Do No Harm (2002) Page 16

  David nodded. "Differential diagnosis. Not Otherwise Specified."

  "NOS. The psychiatrist's crutch. Until I can get more out of him."

  "I'd like to turn him over to LAPD a bit more sorted out. He certainly won't be in the most sympathetic hands."

  "He seems to have some sort of bond with you. Maybe you should see if you can get him to open up. If you lead him to talk about the fear behind his crimes, rather than the crimes themselves, he might be more likely to talk. Zero in on his sense of injustice."

  David stood, squeezing his fist so his knuckles cracked. "Well, I need to check in on him anyway. See if he's ready to ship out." He rested a hand on Dash's massive shoulder on the way to the door. "Thanks for the input."

  Dash drew himself to his feet and glanced down. "Hey, David?"

  One hand on the doorknob, David turned, an eyebrow raised quizzically. Looking at Dash's face, he could not locate the affability to which he had grown accustomed.

  "Be careful."

  Chapter 25

  A burst of noise sped David around the corner, where he saw the UCPD officers standing in the open doorway, one of them shouting for help. David saw Jenkins explode through the swinging doors of the lobby. Jenkins sprinted for Clyde's room, boots hammering, and swept inside.

  David was already running down the hall, past the startled faces and the UCPD cops. He entered the room just after Jenkins. Clyde was thrashing violently on the bed in a seizure, limbs rattling the gurney rails to which he was bound. His eyes were rolled back, showing strips of white, and a line of drool ran down his cheek.

  Pistol gripped tight in one hand, Jenkins charged the bed. David caught up to him a few steps from Clyde's gurney and placed a hand on his chest, which Jenkins quickly knocked away.

  "It's under control," David said. "He's having a seizure."

  Jenkins's eyes were still trained on Clyde. He swung his head slowly to face David, his pupils hard, black pinpoints, and in that instant, David had no doubt that he would have killed Clyde. David's adrenaline rush made his pulse beat at his temples. He met Jenkins's hard stare, the words coming like bullets from his mouth. "Step back from my patient."

  Two nurses and one of the UCPD cops poured into the room, and Jenkins's eyes suddenly loosened. He took a step back, holstering his weapon. "Just making sure the suspect was secure," he said.

  David turned back to the bed and grabbed one of Clyde's arms, which went limp in his grip, even as the rest of his body continued to seize.

  "Back up!" David dropped Clyde's arm and took a step back himself. He turned to the others, registering a quick relief that Jenkins had left the room. "Stand back."

  Clyde moaned, spittle flecking his lips, his head bouncing from side to side on the pillow.

  "Nice try, Clyde," David said. "You can stop now."

  Clyde seized for another moment, then stopped. His tufts of hair had been swirled upright, and when he raised his head, chin shiny with saliva, eyes dark and unblinking, he looked demonic. His grin was sharp and slick, a curved blade. He looked nothing like the frightened, cooperative man David had treated earlier.

  David had known Clyde was faking as soon as his arm had gone limp in his grasp. Generalized seizures occur in all limbs, and sections of the body don't relax under pressure.

  Clyde said, "Can't blame me for trying."

  "Would you mind leaving us alone?" David said to the nurses and the UCPD officer. They complied, the officer shutting the door behind them.

  David was alone in the room with the bound man. He stared at him from about three feet, breathing heavily, trying to process all that had just nearly occurred. Shirtless, Clyde lay on his back, restraints tying his ankles to either side of the gurney, spreading his legs. His white-gloved hands looked odd protruding from the restraints.

  Despite Dash's claims, Clyde was having no trouble making eye contact at the moment. A small line of blood curved from the slit beneath his armpit.

  David waited until he could speak calmly. "That didn't do much good. You opened up that cut under your arm with all your thrashing. Why are you faking a seizure? Did you want to harm someone when they came to help? We're trying to take care of you here."

  "Bullshit," Clyde hissed. His breath was paradoxically rank and sweet--there was an almost medicinal scent to it. His right foot waved back and forth, a pendulum ticking off seconds. "You left me. You left me and didn't come back."

  David pulled over a chair and sat, to put his head lower than Clyde's. Maybe Clyde would be more comfortable talking if David assumed a submissive posture. "I have other patients I need to see. Other patients who need help the way you needed help."

  "I don't need you."

  David drew closer. The blisters on Clyde's chest were resolving. Though still raw, they had either popped or ceased swelling. Again, David was amazed at how well Clyde's scrub top had protected his flesh from the alkali.

  "I'm not here to harm you, Clyde. I'm here to see that you get the medical attention you need. That's why I brought in the other doctor. Why didn't you like him?"

  The room had not been prepared for Clyde--David and Carson had dragged him in because it was the nearest unoccupied exam room, and David had given it only a cursory once-over. Now he stood and searched the room more extensively for unsafe objects, just in case Clyde managed to work an arm free. A lumbar puncture kit, stained amber by Betadine, leaned from the trash can. That meant there were needles, probably down in the trash liner. The unit of blood he'd spotted earlier remained on the counter nearby, among several packages of gauze. Clearly, it had been out of refrigeration for more than the admissible thirty minutes. He'd already removed the scissors; now he glanced in the drawers beneath the counter for scalpels but found none. An oxygen source box protruded from the wall. The flow meter was made of glass, but it was hard and small, like a test tube buried in the unit. It would be difficult to break.

  "I hate you," Clyde said. "I fucking hate you." His lips quivered slightly. "The nurses came in here, told me you would leave me. They said you were saying bad things about me."

  "I didn't say anything bad about you."

  Relief washed across Clyde's face. "That's what I told them. I told them you were a great person, a great man, and you would never do that. I defended you."

  David carried the trash can outside and set it by the door. "This has needles in it," he told one of the cops. "And could you please tell a clerk to call the blood bank, have them send someone down. We have a stray unit of O-negative that needs to be spoiled."

  The officer nodded, and David returned to the room, sat, and faced Clyde. "I don't believe the nurses said those things about me. Do you think you're imagining some of the things they said?"

  "No. No way." His breath whistled and wheezed. "If they take me away, will you come with me? You said you'd stay with me."

  "I'll make sure you get the help you need," David replied evenly.

  "You. I want you. You helped me. You helped cure me when no one else wanted to." Clyde's right foot continued its restless motion back and forth.

  "I'm an ER doctor. I have to stay here."

  Clyde strained against the restraints, and David noticed again the swelling of his hands. His wrists were chafed, one hand up over his head, one down by his side, like a playground monkey. David noticed an old stain on the cuff on Clyde's lower wrist. Probably semen. Sometimes they had to put guys on amphetamines in restraints, but they'd be hypersexual from the drug, so they'd turn on their sides to get at their penises and masturbate themselves bloody.

  "Do you know why you're here?" David asked.

  "Because I'm tied down. Where else am I gonna be?"

  Concrete thinking. Pulling on a pair of gloves, David pressed forward into the Brief Mental Status Examination. "Clyde, do you know what month it is?"

  His eyes beaded until they looked like small spots of oil. "Of course I do. You think I'm fucking stupid?"

  David began applying Silvadene to the blisters on Clyde's ch
est, spreading the antibiotic cream with a fingertip. Clyde winced at his touch. David took care to lean back out of Clyde's space so he wouldn't feel crowded.

  "No," David said. "I think you're sick. I want to help you."

  Clyde laughed, a low snort. "They're running around the hospital scared of me. They have guards here because of me. I'm not sick. I know what I'm doing."

  His vacillation between swaggering self-righteous criminal and emotional catastrophe was staggering in its range and rapidity. "What are you doing?" David asked.

  "Making them sorry."

  "Sorry for what?"

  "For locking me up in the darkness. Not letting me out."

  "Were you locked up? As a child? Were you kept locked up by your parents?"

  "Noises and lights and snakes. They put the lights out on me. They put me alone. I just want . . . I just want them to be sorry. For the flashes and the noise."

  Locked in the dark with snakes--it seemed too stereotypical to be real, like a serial killer's childhood case study. Perhaps the fantastic stories were an indication of delusions or hallucinations caused by LSD, PCP, or speed. Maybe even schizophrenia.

  "Do other people think you have crazy ideas?" David asked. If the question was worded subjectively, Clyde would be more likely to answer it honestly.

  "I don't . . . I don't know. I don't stay around people anymore." Clyde's speech was slightly slurred, as if he were speaking around a thick tongue. "Not people that can look at me back."

  "You said you weren't taking any drugs. Are you sure about that?"

  "I don't take any pills." The same defensive note David had encountered from him previously on the topic. David noted that he had changed drugs to pills. He seemed to be concerned with the issue of taking medicine, not illicit drugs.

  "Did someone do something wrong to you?"

  Clyde breathed hard for a moment, catching his breath. "I don't like the way they look at me. They always look at me like that here."

  "Here? As in here at this hospital?"

  "Yeah," Clyde said. "Yeah. But not anymore. Now they're afraid. You shoulda seen their faces after they got the stuff on them." His fingers, swollen knuckle-wide down their lengths, quivered as his hands twisted in the restraints. His fingernails were yellow and pitted. "I have plans. I'm smarter than you think. I can do things too. I know they're wrong, but I can do them and not get caught."

  "What plans? What are your plans?"

  "Maybe you can stop me. I couldn't. I couldn't stop me."

  A slightly obese female tech stuck her head in the door. Clyde's head snapped up, the loose flesh of his cheeks and jowls taking a moment to still.

  "I'm here from the blood bank to pick up--"

  "Please, not right now," David said.

  "Look, I came down here all the way from--"

  "Not now."

  With a scowl, she withdrew.

  "See?" Clyde said. "Like that. Did you see how she looked at me?" He drew a ragged breath. "I just marked her. Marked her face, her eyes. She's there now, in my mind. Green dangling earrings. Freckles across her nose. Birthmark on her right cheek." David couldn't even recall the woman's hair color, but Clyde, in the four seconds she'd been in view, had drunk her in.

  Clyde raised his head, examining the thick leather cuff that bound his wrist to the railing. "Now I see how you guys are clever, trying to catch me. I can be clever too. I have ways, I have better ways to get at people." Clyde began sobbing quietly. "I don't mean to. I don't like it. It's awful but I have to." He winced suddenly, squinting.

  "Are you all right?" David asked. "Does your chest hurt?"

  "God. Oh God. Dim the lights. Can you dim the lights?"

  David crossed to the light switch and turned off the bank of lights directly over the gurney. The room glowed with light from the X-ray box, which someone had left on.

  The only sound in the room was that of Clyde's labored breathing. David watched him in the soft-lit darkness. Clyde's request stemmed from either a headache or a sudden phobia, he wasn't sure which.

  "When I go out," Clyde said, "the mask goes on. It protects me."

  "Why do you need a mask?"

  A single tear rolled down Clyde's red and swollen cheek. "I want their faces to be gone. I want them to be destroyed and ruined and no more."

  Clear homicidal ideation, available means and well-formulated plans for continued attacks, lack of compassion, self-view as victim--the red flags were rising one by one. David said, "Do you think--"

  The door swung open, flooding the room with light. Dressed in jeans and a Gap button-up, Diane entered. "There you are," she said. "What the hell has been--"

  David sprang toward her, trying to block her from Clyde's view. "Not now. Get out! Who told you you could come in here?"

  She shuffled backward as he pushed her. "The cops said it was okay, that you were just--"

  "Keep this door shut," David growled at the officers. He slammed the door and leaned against it, one palm spread over an anatomical diagram of a lung.

  Clyde's voice drifted around him, a miasma rising. "That one's special to you, huh?"

  "No," David said. "I just don't want anyone disturbing us."

  "Didn't see you jump to when that little pig from the blood bank showed herself to me. Not like you jumped for this one. Don't blame you. She's a pretty nurse."

  David crossed the room and stood over Clyde. The glow of the X-ray box turned his skin a sickly blue, darkening the pits in his cheeks and the twinning tufts of hair that protruded ridiculously like an offset garland. He stared at Clyde, and Clyde turned away with a soft, dying whimper.

  Empathy is not innate. It is a learned emotion, conditioned through trial and error, defeat and reward, forged in a Skinnerian oven. David sifted through forty-three years of instinct and socialization, searching for the string of a buried argument. The only way a person can know that someone else's pain matters is if someone has taught them that their own does. If no one ever showed that to Clyde, as a baby, as a child, then he had learned that his pain did not matter. And, more acutely, he would have learned that things in pain did not matter.

  "Your pain," David said. "The awful pain on your chest. I'm sorry that happened to you."

  Clyde watched him, rigid and sweating.

  "The way you feel, the pain you feel--the women who you threw alkali on feel that also. That same pain."

  Clyde's eyes watered. Tears beaded and stuck to his thick lashes. "My head hurts," he said.

  David wondered what thoughts rattled through the corridors of Clyde's mind. "I need to go see some other patients. I'll check on you later."

  Clyde turned his face away, staring darkly at the wall. "No you won't," he said.

  David left him bound in the semidarkness.

  Chapter 26

  YALE was waiting for David outside Clyde's room, his arms spread. "Well, we're ready to take him off your hands. Press is cordoned, transport vehicle's waiting in the ambulance bay." He thrust a clipboard at David. "Please sign him out."

  Diane paced the hall behind Yale, hands tucked into the back pockets of her jeans. His face still flushed, Jenkins congregated with a few officers farther down by the lobby doors. Murmuring to one another and shifting on their feet, they directed their stares toward David and the closed door of Clyde's room. Waiting like jackals for a whisper of opportunity.

  David felt the crush of an ugly dilemma. What was already a difficult, complex decision was now enflamed by the agitation of the hospital board, the press, an angry city. He felt the myriad pressures in the heat rising to his face, and he fought to find the correct response. Something flared in him, bright and sharp, and he found himself saying to Yale, "I'm afraid the patient is not ready to be released."

  The clipboard smacked against Yale's thigh. "No?" He flicked his wrist and the Rolex appeared. "Eight-fifteen. Your shift is over. Who's the next attending on call?"

  "The patient is not improving at a rate that indicates he'll be ready to be move
d tonight."

  Yale opened his mouth, then closed it. He scratched his forehead with two fingers. Diane was watching David, a puzzled expression on her face.

  "When is the earliest he'll be ready?" Yale asked.

  "Eight tomorrow morning."

  "And it's just a coincidence that that's when your next shift begins?"

  "Yes. I'll brief the next attending to contact me in the event of any change in Clyde's condition, no matter the hour. If he has a miraculous recovery in the night that enables him to be moved, I'll come in immediately and sign off on him."

  One of the clerks stuck her head out of the CWA but withdrew it quickly when David looked at her. Two nurses whispered to each other in the doorway of Twelve.

  "You said you thought he'd be ready to be moved by now," Yale said.

  "My patients don't always abide my expectations."

  Yale dropped the clipboard on the tiled floor, where it made a startlingly loud bang. "If you insist, I suppose we have little choice."

  Jenkins and the other officers stood in a flying wedge at the hall's end, looking foolishly formal.

  A grin flashed across Yale's imperturbable face and vanished instantaneously. "We'll be here waiting."

  Diane paced tight circles while David signed out to Dr. Nelson, a young attending who'd trained under him. She walked swiftly to keep up with David as he headed through the hospital toward the lobby, avoiding the ambulance bay so he wouldn't have to pass Jenkins.

  "What are you doing, David?" she said. It clearly was an effort for her not to raise her voice. "We've released patients to custody in worse shape than that."

  "If I release him," David said, "he's likely to die."

  "Nobody dies of that kind of alkali burn."

  David looked at her, his stomach twisted into a knot. "I'm not talking about the burns."

  Removing his cell phone from his pocket, he ducked into the empty fluoroscopy room and had the operator put him through to the University Police. Diane sat on a gurney, waiting patiently.

  "I need to reach Officer Blake. Urgently . . . Yes, I would appreciate it if you'd page him to this number." David rattled off his cell phone number. "No, I'd rather not say what this is regarding, but please tell him it's extremely important."