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You know, I underestimated how hard it would be to write all of this down, though the fact that all of you seem so ready to believe it, and even speculate about what was going on, is somewhat comforting. I have read your comments, and while I can tell you right now that none of you are even close to realizing just how fucked this patient was (and in fairness, you don’t even have the full story yet), it’s nice to see that people will take a story like this seriously. There might be hope, after all.
Anyway, where was I? Oh yeah, Joe’s file, and the fact that it basically went dark for four years.
Well, in 1986, the file started up again. It seemed funding cuts forced the staff to make patients share rooms. As such, there was a note from the new Chief of Medicine, Dr. A------, instructing staff to find roommates who seemed unlikely to trigger whatever Joe’s condition was.
The staff evidently failed at this. The next memo that bore any content was also from Dr. A------, and was addressed to a Dr. G-----, who I knew as the present Chief of Medicine. It ran like this:
Memo dated December 14, 1986 From: Dr. A------ To: Dr. G----- I don’t know whose idea it was to move Philip A---- into Joe M----’s room, but whoever it is, I want them fired. Putting a grown man with such serious anger issues in a room with a boy who’s got such a powerful need to push people’s buttons was obviously not going to have positive results. So now, it seems we have at least one patient whose family might press charges if they ever found out what their son has been through. I take it you’ve heard the stories already about Philip needing to be sedated before he could make good on his promise to “kill the little f--king monster.” I don’t know what this will do to Joe’s condition, but I can’t imagine it’ll be good.
After this first disaster, records indicated that Joe had been paired with someone closer to his age: an eight-year-old boy who’d been admitted for disorganized schizophrenia. This, apparently, had a much worse result.
Memo dated December 16, 1986 From: Dr. A------ To: Dr. G-----
Our insurer will not be happy if we get more incidents like the one with Will A------. The one bit of good news in it, I suppose, is that the autopsy shows no signs of foul play. I suppose Joe’s violent tendencies must’ve been toned down a bit. But even if the autopsy will probably absolve us of any blame, I worry that a good attorney will pick it apart in court. When was the last time an eight-year-old died of heart failure? Check with the nurse and pray we didn’t give Will too strong a dose of something.
Joe’s next roommate was a girl of twelve who’d been admitted with post-traumatic stress disorder from sexual abuse by her father. There was a note next to the new rooming arrangement instructing orderlies and nurses to periodically look in on the two, because the girl apparently had a tendency to become violent at the slightest provocation. As it happened, she was the one who benefitted from this protection.
Memo dated December 18, 1986 From: Dr. A------ To: Dr. G----- Fire every orderly on duty last night. Except the one who caught them at it. I want him put in charge of the ward. You will personally take charge of Nadya I------’s treatment. Only an expert hand will be able to do anything after whatever that brat tried to do to her. And by the way, find out how he learned about that stuff. If the orderlies are talking about that sort of thing around juvenile patients, they need to be fired or reprimanded. Ten-year-olds might develop urges like that early, particularly boys, but it’s not usually urges toward anything that...specific. In the meantime, make sure we put restraints in Joe M----’s room so he can’t do anything like that again.
The last roommate Joe had who was drawn from the general population of mental patients was a teenage meth addict who’d developed severe paranoid personality disorder, probably picked because he would’ve been easily able to overpower Joe if the boy tried to assault him. What’s more, as a further precaution against that sort of assault, the two were placed in a room where they could be permanently restrained to stop them from hurting each other. However, this didn’t go any better.
Memo dated December 20, 1986 From: Dr. A------ To: Dr. G----- Firstly, have someone look into getting us stronger straps for our beds. After what happened last night with Claude Y----, and everything else that’s happened this past week, we’re going to need to assure the public that nothing of the kind will happen again. Also, get the orderlies to go over the room one more time, because I am honestly incredulous at the explanation they’re giving us. I don’t care how paranoid Claude was; there’s nothing in that room that could scare him enough to make him chew through several different leather straps, and throw himself out the window. The straps would be hard enough, even with an average adrenaline rush. But to force open a barred window? There had to be something wrong with the bars, or the bed, or the window.
One way or another, though, I mean to find out what that child is doing to make accidents like this happen. Assign any orderly you want to stay the night with him tomorrow night. Make sure the orderly has anything he needs to defend himself -- tasers, batons, whatever. Treat this as a case of a criminally insane patient, even though we can’t prove much of anything’s happened beyond the Nadya incident. Oh, and get the orderly to take a tape recorder in. If that little bastard so much as breathes, I want it available for analysis.
There was another record indicating where to find the audiotape that apparently resulted from this order. I jotted it down as well. There was one final communication from Dr. A------ on the subject of Joe, and in it, I finally found at least a partial answer for why the staff so despaired of diagnosing this particular patient. But unlike the previous documents, this wasn’t a memo. It was a handwritten note, apparently preserved by Dr. G-----.
Dear Rose,
I just spoke to Frank. I think it’s fair to say he’s not going to be ready for work for at least a month, the state he’s in. And you know what? I’m actually going to let him have that time as paid sick leave, because it’s my fault he’s like that. Can’t punish someone for following your own orders. Mind you, if he’s not better by the time it’s over, we’ll have to keep him here.
I’ve also come to a conclusion: Whatever Joe has, I’m sure we can’t cure it. I don’t even think we can diagnose it. It’s obviously not in the DSM. And given the effect he has on others, I’m starting to doubt if anyone could diagnose him.
You know what? I’m getting ahead of myself. First, let’s talk about what Frank told me. He says that the entire night, Joe just kept whispering to him. That’s it. Just whispering. But it wasn’t a child’s normal voice. Somehow the boy had managed to make his voice go all guttural and hoarse, and he kept trying to remind Frank of things they’d done together -- like he knew him from somewhere.
But the thing is, Rose, the things Joe was trying to remind Frank of? They were all nightmares Frank had as a child. He said it was like the monster in those nightmares had been whispering to him all night, saying how much he missed chasing him, and catching him, and eating him.
It sounded outlandish. How would a boy that young know what a 40-year-old orderly used to dream about? So I listened to the tape. And the thing is, I can’t come to any other conclusion but that he imagined it. I didn’t hear a sound, and the microphone was turned all the way up. What’s more, Joe was restrained all the way on the other side of the room, so if he was making a sound loud enough for Frank to hear it, the mic would’ve picked it up. I don’t think he could’ve disguised it unless he was right up next to Frank’s ear and whispering, which is obviously impossible.
Even weirder is that after a bit, I started to be able to hear Frank breathing very loudly. And his breathing patterns weren’t normal. It sounded like he was hyperventilating. Like he was having a panic attack, in fact. But I listened to it over and over again, and the thing is, there were no other sounds. At all. So I have no idea what Frank’s talking about.
I now know for sure, after this session, and after the one I had with him, that we can’t cure Joe. It’ll take a better doctor than me to figure him out, and good luck finding one who’ll be willing to come work in this shithole. Maybe he’ll die in here. But there’s nothing we can do.
Rose, you’re going to be Chief of Medicine one day. We both know it. We’ve both discussed it at length. I know you’ll be tempted to try to treat him yourself. Please don’t. I don’t want you becoming a nervous wreck, too. Just keep him here at his parents’ expense and feed them whatever story you have to. They’re rich enough to afford a lifetime of care. Even if they somehow go poor, find room in the budget. I couldn’t have it on my conscience if I knew I’d had him in my care and he somehow got out to cause trouble in the real world with whatever he has just because we failed. Promise me, Rose. -Thomas
After this letter, there was only an official document stating that all therapy with “Joe” would be stopped. He would have his own room, but at the price of being kept restrained in it 24 hours a day, seven days a week. Only a select few orderlies would be allowed in to routinely change his sheets, and only the most experienced nurse would be given the task of administering medication to “Joe.” All staff were to be encouraged to stay away from him. He would not be referred to except by the extremely nondescript shortening of his name, so that anyone wanting to find out more information wouldn’t know where to start. It was, in short, everything that I’d observed since arriving at my new workplace.
Even so, if I’d been intrigued before, I was hooked now. Here lay the possibility of discovering a previously undocumented disorder -- not merely a permutation of something already in the DSM, but something new entirely! And I had patient zero under this hospital’s roof. My choice of residency now seemed almost an act of God. There was just one thing to do now: Listen to the audiotapes I’d seen referenced.
I immediately went back to the file clerk and showed him the record numbers for these, expecting to get them fairly quickly. However, to my surprise, after he’d typed in the numbers on his computer, his brow furrowed in confusion and he walked back into the records without a word. Some half an hour later, he returned looking even more confused.
“There’s nothing under those numbers, son,” he said. “Never has been. You sure you wrote them down right?”
I was quite certain I had, and anyway, I couldn’t risk another trip that could alert him to which file I’d been looking at. Besides, if they had ever been there, it would make sense that they might have been destroyed or removed given their connection to the hospital’s biggest problem patient. I faked a tired grin and shook my head at the record keeper.
“Someone’s played a joke on me,” I said. “Sorry for wasting your time, sir.”
I walked out of the records office and snuck discretely out of the hospital. I didn’t want to be seen by someone who might wonder what I was doing there on my day off. Besides, I needed time to think about what the file had said before making any sort of attempt at speaking to its subject.
That Joe had started with some sort of empathy-based disorder was obvious. What was confusing was how extreme it was. His emotional empathy -- that is, the ability to feel what other people were feeling -- was obviously nonexistent, if he’d been making people kill themselves and trying to rape a girl before he even knew what rape was. But his cognitive empathy -- ie, the ability to recognize what others were feeling -- must’ve been unbelievable. Almost superhuman. Not only could he spot another person’s insecurities, but he could predict with perfect accuracy how to exploit them in order to cause maximum distress. It was the kind of skill I’d have expected to see in a trained CIA interrogator, not something spontaneously developed by a young child.
More puzzling still had been his apparent shift in tactics right after his disastrous encounter with his first roommate. Prior to that, the numerous therapy records had all indicated that his preferred approach was to induce feelings of anger or self-hatred in his victims. Yet immediately afterward, as if his modus operandi had changed on a dime, he’d switched to inducing fear so extreme it would trigger a fight or flight response. Why this sudden shift in approach? What had happened to change his symptoms?
And that was assuming it had even been him who’d made those feelings of fear trigger. The fact that the orderly’s encounter with him revealed only radio silence made the puzzle deepen. I went back and looked at the record of the first roommate. The implication was clearly that Joe had been assaulted. Could that assault have made him have a psychotic break and go catatonic? But then, how to explain the obvious sexual assault of the following night?
These were all questions I knew had plagued Joe’s physicians for years, so the prospect of solving them in a single night without so much as talking to him was likely impossible. Still, my mind ran over them again and again long after I’d tried to curl up in bed and fall asleep. Eventually, I drifted off.
This didn’t help. Probably because of the reference to the orderly’s negative experience, one of my childhood nightmares resurfaced that night. I’d glance over it, only it has relevance to what happened later, so I’d better explain.
When I was six, my dog Marty drowned in a nearby river. We’d been out playing fetch nearby, and in one particularly exuberant moment, I threw the stick so far out of sight that I couldn’t see where it had gone. As it happens, it had landed in the river, and there’d been a rainstorm the night before, so the river was particularly turbulent. All of this is to say that when Marty ran to grab the stick, he got swept under by the current, dashed his head on some rocks, and drowned before being fished out a mile or two downstream.
I’d known something was wrong when he didn’t come back with the stick, and my parents tried to protect me from the worst of it. However, when they brought the corpse round to the house, I somehow thought I could bring life back to my childhood pet, so I fought to see the body. I still regard the sight of Marty’s bleeding skull as one of my early childhood traumas, though I’ve since made peace with my own role in his death.
But that wasn’t true at first, which is probably where the nightmare I’m about to describe came in. In the dream, I was standing on the edge of the river with Marty, but it wasn’t just an ordinary river. Instead, it came alive, and started trying to drag me under with long, wave-shaped, tentacle-esque arms. In the dream, I always managed to fight my way back to the shore, but Marty wasn’t so fortunate, and I had to watch as he paddled and struggled with the tentacles strangling the life out of him. I wanted to jump in and try to save him, but as is often the case in dreams, what you want to do and what the dream lets you do are different things. As a child, I would always wake up crying at the moment when his shaggy head vanished beneath the water.
But the night after I found Joe’s file, there was one more detail that jogged me out of sleep, and that was this: as Marty vanished, I could hear the river laughing. It was a throaty, moist, deep noise that sounded like it came from a throat that was in the process of rotting. I think I must have screamed, because the next thing I remember is my fiance shaking me awake and holding me.
Fortunately, the dream didn’t recur that night, and I more or less forgot about it as I returned to the hospital, fully intending to see if there were some way I could get an audience with our mysterious problem patient. However, as I arrived, a new distraction presented itself.
A crowd had assembled around the main hospital entrance, including more than a few people whose cameras and microphones positively identified them as reporters. Immediately curious what was going on, I fought my way through the crowd, only to see a stretcher holding a body bag being loaded into a police van. Now worried, I scanned the crowd for any face I might recognize and spotted an orderly who I’d seen working on the same ward as me. I fought my way over to him and asked what happened.
“Nessie died,” he said, his voice so hollow it sounded as if it came from a million miles away. “They’re saying she threw herself off the roof last night after making her rounds. No one knows why, but one of the patients says she did it after she’d finished...you know, with him.”
Now just as horrified as my counterpart, I reached out and gave him a stiff one-armed hug, as if to reassure him that someone else felt the same thing he did. He didn’t react. Apparently, the shock was still too strong.
Note: The next update will take place on Friday. We're getting closer to the stuff I find really difficult to talk about, so my writing pace is probably going to slow.
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