
He replied with an equally precise answer that earned him a full score. I was surprised that he deigned to answer at all.
I tried the next question on my list, again, he answered, again, he answered correctly with a brevity and clarity that hinted at genius.
He stayed with me through that subtest and on to the next. I didn't know much about Chester, but I learned quickly that he thoroughly enjoyed the challenge of outwitting not only me but also the constructors of the test.
Forty-five minutes later. I knew Chester's intelligence quotient. Chester was the smartest person I had ever tested.
The projective tests that I would administer after the WAIS-R, the Rorschach and the TAT or Thematic Apperception Test, require a test subject who is willing to be verbally engaged, even effusive, at the very minimum, responsive, that did not describe Chester's demeanor that morning, we breezed through both tests in less than an hour, he was so guarded that I believed the results would be next to useless, but he did seem to take some pleasure frustrating me, that, too, was, of course, grist for the mill. I had higher hopes for the MMPI, which he would self-administer under nursing supervision over the course of the next day or two.
After the testing session was complete. I ran into Sawyer in the nursing station. I said. "Your patient is kind of bright."
"Really? I suspected that. How bright is he?"
"Sawyer, the man's IQ is one seventy-seven. I've never tested anyone whose IQ came close to that."
I let the number hang in the air between us, an IQ of one hundred was "average." One-fifty was usually considered "genius." One seventy-seven was stratospheric.
"Wow,” she said, smiling. "This will be odd. Treating someone who's almost as smart as me."
I wished I knew if she was kidding.
As the Halloween holiday gave way to the beginning of November I saw little of Chester, with an on-board blood level of lithium growing sufficient to provide a buffer against the tides of his mania, he became a quiet man who kept to himself in the unit dayroom. Each day, he would choose a chair and table by the window, set up a chessboard, and work out solutions to chess problems that he created for his own amusement. Usually he refused offers to play a game. Occasionally, though, a sadistic streak would surface and he would accept a challenge from another patient or a staff member, he would beat them in no time at all, and would be certain to demoralize them in the process and taunt them at the conclusion of the game.
In therapy groups he remained sullen and condescending. His edgy demeanor was directed not only at the professional staff, but also at any other patients who stepped in his path.
Chester stayed cool with Sawyer, his psychiatrist, she told me once that their therapy sessions felt more like fencing, however, than chess. Chester didn't attach himself to anyone else on the staff, either. Even difficult patients often identify one ally among the staff. Usually they choose a nurse or a mental health assistant. Not Chester, he never chose a confidant.
On day six of his admission, the second of his two permitted seventy-two-hour mental health holds expired, and Sawyer, in consultation with the ward chief, Susan Oliphant, decided that Chester's current mental condition, although certainly not stellar, didn't warrant certification, after the second hold expires, certification is the required next legal step to hold someone against his or her will for continued treatment. Since certification involves a longer period of loss of freedom— ninety days— it is more cumbersome legally than a seventy-two-hour hold. Certifications, therefore, are used infrequently, and one would not be applied to Chester.
Chester decided to check himself off the unit and out of the hospital as soon as Sawyer notified him that his hold had expired, although Sawyer made a valiant attempt to persuade Chester to stay in the hospital voluntarily; he wouldn't budge, he seemed to soften a little as she spoke with him and actually went through the motions of accepting a referral for outpatient follow-up with his local mental health center. Ultimately, though, his discharge was AMA— against medical advice.
We talked about him briefly at rounds the next day. None of the professional staff expected that he would take any of his prescribed lithium post-discharge, we all thought that someone on our unit or at the inpatient unit at Denver General across town would see his face again soon. How soon would he be back? There was no telling, the next time his bipolar disease cycled into mania could be next week, or next year.
I don't imagine I'd thought about Chester more than once or twice since that day after he was discharged.
EIGHTEEN
Lauren asked. "Is he a good candidate? The chess player?"
I wondered about her choice of words. "Candidate." not "suspect." I said I wasn't sure about how good a candidate he really was, but I told her what I could remember about him.
"There's not much there,” she acknowledged, "other than the fact that he's smart enough and methodical enough to pull it off."
I didn't disagree with her assessment. Smart enough and methodical enough carried a lot of weight, though. "He was a bitter, resentful man. But there were quite a few of them on the unit back then. I just don't remember any of us pissing him off enough that he'd want to kill all of us."
She pulled a pillow from the other end of the sofa and hugged it to her abdomen. "From a psychological point of view, if he was doing it, killing everybody, when would he be committing the murders? Would he do it when he was sane, or when he was crazy?"
"You know, it's a good question. Given the nature of these crimes. I would say it would have to be when he's sane, the delusions he was suffering during his manic phase are too unpredictable for the kind of long-term planning necessary to carry out these murders, and violence of this kind— actually of any kind— is certainly not typical of bipolar disease. For all we know, his illness may be well controlled on lithium and he may cycle into mania infrequently; giving him plenty of time to develop his strategy and plan his next murder."
"And you don't recall anyone humiliating him, or embarrassing him? Nothing like that?"
I shook
my head and simultaneously shrugged my shoulders. "Sawyer probably remembers more than I do, she spent a lot of time with him during that week. When you talked with her on the phone, did she say what his name was?"
"No." Lauren said, "she didn't." She stood and stretched and kissed me on top of the head before she added. "This doctor in the ER, the one who admitted Chester that first night, what was his name? Maybe he knows something. Have you thought of talking with him?"
I hadn't. "His name is Sheldon Salgado, he's still in town— actually he's on the faculty at the medical school, he's a pretty big deal these days in biological psychiatry-It's a good idea, sweetie. I'll call him."
But at first I couldn't bring myself to call him. Now that Lauren's suggestion had placed Sheldon Salgado on my radar. I was afraid I would learn that he, too, was already dead, that Chester or D.B., or somebody else, had covered all the bases ahead of me and knocked him off.
Sheldon Salgado was a mensch, a star at Harvard Medical School, he could’ve gone anywhere he wanted for his residency in psychiatry. But his wife, a pediatrician in training, matched at Colorado. Never considering the prestige factor, he followed her here.
I hadn't known him well during our training. Our paths had crossed on a few rotations, that was it. What did I remember about him? Sheldon was thin as a whisper, stood an inch or so under six feet tall, and had great taste in ties. Long before the rest of the psychiatric community converted, he was preaching the doctrine that psychobiology was the key to the etiology of mental illness and pharmacology was the key to treatment, although the residency rumor mill pegged him as an average or below-average psychotherapist, even as a resident he was renowned as an astonishing interviewer. His diagnostic skills shined particularly brightly in the ER. When I was an intern, he was in the third year of his residency: and he had been appointed chief resident on the Emergency Psychiatric Service.
At the end of the year, after his training was complete, he took a teaching and research position at the school. His diagnostic acumen kept his referral practice booming with requests for second opinions and medication consultations. Over the years I'd sent at least a half-dozen of my own patients his way seeking advice on whether they might be responsive to pharmacological intervention.
Manner of Death Page 16
