After Hours (18 page)

“So.” Dr. Morris opened a folder on his desk, tapping the stack of forms with a pen.
“Patient is thirty-two, long history of violence, multiple convictions. Drunk and
disorderly, assault and battery, breaking and entering . . . Every unsavory ampersand
combo you could want. Latest and most credible diagnosis lands him on the psychotic
end of the schizoaffective rainbow, with some major and long-lasting mixed and manic
episodes. Multiple voluntary drug treatment programs—for cocaine mainly, plus alcohol,
and a botanical garden’s worth of cannabis, which never plays nice on that spectrum.
Oh and meth, one conviction.”

I shivered at
meth
. The closest thing the human race currently had to a zombie plague.

His gaze zigzagged down the page. “Five voluntary programs, to be precise, and exactly
zero completed. Not a finisher, shall we say. History of violence with treatment facility
staff.” Dr. Morris smiled wanly at me like,
Oh goody! Lucky us.
“Bit of a pharma cocktail, both prescribed and recreational. Though his outbursts
seem to have lessened greatly since he’s been treated as a schizoaffective case.”

“That’s good.”

“He was interviewed during an emergency hold following an assault, and the doc there
wants him with us, instead of prison. Patient doesn’t relish either option, but who
would?”

A knock came at the door behind me and Dr. Morris boomed, “Come in.” I swiveled as
a gangly young African American guy in a white coat entered the room. He smiled at
me and adjusted his glasses, and pulled over a second chair.

“Erin Coffey, this is Darius Flowers, my talented new victim from CMED. Coffey and
Flowers,” he mused. “Charming. Darius, Erin’s one of our newer LPNs, with an eye on
earning her BSN. She’ll be sitting in as well.”

We shook.

He rewound the spiel and briefed Darius about the incoming patient. We both nodded
like babies watching a yo-yo, and I caught myself thinking,
I could’ve been a med student.
I was studious, and had managed strong grades even with all the drama I’d had going
on through my certification, plus I had a pretty high tolerance for blood. All I was
lacking was the huge wad of cash, and the nuts to cut the cord with my sister. I wouldn’t
hold my breath.

“I think that’s enough of my yammering,” Dr. Morris announced, getting to his feet.
“The admission interview will teach you more than this stack of papers ever could.”
He shut the folder and we followed him out of his office, waiting as he locked it.

He led the way. I hardly spent any time on S1. It was mainly the psychiatrists’ domain,
and while the nurses from the locked ward were often in and out, conferring about
residents, orderlies and techs and junior staff like me received most of our information
secondhand.

The first floor was nicer than S3. It seemed sunnier, with oak wainscoting and hardwood
floors, not the speckled linoleum we had upstairs. Our footsteps were noisy, echoing
with history.

Dr. Morris led us down a long hall, punctuated by doors with frosted windows, each
boasting the name and credentials of one of the staff doctors. At the very end of
the corridor was a windowless door with two plaques. The first read
Admissions
and the one below it,
Vacant
. Dr. Morris slid the bottom plaque from its brass runners, flipped it over, and put
it back in place reading
In Session
. He keyed in a code and led us inside, leaving the door swung wide.

“Only S1 office without windows,” he told us, wheeling chairs over. “Normally we’re
happy to give patients a view, minimize the confinement vibe, but in here we can’t
afford too many distractions. Too much stimulation. No telling what shape folks are
in when they get delivered.”

He arranged two chairs facing another two chairs, plus one more, off toward the corner.
That was my seat. Part of me was a bit hurt, shunted to the sidelines, but another
part didn’t envy Darius’s proximity to a new and unpredictable patient. Who the fifth
body would be, I didn’t know. A police escort or security guard, likely.

Darius and I were both nervously eyeing the room, scanning the austere wood paneling,
and like me, maybe he was getting an escape route plotted, in case things got intense.

Dr. Morris flipped the folder open on his crossed legs. “Don’t you two just tremble
like fawns?” he teased, scanning a page. “No need to panic. The patient’s been detoxed
to his previous doc’s satisfaction, and his paliperidone regimen seems to be working.”

I scanned my mental flashcards for the side effects—restlessness, tremors, tics—so
I wouldn’t make the mistake of blaming them on his disorder, when and if Dr. Morris
asked my opinion. Darius was surely doing the same, nodding with a blank expression
as Dr. Morris outlined the patient’s meds situation.

Voices came from down the hall, but I was too far from the door to see who was approaching.
A woman’s voice grew louder, then a face I recognized appeared—a senior nurse who
spent most of her time on S1 but made the occasional appearance during hand-off.

“Ready for Mr. Paleckas?”

Dr. Morris smiled graciously, all his wryness dutifully packed away. Darius’s hand
was frozen above a legal pad, pen hovering at the ready.

Two men entered. I barely noticed the first one, as the second was Kelly.

My nerves short-circuited, morphing from trepidation to that funny, pleasurable knot
of misgiving I always got around him. I kicked it aside. Now was not the time for
distraction.

Kelly waited for the patient to sit, then did the same, linking his fingers atop his
belt buckle and looking blasé. I just bet he’d prefer to be standing, arms folded,
but I supposed it wasn’t helpful to give the patient the impression he was being held
and interrogated. Kelly and I shared the briefest eye contact, and if he was as surprised
to see me as I was to see him, he didn’t let me know it.

The nurse briefed Dr. Morris on the patient’s latest vitals before taking her leave.
She shut the door with a heavy, telling click, and Dr. Morris leaned forward to offer
his hand. “I’m Dr. Robert Morris. You must be Lee Paleckas.”

Lee accepted the shake. He was medium height, wiry, and surprisingly attractive—charismatic,
if not actually handsome. He looked a bit like Edward Norton, only . . . twitchier,
and with an unhealthy milkiness to his complexion. A vampire Edward Norton, who could
stand a few square meals. He was already dressed in Starling’s gray uniform, and it
made him look undeniably like a convict. He even seemed to be wearing invisible cuffs,
his hands now dangling limply from his wrists between his spread legs.

“Who’re these people?” Lee asked Dr. Morris, sounding more tired than suspicious.

“This is my intern, Darius, and one of our nursing staff, Erin. I’ve asked them to
sit in on this chat, but all the same confidentiality applies.”

Lee sniffed and rolled his eyes, clearly annoyed to have an audience but seeming resigned
to us. Resigned to this entire situation, maybe resigned to his whole damn life. I
decided to channel my inner Kelly Robak and sit nice and still, blend into the furnishings
until or unless my services were needed. I’d observe with my ears and eyes and intuition,
and leave the obsessive scribbling to Darius.

Dr. Morris opened the interview with the basics, determining that Lee had grown up
outside Louisville, Kentucky, in a broken home, had been getting into trouble since
he could crawl, and had been paranoid and punchy for as long as he could remember.

“I just don’t trust people.”

My gaze shot reflexively to Kelly. His cold gray eyes settled on mine before I could
look away. Which of us was accusing the other of distrust?

“And if I asked what your diagnosis is,” Dr. Morris said to Lee, “what would you say?”

“I’m bipolar. That’s what every shrink’s said about me since I was nineteen.”

“It was the hospital’s opinion that you may be what we call schizoaffective. And that’s
a possibility I’d like to explore during your time here at Larkhaven.”

“Ain’t those the same thing?”

“Similar, but not the same.” Namely, not the same to the tune of psychosis. “You may
also have a combination of the two.”

“Fuckin’ great. Lucky me.”

“In the last interview, you told your doctor you’ve heard voices. Is this a new phenomenon?”

He shook his head. “Nah. It’s just not something you want to advertise, you know?
’Less you’re looking to wind up in the nuthouse.” He cast his gaze around the room.
“But it’s a little late for that, now ain’t it?”

“What do your voices say to you, Lee?”

He tensed for a moment, then slumped with a sigh, too worn down to bother resisting
the conversation. “They don’t say things
to
me, exactly. But sometimes, if I’m talking to somebody and I don’t trust them . . .
I’ll hear what they’re saying, with their mouth. Then I’ll hear like this echo of
what they’re
really
thinking.”

“Okay.”

“I mean, I’m not stupid. I know it ain’t actual mind reading. But maybe some guy at
a bar’ll say, ‘Did you catch the Lions game?’ But then I’ll get this echo, with his
voice saying all fucked-up shit, sex shit sometimes, stuff this stranger wants to
do to me.”

“That must be upsetting.”

Lee leaned back in his chair and gave Dr. Morris a leveling stare, one that said,
loud and clear,
Is that shit the best shrink line you got for me, Doc?
And in that moment, I decided I liked Lee. I hoped he’d find his time at Larkhaven
useful, and that I might be able to make his stay a little more pleasant.

“And your voices never tell you to do things?”

“Not really. Only if the person I’m talking to is thinking that. But nothing like
you hear about, about demons and aliens. Just made-up whatcha-call-it. Telepathy.”

“Have you heard people’s thoughts for a long time?”

“Since I was a teenager, maybe?” That was in line with schizophrenia and schizoaffective
disorder, for auditory hallucinations to begin manifesting in young adulthood.

“Did you believe you were hearing people’s real thoughts, all this time?”

“At first, yeah. I thought I was special. Like I had a superpower. Except it scared
me, since nobody was ever thinking anything nice, nothing that ever made me feel anything
but sick.”

As forthcoming as Lee was being, his affect was incredibly flat and dry, making it
difficult to know if he was being open or just rattling off the same answers he’d
given to a dozen doctors before. He also seemed tense, a bit jittery—but it felt like
that was more physical than mental, a side effect of the antipsychotics.

“When did you first begin to suspect the voices might be coming from your own head?”

“I guess I was maybe twenty-one. I was visiting my grandma, and we watched this old
movie. Black and white. I can’t remember what it was called, but it was about this
chick that like, wakes up in a mental hospital.”

The Snake Pit,
I thought. I’d watched it with my grandma, too, years before I wound up nursing her.

“The chick heard voices. Not like the way I did, but that was the first time I kinda
got what people meant when they talked about ‘hearing stuff.’ I’d heard about crazy
people having that, but for some reason, I never thought I was crazy. I thought I
was special. That my brain was better than everybody else’s. Until I saw that movie.
Then everything kind of went to shit, because back when I’d thought I was reading
everybody’s thoughts . . . It sucked. I didn’t trust nobody, but I trusted myself.
And my own brain. After I started thinking maybe I was crazy, then I didn’t trust
anything. And I knew all that fucked-up shit I was hearing, that must be stuff I’d
come up with. In my subconscious or whatever.”

“When did you first start experimenting with drugs?”

“Shit, I dunno. Fifteen? That’s when I started smoking pot, anyhow. I didn’t do nothin’
worse until I was in my twenties.”

“And is that around the time the voices started? When you started smoking pot?”

“Maybe, yeah. I never really liked it much—the weed. But after I got told I was bipolar,
this one doctor mentioned, just like, in passing, how some people with that got benefits
from smoking.”

Dr. Morris’s professional façade fell away for a moment, an exhalation of pure annoyance
hissing from his nose. “I see.”

“So I smoked a lot, the last ten years. It was cheaper than seeing a shrink.”

“Pot has been shown to ease some symptoms of bipolar disorder. But it’s also been
shown to exacerbate those on the schizoaffective spectrum. Did your trouble with the
law begin during this period?”

“I was never a good kid, but it did get way worse after the pot, yeah. And the voices
got louder. And nastier.”

The interview went on for another hour, a conversational trip down Lee’s crime-riddled
memory lane. He didn’t withhold much of anything as far as I could tell, but his flatness
made it difficult to get any handle on his temperament. And temperament was telling,
just as much as these illuminating anecdotes.

But one thing was refreshingly clear—he was one of the most self-aware schizo patients
I’d yet encountered. And that could be the difference between an institutionalized
life and a manageable one.

After Dr. Morris had heard everything he cared to, he shook Lee’s hand, and opened
the door, calling for the nurse. She appeared shortly, and she and Kelly escorted
Lee down the hall. I’d nearly forgotten Kelly was there. He knew how to make himself
inanimate when that was what a patient needed.

“I look forward to talking some more this afternoon,” Dr. Morris called after them,
then bade Darius and me to stand. “Let’s take this back to my office.”

We followed him out the door, waiting as he slid the
Vacant
plaque in place. After a pit stop for coffee, we re-adjourned to his stately quarters.

“Well,” Dr. Morris said, crossing his legs and glancing between us. “What did we think
of Mr. Paleckas?”