Deadly Delusions

by Barbara Ebel

  “Not since med school started. Before that, I can’t say because I didn’t spend that much time with him like now.” He frowned and wiggled his finger. “Well, come to think about it, last winter he said something about a major depression because he still hadn’t been accepted to medical school.”

  Annabel sat back and sighed. How would her new patient keep up his current work in gross anatomy or studying? Every day a med student goes without his or her daily work and studying makes it more difficult to catch up and continue. The more she thought about it, the more she realized he may be in scholastic trouble already.

  “Any more questions?” Fred asked.

  “Sure,” Annabel said. “For the rest of my H&P, does he have a past history of medical problems or surgeries?”

  “I don’t think so.”

  “He did mention recent alcohol use,” Joshua said.

  “That’s for sure. What made him do it is anybody’s guess, but he bought a big bottle of licorice liqueur and drinks it every night.”

  “Did his hyperactivity start before the drinking or had he started drinking and then showed all this increased activity?”

  “Definitely he was hyper first because he bought the booze during one of his zippy trips to a mall and liquor store … one of his shopping sprees and late nights.”

  “You have been very helpful,” Joshua said. “A few more things … any family names or numbers you can provide us with?”

  “Sure,” he said. He gave Joshua his mother’s name and number from his cell phone and said, “What about school?”

  “Our attending, Dr. Keeton, will take care of it. The way I see it, she has to first decide if he needs to be detained … which I think is a no-brainer … and how we’ll accomplish that. I believe she will need to talk to the school’s medical faculty chairman. We’ll take care of everything. We’ll call you or you come see him so we can all exchange information. Why don’t you go in for a few minutes and visit him? We’ll go back in once you’re finished.”

  “Thanks,” Fred said. He shook both their hands. “Please take good care of him.” He strutted off to Noah’s room.

  “I’m sorry to see a fellow student in this predicament,” Annabel said.

  “Me, too,” Joshua agreed.

  “And Dr. Washington,” Annabel said, “before it gets too late to ask, may I leave early for an important doctor’s appointment? It’s another follow-up since I had a little bit of surgery. If everything is okay, I shouldn’t need to go again during this rotation.”

  Joshua studied her face. “No problem. Do you have enough time to give Noah Goodman a mini-mental status exam for your H&P?”

  “Yes, I believe so.”

  “Good. After that, feel free to leave. As the days unfold and lab work comes back, we’ll have a better understanding of Mr. Goodman.”

  “Thank you,” she said.

  Joshua grabbed an empty chart and began writing his own notes in the quiet seclusion of the same corner. Annabel waited at the side of the main desk for Fred to come out. She wondered about Bob and Dr. Keeton and the patient they were seeing.

  Another examining room door opened; Bob came out and scurried to the desk. “How’s it going in there?” Annabel asked.

  “Phew,” he said. “I never knew depression could be this damaging. This man’s wife brought him in because he’s talking about killing himself. She caught him digging into every bathroom and kitchen drawer looking for old pain meds. He wanted to pile up a stash of narcotics and take them tonight as the last thing before bed. That way when he overdosed and died, she would think they both just went to sleep.”

  “How horrid.”

  “Hey, are you okay? Did you mention your appointment?”

  “Yes. Dr. Washington is wonderful. No problem. I’m going to do a mini-mental status exam and then I’m headed over to dermatology. I’ll see you tomorrow.”

  “Okay. Have a good night.” Bob plucked order sheets out of a bin for Dr. Keeton and scurried back to the room.

  -----

  Back inside, Bob resumed his spot near the door and handed Dr. Keeton the empty sheets. His new patient sat on the examining table with his wife in a chair right beside it. The couple were in their early forties; Susan Wells sat forward with alertness and concern. Her husband, Eugene, wore circles under his eyes and a despondent mood played across his face. The shoelaces of one sneaker dangled untied and the waistband of his trousers seemed loose.

  “As I was saying,” Mrs. Wells said, “Eugene lost his job about six months ago. He had a lucrative job as an assistant manager with an auto manufacturing company outside of Cincinnati and the plant shut down and went to Mexico. However, we saw it coming and he had a tentative other job lined up, but that fell through at the last minute. Fortunately, I own a shop which does well enough to support us while he’s looking. But, really, he’s been lazy with his job search for some time and there are no options on the table. He’s been moping around more and more. Doesn’t sleep, doesn’t eat like he should, and won’t help me out.”

  “That’s difficult for you,” Selina said and turned to the husband. “Mr. Wells, on a scale of one to ten, how depressed are you feeling?”

  His joyless eyes stared at her. “If she brought me in here because I was about to swallow a handful of pills to simulate death,” he said ever so slowly, “then I qualify as a maxed-out miserable scale of ten.”

  “Tell me more about that.”

  “There’s no point. There’s no point to anything. I am worthless. I worked that job for twelve years and my boss and I were in charge of a whole union crew. Then my father died a month ago. Salt of the earth he was. Now there’s nothing left for me. Even if there was something to do, I possess zero energy.”

  Bob waited on Eugene’s every word. His slow speech seemed to be a result of a decreased ability to concentrate or slowed thinking. He’d never seen or heard someone so gloomy. How could anyone end up this heartbroken to not want to wake up to a new sunrise? He found the situation deplorable and he wanted to help this man like his mentor, Dr. Keeton.

  “I’m sorry to hear about your father,” Selina said. “Those are two big losses in one year. Are you losing weight?”

  Eugene looked at his wife. “Yes,” she said. “I don’t know how much, but he’s thinning down. His cheekbones are more prominent. Even when I buy him his favorite ice cream, he barely puts a scoop in a bowl.”

  Selina recrossed her legs at her ankles. “Mr. Wells, besides the pills that you thought about ingesting, are you taking any prescription drugs or over-the-counter medications?”

  He shrugged.

  “He has no medical problems,” Susan said, “so he’s not on a thing. He doesn’t even take the vitamins I buy.”

  “What about alcohol or drugs?”

  “I used to have a social drink or two but not for a long time,” he said. “And street drugs are out of the questions. Not interested.”

  “Okay, good,” Selina said. She kept an even tone and then asked him in a non-judgmental manner: “Do you ever hear voices in your head?”

  “No. I’m not crazy if that’s what you’re thinking.”

  “That’s a routine question. The answer is important because the student doctor here and I are going to be like your ambassadors on the road to help you feel like your old self again.”

  He frowned and picked his head up a little. “But it doesn’t matter because without a job, what kind of man am I? No, there’s no point.”

  A perverse quiet fell after his words. Bob wondered what Selina would say or do next. She was such a wizard in this field, he wondered if all psychiatrists were like her. Day by day she carried a heavy burden on her shoulders whereas he was just a bystander for four weeks. Years of doing this must not be easy.

  “There is a point. Someday you’ll reflect back on this day and be extremely happy that you didn’t take those pills. You will have little grandchildren. Some night you will cuddle with one of them while reading to him or her b
efore bedtime. You don’t want to miss that opportunity.”

  Eugene frowned. One leg made a little twitch. He looked at Susan and she gave him a half smile.

  “You are going to let me admit you voluntarily, aren’t you?” Selina asked.

  He nodded reluctantly.

  “Good. Dr. Palmer and I will both talk to you some more, either before or after your admission. I am ordering some tests to make sure there are no medical issues going on which we don’t know about. All indications make me believe you are suffering from a major depression. She leaned forward, assuring him with her warm eyes that he was in good hands.

  “We will put you on an excellent anti-depression drug if needed,” she continued. “In addition, during your hospitalization and then as an outpatient, you will be in therapy. These methods have withstood the test of time.”

  She looked over at Susan. “May I speak to you outside for a moment?”

  “Sure,” Susan said.

  “Dr. Palmer,” Selina added, “please finish working with Mr. Wells so you can complete your H&P.”

  “Sure thing,” Bob said.

  Dr. Keeton and Susan walked out of the room.

  “We will be admitting your husband across the way,” Dr. Keeton said, “in the hospital’s psychiatry ward. He will be placed under suicide precautions.”

  “This is a relief,” Susan said. “Thank you. A burden is already lifting from my shoulders.”

  “If you’re sticking around for after his transfer, why don’t you go grab a late lunch or early dinner in the cafeteria? It will take some time for his labs to be drawn, orders processed, and for him to settle across the way. Unless you want to come back later?”

  Susan hoisted her bag’s shoulder strap and thought about it. “I’ll make better use of my time to run out and do an errand or two, grab a bite to eat, and then come back. I’ve been carrying the household work load and I need two of me to get things done. Will you tell him then? I’ll check on him in the hospital later.”

  “I’ll be happy to.”

  Susan stepped away but turned back. “And Dr. Keeton, thank you so much.”

  -----

  Bob asked Mr. Wells more questions and learned his clean bill of previous health also included no surgeries. He used to attend a neighborhood gym for cycling on a stationary bike and using a treadmill, but he stopped with the onset of his depression.

  Bob went forward with a mental status exam; a snapshot of Eugene’s thinking at the moment may be so different than what he thought during the weeks prior to his admission. He already had a history of suicidal ideation but what would the thought content of a mental status exam reveal?

  “Can you spell the word ‘dime’ forward and backward?” Bob asked him, evaluating his attention.

  “E-m,” Eugene said and stopped.

  “Can you serially subtract sevens from one-hundred?” Bob asked.

  Eugene stammered. “Ninety-three.” Again, he stopped, confirming Bob’s suspicions that his concentration was terrible.

  “Can you tell me the president of the United States?”

  Eugene answered correctly with little delay.

  “Good,” Bob said. “And what if you found a lost dog at your house with a collar on and an I.D. tag?”

  Eugene shrugged. “Maybe give it some water.”

  After more evaluation of his cognition and sensorium, Bob went back to his risk for suicide. “I know what happened before you came in today, Mr. Wells, but how are you feeling now? You had a plan early today but do you have a plan now to carry out suicidal thoughts?”

  “No,” Eugene said, his mouth barely moving.

  “So you don’t feel suicidal?”

  “I don’t know. Too many questions.”

  Bob finished by doing an actual physical exam on Mr. Wells. His lungs and heart sounded fine. He had all the information needed for a thorough H&P and when he went outside, he read over the chart and wrote down the patient’s vital signs from his admission. Selina sat across from him, writing her orders.

  “What do you think, Dr. Palmer?” she asked.

  “Major depression.”

  “Yes. He seems straightforward but we still do the necessary work-up. Are there any psychotic features to his depression?”

  “No.”

  “Correct. Voices aren’t whirling around his head like Annabel’s patient, Mr. Blake.” She scooted her chair back a bit and crossed her legs. “You will probably get to work with him for a good deal of your rotation. Relieving his depression enough for him to go home will take some time and, for now, he’ll be under suicide precautions.”

  “It’s an experience for me. Now I understand how debilitating depression can be.”

  “Yes. Someday he’ll be a different person again and wear a smile. Now, finish up your H&P. Someone is coming to escort him over.”

  Bob took pride in his H&P. He wrote it out thoroughly and included every necessary part of the report. His assessment and plan were already determined because of help from Selina but he did need a thorough discussion with her about anti-depressants. He had some knowledge about them but he would study tonight and learn the different classes.

  When Selina finished, she left for a cup of coffee, and then returned to find Bob still there. “If you’re finished, perhaps you can take Mr. Wells and his chart out to the atrium. The orderly should be here any minute. I need to go discuss Dr. Washington’s and Dr. Tilson’s patient with them.

  “Sure thing,” Bob said. He placed his H&P in the binder, snapped it shut, and went into Mr. Wells’ room.

  “Looks like they’ve been in to take your blood,” Bob said with a smile. “The worst part is over. Come with me. We’re going to the entrance where someone will be escorting you over to the hospital. Your wife is coming back later, too.”

  As if his hips were distressed and his back hurt, Eugene pried himself off the table and stepped on the floor. Bob walked slowly a little bit ahead of him. They passed the desk and, at the door, Bob opened it for the both of them. Several steps later, they stood at the reception desk.

  No one was yet at the desk to bring Mr. Wells across the way. The security officer stood leaning against the counter talking with the receptionist.

  Bob slapped the palm of his hand against his forehead. “I forgot your chart,” he said to Eugene. “I’ll be right back.” He nodded at the atrium guard and retraced his steps through the door.

  Eugene Wells stood drooping like a sad willow tree, his head bent down. To his left, the uniformed man resumed talking to the lady. On the right side of the man’s belt, the guard wore a holster with a firearm. That’s what I need, Eugene thought. With a slight turn, he pulled the gun straight out, pointed it at his head, and pulled the trigger.

  Chapter 9

  Bob picked up Eugene Wells’ brown binder from the emergency services counter, turned around, and retraced his steps. His hand gripped the door knob to the atrium at the same time his whole body startled by a booming sound. The deafening noise rattled the windows on either side of the room and the chart fell out of his hands. Gunfire? No, that’s impossible, he thought; but it couldn’t be a truck’s backfire either. They were too enclosed inside a thick-walled building to hear something so far from the street.

  He picked up the binder from the floor. As a sense of doom hit him square in the gut, he flung the door wide open to a horrific scene beside the reception desk. Mr. Wells was spread on the floor with a gaping hole in his head. Brain tissue, scalp parts, and blood littered the area around him and the counter.

  The receptionist, in a rolling chair, had pushed herself flush against the back wall with her hands over her lower face. Bob and the security guard locked their eyes on each other for a second in disbelief and shock.

  “Oh my God!” Dr. Keeton exclaimed, now standing with Dr. Washington beside Bob. She stepped over a portion of Eugene’s body and the mess and fumbled for his carotid artery. “Call EMS,” she shouted, “as well as the officers. Neither group can be
that far away.”

  After looking at the secretary still immobilized with fear, the security officer stepped behind the desk and called. Bob took one step backwards and leaned over the counter, sliding the chart across. When he faced the horror again and watched his two superiors take charge, his hands shook and his nerves tingled up his back and shoulders. Only now did he see the gun. He put two and two together where it came from. This is my fault, he concluded.

  Bob had no idea what to do but to stay out of the way. He looked down and realized he’d leaned against the reception desk so now his shirt wore smeared brain matter. His feelings became difficult to control as his lips trembled and he fought to hold back crying. Eugene Wells – in their care to stop such a thing – was now dead solely because of him. He was stupid, so stupid, to leave without the man’s chart and then leave him unattended when he was officially under suicide precautions.

  His nightmarish thoughts intensified as he saw EMS men plunge through the door from the hospital and police sirens grow louder. Besides the loss of Mr. Wells, what kind of trouble would he be in? How could a student do anything worse than what he just did?

  -----

  The atrium jammed up when Banks and Lowe and the same two paramedics returned. Dustin Lowe secured the area outside by running a yellow strip across the front to disallow anyone from entering.

  The paramedics knelt down into the meat of the grizzly incident. Their work pace slowed after determining that Eugene Wells had thoroughly completed his mission. Meanwhile everyone heard Officer Banks questioning of the guard; the poor man as well as the receptionist were not accustomed to physical gore of any type so the officer walked him behind the desk. Even though he witnessed what happened, he didn’t need to keep staring at it.

  “It happened really fast,” the security guard said. “One minute that guy came out from the back with the student doctor. I was standing at the counter, the student walked away, and the next thing I know is that man pulled my gun outta here and shot himself.” He put his hand on his empty holster.

  Edgar Banks signaled to his partner. Bob thought they must have some kind of unspoken communication because Lowe took him by the elbow and escorted him behind the desk also.