Tachycardia and Other Tales Read online

  It would only get worse for reasons well documented. But she had come to this old memory of that morning through the uncertainty of this morning, and her thoughts focused on the unknowns of those first hours and days. She remembered first thinking of her family. Where were they? Were they OK? Why didn’t the phones work? Were more attacks coming? Who did this? How many people had died? How was she going to get home? What would she do about food?

  After the tunnels were closed and everyone south of Canal Street was ordered to evacuate at 11:00 am, she went downstairs and bought as much food as she could afford from the market, loaded it in a back pack, and started walking back to Karen’s apartment. She recalled finding Karen outside her apartment building, pacing back and forth on the sidewalk, unable to call anyone and unsure of what to do next. She remembered tanks rolling in the streets by early that afternoon, a sight she wouldn’t see again until the day of Trump’s inauguration down in Washington. She thought back to how they spent the next several days surveying the scene from the apartment window or walking the streets as much as they were permitted and of how they spent hours trying to help families connect with missing loved ones. She thought back to how once communications stabilized, she talked with family and friends and followed the developments on TV and online. Each day there were new details and new commentaries, but so much uncertainty. She thought of Thompson’s words from espn.com Page 2 on September 12th:

  “The towers are gone now, reduced to bloody rubble, along with all hopes for Peace in Our Time, in the United States or any other country. Make no mistake about it: We are At War now -- with somebody -- and we will stay At War with that mysterious Enemy for the rest of our lives.

  It will be a Religious War, a sort of Christian Jihad, fueled by religious hatred and led by merciless fanatics on both sides. It will be guerilla warfare on a global scale, with no front lines and no identifiable enemy……

  ……We are going to punish somebody for this attack, but just who or what will be blown to smithereens for it is hard to say. Maybe Afghanistan, maybe Pakistan or Iraq, or possibly all three at once. Who knows? Not even the Generals in what remains of the Pentagon or the New York papers calling for WAR seem to know who did it or where to look for them.

  This is going to be a very expensive war, and Victory is not guaranteed -- for anyone, and certainly not for anyone as baffled as George W. Bush. All he knows is that his father started the war a long time ago, and that he, the goofy child-President, has been chosen by Fate and the global Oil industry to finish it Now. He will declare a National Security Emergency and clamp down Hard on Everybody, no matter where they live or why. If the guilty won’t hold up their hands and confess, he and the Generals will ferret them out by force.”

  Back on the DC roof, she then thought of Trump with his generals and making it great again. She thought of how the Bush era had also come to pass.

  She thought of the miracle of the Obama presidency. How did it come to be anyway? Was his presidency to 9/11 what the Reformation was to the Civil War? She thought of the failure of the Clinton candidacy. She thought of the uncertainty of what might be ahead from 11/9.

  The puppy barked with certainty.

  King for a Day

  He opened his eyes and he was the King.

  “Cool” he said aloud even though he was alone and laying on his bunk facing the wall. But being the King meant he had a lot of work to do, especially before his 10 am appointment, so he quickly rolled over and swung his feet to the floor and lifted his torso to a rather rigid sitting position. The kind of light that you see on cold, clear mornings was coming through the window and the room was so chilly he could see his breath with his first deep exhale of the day. The windows were smaller up here on the fourth floor, so you lost less heat compared to the big ones on the floors below, but on days like today you could tell that you were far away from the big furnace in the basement. It was definitely better than the windowless Ward F rooms one floor below that had been used for violent male patients back in the heyday of the asylum and besides, he had been here so long that he was used to the cold. The patient population, and the staff hired to watch them, had dwindled so much recently that they let him live here like it was his apartment. It was December 1993, just before the holidays, and it was rumored that the Weston State Hospital, once known as the Trans- Allegheny Lunatic Asylum located in Weston, WV, would be closing soon. The old girl had been in operation since 1881, was over a quarter mile long with ten acres underroof and with over a thousand windows. It had been designed by Dr. Thomas Kirkbride, a 19th century Philadelphia physician who pioneered ethical treatment of the mentally ill, who up until his time had thought to be possessed by demons and shackled in basements or prisons. It is to him who we owe the image of the rural, stately insane asylum with manicured grounds and therapeutic outdoor activities, high ceilings and large windows to bring healing light and breezes indoors. Over a hundred hospitals were built using his design, but this one was the grandest, and second only to The Kremlin as the largest hand-cut sandstone building in the world.

  But building it wasn’t easy. When the state of Virginia decided to construct a new mental hospital in its western reaches, the town of Weston was selected despite the objections of several other cities also looking for a growth opportunity. But then as now, the only thing that can overcome prejudices and stereotypes of Appalachia is cheap real estate. After two hundred and seventy acres were purchased for under $100,000, construction began in 1858. Development went as planned using a combination of slave and paid labor until the first Confederate shells of the Civil War fell on Fort Sumter on April 11, 1861. In June, the grounds and completed parts of the asylum were occupied by Union forces led by Colonel E.B. Taylor and used as the staging point for the raid on Weston’s Exchange Bank of Virginia. The bank held $30,000 of gold coin belonging to the state of Virginia to fund construction of the hospital. The currency, which was now considered Confederate property, was seized and used to fund the formation of the new state of West Virginia in June of 1863. The asylum took its first patients in 1864 and at its height in the 1950s would hold 2,500 patients despite being designed for 250, which was about what it held on this cold morning in late 1993.

  He had slept in his clothes, so there was no need to change. He put on his shades. Security had become so lax and he hadn’t attempted suicide for months, so he had shaving privileges. He grabbed his razor and walked down the hallway to the common bathroom and shaved his mustache and the chin of his beard, leaving massive sideburns just as the morning bell sounded that is was time for meds and breakfast. As he exited the bathroom, the hallway was filling up with fellow patients making their way to the medication line in the common area. He was third in line and the cold had everyone moving slowly and talking little. When he reached the head of the line, a nurse handed him a Dixie cup of water and a smaller paper cup filled with his morning doses of trazadone, valium, and amitriptyline. He shook off the Dixie cup like pitcher waiving off a sign for the curveball and tossed back the meds. He took the ornate central staircase down towards the first floor and the cafeteria. He passed the rooms once used for hydrotherapy, insulin treatments and icepick lobotomies. When he got to the cafeteria, he placed a bowl and spoon on his tray (there were no knives and forks in the asylum) and walked up to the breakfast line. He reached into his mouth, pulled out the medications out of his cheek, dropped them into the bowl and then handed it over the Plexiglas counter to the server who worked the breakfast line every day.

  “The King today, huh?” the server asked, noticing the shades and chops.

  He nodded.

  The server looked into the bowl, took out the medications and evaluated them in his hand as if he was a pharmacist. He popped the valium and trazadone into his mouth and dropped the amitriptyline into the massive vat of oatmeal in front of him. He stirred in the medication with the others that he had disregarded so far that morning and then ladled a large amount o
f oatmeal into the bowl. He turned and ripped off a sizable piece of foil, folded it a few times and then handed both items back over the counter. He placed the foil into his back pocket and dropped the rest at the dishwashing station before heading back upstairs. Back in his room, he passed the foil through the bars on the window and then spread it open. He didn’t have any tape to seal the edges, but the foil set well on the sill and with the support of the bars, blocked out most of the light.

  He then laid back on the bed with his hands behind his head, in the dark, while wearing sunglasses until his appointment.

  At 9:45 he got up and walked down to the second floor and took a seat in the waiting room outside Dr. Patel’s office. He nodded over at the receptionist who acknowledged him in similar fashion over top of her fashion magazine. He was a little anxious, but he knew that Dr. Patel knew more about Bach than Burt Bacharach, and when the door opened and she smiled and waived him in, he rose without hesitation.

  Dr. Patel knew the hospital was closing in a few months and she knew that she was leaving at the end of this week for her next job back home in DC. She was looking forward to seeing The Nutcracker at the Kennedy Center and holiday shopping in Georgetown. She couldn’t wait to get out of here and back to her elite east coast circles and Ivy League colleagues. She had only come here for some loan forgiveness and to work under a former mentor who resigned a few months after she arrived. Her friends gave her hell for being in West Virginia and she felt like she had wasted three years of her life. She knew that she would not have a replacement and was miserable and pretty much mailing it in at this point. But the work was becoming overwhelming and the uncertainty was causing most of the patients to decompensate. Most of the remaining patients had been institutionalized for the majority of their lives and the thought of such enormous change was affecting everyone. The patients with anxiety disorders were becoming more anxious and the depressed were more depressed. The bipolar patients were becoming manic and their flight of ideas had them focusing on sex and religion. The schizophrenic were more psychotic. It was the end of the Kirkbride era, with funding cuts and new medications to treat mental illness, behavioral health was moving out of institutions and into the community. But she didn’t really care anymore. She didn’t feel like she was on the leading edge of her transitioning profession, she felt like she was on Titanic.

  Instead of starting the session with an open-ended question as she was taught to do, she started with a long statement. She looked up from the chart, choked a little bit at the site of the unkempt patient slumped back into the chair before her wearing sunglasses and sporting tremendous sideburns. And then she started.

  “Well, as you may have heard I will be resigning before the holidays and the hospital will be closing soon. There will be some big decisions coming soon about where you will be living. Some of the patients here will be provided apartments around the state while others will be transferred to the new state hospital being built just down the road. It is our goal today to decide whether you will be transferred to the new facility or placed out in the community.” After looking down and flipping to the front of his chart she went on, “You have been here so long, since August 16, 1977! I am sure that you must be anxious about the change.”

  She feigned sincerity as best she could and asked, “How do you feel about that?”

  “All Shook Up.”1 he said after an uncomfortable pause.

  “About me leaving or about the hospital closing?” she asked.

  “I’ll a have a Blue Christmas without you.”2

  “What about the hospital closing?”

  “Don’t,”3 he said, “Don’t Be Cruel.”4

  “What do you think about living outside the hospital?”

  “I’ll Be Home for Christmas?”5 he asked.

  “Well no, it would be after Christmas, sometime in the spring. But, I am leaving before the holidays. But what about you? Do you think you are ready to be in the outside world again?”

  “In the Ghetto?”6

  “Why of course not” she said, “since you don’t have any family it would be some nice public housing with rent support under the care of a social worker and with outpatient sessions just like the one we are having today. How does that sound?”

  “That’s All Right”7

  “Exactly! You have lived in this hospital for sixteen years. It is completely normal to feel anxious about moving on. But we have had so many sessions together and I feel you are ready!”

  “Am I Ready?”8

  “I think you are. You have been very stable on your medications for quite some time and we have weaned you down to only three.”

  It was getting harder and harder for her to pretend like she cared.

  How do you feel about your current regimen of valium, trazadone and amitriptyline?

  “An American Trilogy.”9

  “Uhhhh. Well, I guess that is one way to put it. It’s a relatively mild cocktail for someone with bi-polar disorder with psychotic features like yourself. Have you been depressed lately? Have you felt blue?”

  He squirmed in his chair a little bit and settled in a more upright position.

  “Moody Blue.”10 he blurted. He hesitated for a moment and they stared at one another for a few seconds. She was opening her mouth and getting ready to ask another question when he went in.

  “Blue Moon.”11

  “Blue Moon of Kentucky.”12

  “Blue Hawaii.”13

  “Blue Suede Shoes.”14

  He shrugged a little bit after the last one.

  “Oooooh-Kaaayyy” she responded, feeling slightly uncomfortable for the first time in the session. “Have you felt anxious?”

  “One Night.”15

  “At night? You feel anxious at night. Is that what you are saying?” her own anxiety was beginning to show through now. What are you feeling at night? Do you have insomnia? What goes through your mind at night?

  “Suspicion”16

  “Suspicious Minds”17

  “Paranoia!” she exclaimed while pointing a finger to the ceiling. Realizing for the first time that she may have committed the mortal sin of behavioral health by letting a potentially violent patient between her and the exit who in this case, was sitting in a chair between her desk and the door.

  “Are you seeing things or hearing voices?

  “Guitar Man”18

  “OK. So, you are hearing things. You are hearing music in your head at night. What about suicide? Have you had thoughts of hurting yourself?”

  “It’s a Sin”19

  “It’s a sin? What’s a sin? Ohhhh, you mean suicide is a sin. Is that what is keeping you from hurting yourself? Your religious beliefs?”

  He leaned forward now in the chair and moved his hands onto his knees and said,

  “He”20

  “He is My Everything”21

  “He Touched Me”22

  “He Knows Just What I Need”23

  “How Great Thou Art”24

  “I Believe in the Man in the Sky”25

  For the first time in the session she began to worry about her wellbeing. She looked down on the inside of the desk where someone had installed a panic button at some point over the last century. Even though she could see that the wires didn’t connect to anything she pushed it several times just in case as he went on about his faith. The state had cut funds so much that the maintenance man now doubled as the security guard and she knew that he was probably not within shouting distance. She would have to manage this patient, who was now literally on the edge of his seat, on her own. She started to redirect him away from religion which seemed to agitate him.

  “Very well,” she stated calmly, “I have a great deal of respect for your beliefs and do not mean to minimize them in any way. Would you say that God and religion takes up most of your thoughts or do you also think of other things?”
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  He leaned back in the chair and tilted his head to the right a little.

  “Love Me”26

  Love Me Tender”27

  Love Me Tonight”28

  Big Hunk of Love”29

  Burning Love”30

  Can’t Help Falling in Love”31

  She leaned back in her chair and state quite simply, “I see.” She then closed his chart and wrote “INPATIENT” on the front of the chart in large bold letters. She then looked up again and said, “I am recommending you for continued inpatient treatment when the new hospital opens in the spring. This concludes today’s session. Thank you.”

  He got up from the chair, nodded and stated, “My Way.”32

  He then turned and walked out of the office and back up to his room on the 4th floor.

  * * *

  1 Written by Elvis Presley and Otis Blackwell, released 1957

  2 Written by Bill Hayes and Jay Johnson, released 1957

  3 Written by Jerry Leiber and Mike Stoller, released 1958

  4 Written by Elvis Presley and Otis Blackwell, released 1956

  5 Written by Walter Kent, Kim Gannon, Buck Ram, released 1957

  6 Written by Mac Davis, released 1969

  7 Written by Arthur Crudup, released 1954

  8 Written by Sid Tepper and Roy C Bennett, released 1966

  9 Written by Mickey Newbury, released 1972

  10 Written by Mark James, released 1976

  11 Written by Richard Rodgers and Lorenz Hart, released 1954

  12 Written by Bill Monroe, released 1954

  13 Written by Leo Robin and Ralph Rainger, released 1961