The Conservator

By Frederick R. Lurting

Cigarettes are a strange commodity in an insane asylum. Not everybody has them; hence, they come to serve as a strange currency. Some ask for cigarettes; others hand them out. They can be symbols of friendship and sources of conversation. Most of all, however, they are the only material object that is not confiscated from the patient when he or she enters the asylum. Thus they become an element of identity and assume a much larger reality than they actually have.

• Language: English
• Publisher: Xlibris US
• Release date: Apr 29, 2019
• ISBN: 9781984530622

Book preview

CHAPTER 1

T he brown sheriff’s squad car turned lazily onto the entry lane of the hospital. Nick Anderson’s wrists were in pain but not as excruciatingly as they had been in the past. The sheriffs had absentmindedly placed the handcuffs on Dr. Anderson’s wrists and inadvertently left a slight amount of play between the skin and metal of the cuffs. Dr. Anderson had learned the hard way the cunning manner in which handcuffs are designed. The simple circle of steel is manufactured to impinge most forcefully over the bony prominences of the wrist, striking the bony protuberances directly. The dangerous aspect of this design is that the essential arteries and nerves of the hand lie in juxtaposition to the bony prominences, and the normal application of handcuffs thereby impinges upon the radial artery and nerve, the median nerve, and the ulnar artery and nerve, essentially compromising all the neural input and nearly all the vascular input to the hand. Dr. Anderson had had a previous experience of having had handcuffs applied by a sheriff who used his bootheel to forcefully squeeze the handcuff between his boot and Dr. Anderson’s spine while he was lying on the floor. After over six hours in the apparatus, they were removed, demonstrating clean lacerations over the radial, median, and ulnar nerves and the radial and ulnar arteries. There was a line of color demarcation at the wrist with the hand appearing ischemic and nearly cadaveric. There was no feeling in the right hand, and movement of the fingers was slow. When the condition of the hand was pointed out to the sheriffs and the doctors, it was utterly ignored. To request the sheriffs to loosen the cuffs had always been utterly futile, generally resulting in a blank look of complete disdain. Generally, if one was in a squad car, the usual response of the assistant deputy sheriff was to turn the FM radio up to full volume. If one has never had the experience of riding a significant distance in a police squad car, it’s something akin to riding in a Rolling Stones’ mobile recording studio. The ambiance very effectively eliminates all conversation.

Thankfully, Dr. Anderson’s hands were only painful. The drive had been nearly four hours, and with the handcuffs secured behind him, they were squeezed between Dr. Anderson’s back and the hard formfitting plastic seat in the rear of the police restraining vehicle. Given the configuration of the hard plastic seats, the restraining cage, and the handcuffs, it was difficult to find a comfortable position or posture for any period. The sheriffs obviously knew the ride would be much more comfortable if the hands were placed in front of the person being transported. To raise the issue would have been futile.

The squad car slowed immediately upon turning onto the entry lane of the hospital, abiding by the fifteen-miles-per-hour speed limit. As the car slowly meandered along the curving lane, Dr. Anderson reflected on the alley of sugar maples lining the road. On a bleak landscape, with the cathedrals of austerity standing in the distance, someone had had the artistic foresight and wherewithal to plant a miniature arbor. Dr. Anderson, having been here once before, knew the sugar maples to be the singular attempt at beauty on the campus. On this clear night with a sky of sparkling stars and a full moon, the trees were highlighted in a gentle luminosity. Dr. Anderson had walked many times along the path, and the trees had come to symbolize to him a singular gesture of hope in an otherwise desolate panorama.

As the squad car approached one of the absolutely utilitarian rectangular sterile redbrick buildings, the gravity of the situation facing Dr. Anderson started to become burdensome. Many of the problems he faced would be laughable if they were not so sad. Others were so convoluted they were dangerous. The stark fact that this was the second time he had been brought here only compounded his difficulties.

As the squad car came to a stop at the rear entrance of the building, Dr. Anderson shook his head in disbelieving amazement that a simple hospital patient had to be arrested in order to be transported to a hospital. Actually, he had gotten off easy this time by simply having his hands injured. Patients, regardless of their condition, were apparently generally perceived to be nearly as dangerous as murder suspects. The sheriff’s deputies escorted Dr. Anderson through the entry door into an L-shaped admitting lounge. He was directed to one of many chairs in the room, where he was told to sit down. As is true of many admitting rooms, as soon as a patient appears, the admitting clerk promptly finds a stack of papers he must attend to immediately.

Across the room, sitting in a plastic ice cream scoop chair was an old man. He was emaciated, and he wore a flimsy shirt that vaguely resembled a cutoff hospital gown. Even a layman would have no trouble concluding that he appeared ill. He sat motionless, his elbows on his knees, his chin in his hands, staring at the floor, and intermittently, he drooled on his slippers. The old man was an all-too-familiar sight, one of the scores of icons testifying to the age of pharmaceutical psychiatry, psychopharmacology as it is more affectionately called. He was unattended and unobserved presently, but at some time later in the evening, an aide would stop by and lead him to his bed. Tomorrow would be different for him only in the selection of the chair in which he would sit.

Dr. Anderson waited patiently, still handcuffed, for approximately one-half hour. The sheriffs remained standing, leaning against the wall in the entryway of the admitting lounge. They were chatting quietly between themselves. Shortly thereafter, a nurse emerged from behind a glass window in the lounge. Dr. Anderson identified him as a nurse only by his presence and by virtue of the fact that he carried a clipboard. In reality, he could have been an admitting clerk; or, for that matter, anybody. He was short, of medium build, and he had long gray hair that cascaded straight over his shoulders and down his back. He also had a long untrimmed gray beard. He was dressed in a faded multicolored plaid, outdoor man’s shirt, faded blue jeans, and dirty white sneakers. For all intents and purposes, Dr. Anderson thought the man could easily pass for Willie Nelson’s brother. It had been years since nurses had given up wearing uniforms, name tags, or any other type of identifying insignia. The nurses had given up their clean, starched, pressed white uniforms; their white hats; their attached medals for years of service; and their name tags for the whatever comes out of the closet wardrobe. The idea was to appear more personal to the patients, give the patient someone they could relate to more easily and hence put the patient more at ease. Dr. Anderson had no problem relating to the man just by knowing who he was and what he was.

As the man approached Dr. Anderson, he mentioned neither his name, nor his status. He simply looked down at his clipboard and began reciting a list of demographic questions: name, age, address, telephone number, and insurance company. He finished his questions quickly and then signaled the deputies to approach. Crossing the room, one of the deputies removed a key from his pocket and then very efficiently unlocked the handcuffs without saying a word. They remained standing in place. The nurse then produced a small manila envelope and asked Dr. Anderson to empty his pockets. Dr. Anderson produced his house keys, car keys, file keys, and a modest amount of change. Handing over his wallet, Dr. Anderson watched as the man removed anything that could be used to interact with society: credit cards, gas cards, insurance cards, Social Security card, and library cards. He, of course, also removed the folding money. The one concession they allowed was to leave one’s driver’s license in place; apparently a law. Dr. Anderson, however, did not have a driver’s license, and hence, when the wallet was returned to him, there was nothing in it that could be used to identify who he was. Before sealing the envelope, the nurse returned the modest amount of change to Dr. Anderson. This was the first phase of a carefully orchestrated and regulated process of dehumanization and incarceration. It was uniform. It did not matter who one was, why they were at the hospital, how minor or major their problem was, all were reduced automatically to the lowest common denominator. In the process, Dr. Anderson had already been arrested; transported halfway across the state of Virginia, far from his home; relieved of all his personal effects; and had not yet even seen a professional, much less spoken with one.

After the man had sealed the envelope, he nodded to the deputies, who then left without saying a word. The nurse indicated to Dr. Anderson to begin walking in the opposite direction. The two turned a corner and began walking down a long corridor. They walked in silence. About halfway down the hallway, they encountered a large metal door. The nurse reached into his pocket, retrieved a set of keys, and unlocked the door. After walking through the open door, it was then closed by the nurse with a very substantial sound. The nurse turned the key and locked the door. Dr. Anderson hated the sound of the doors. No matter how many times one hears the iron clang, one never gets used to it. Whether it is the reality that one is actually incarcerated or simple symbolism, it is nonetheless an ultimate statement by society toward an individual. It is an eternal scar and should so be noted for the benefit innocent detainees.

A short distance down the hallway, the nurse abruptly stopped and pointed to an open door leading to a medical examining room. Dr. Anderson followed the direction of the extended hand and walked into the room. The man told Dr. Anderson to change into an examining gown and wait for the doctor. He closed the door and left Dr. Anderson alone in the room.

Dr. Anderson changed into the gown and then jumped to sit on the examining table. Dr. Anderson sat quietly, thinking to himself for several minutes. This was not the first time he had been through this, but that did not mean he was comfortable with the process. To the contrary, he was beyond perplexed; he was terrified by the situation and the circumstances. What would transpire for the next few days was a series of pro forma procedures. He was caught in the gears of a machine that had no reverse. What was about to occur defied everything he had learned in medicine. He was about to be questioned and examined by a young doctor, either a medical student or a junior resident. In either case, the young physician would probably not even have had psychiatric training but would be serving an elective rotation as part of their overall medical training. If the student were a third-year medical student, this may be his or her first examination ever. Dr. Anderson had great compassion for medical students and residents. After all, he had gone through the system and had appreciated opportunities, when he was granted a certain latitude of independence. The problem in this situation, however, was the fact that this examiner would have only a few days or weeks of experience in this speciality. Here, they were unsupervised and without immediate checks and balances. Their history and physical examination would be the first on the chart, and the patient may not see a certified attending physician for six weeks or more. The resident’s history and physical examination would be used by the magistrate, psychologist, and lawyers to determine whether the detention order should be extended into a commitment. The resident’s diagnosis would be used as the basis for prescribing psychotropic medications. In short, Dr. Anderson had never seen such latitude allowed a junior trainee.

More important to Dr. Anderson than the physician’s inexperience, however, was the fact that neither the medical student, nor the resident was going to actually listen to what he had to say. It was an immutable impression left on him by his previous experiences. To utter such an opinion to a psychiatrist, as well as from the other members of the status quo who participated in the process, was to engender a vociferous denial. Worse, to utter such an allegation would often be rejoined by the comment, Such a comment is only a further indication of your mental illness, the most common rejoinder to any such complaint is too general and too vague.

Dr. Anderson sat on the examining table, reflecting on his previous experience. The first time he went through this process, his words were so twisted by the examiner that everything he said was deemed to be delusional. He had to go to a court of law and prove what he said was true and not delusional. The experience was hideous, and the records follow him to this day. Sitting on the table, he knew that nothing he could possibly say could possibly reverse this process. Even if he was sitting at the top of the bell curve of normalcy, it would not make any difference. The examiners were not looking for normalcy; they were looking for pathology.

Dr. Anderson toyed for a moment with saying nothing, but he quickly rejected the idea when he realized that the tactic may be of some help to a suspect locked in jail. It would be immediately interpreted in this context as an indication of paranoid behavior. No, there was nothing he could say that would have any impact. He remembered speaking with a psychiatrist about the situation and having him say, Well, why didn’t you just explain yourself and talk your way out?

Dr. Anderson simply looked at him for a few seconds and said, You don’t think I tried?

Dr. Anderson continued to sit on the examining table. This was a place where one learned to lose time. Eventually, the door opened, and a tall, thin doctor walked into the examining room, neatly trimmed, wearing surgical scrub clothes and a long white coat. He did not introduce himself. He sat on a short stool to the side of the examining table. He appeared neither anxious nor distracted.

He began arranging the papers on his clipboard. After a few moments of silence, he looked up and asked, Why are you here?

Dr. Anderson sat quietly for a few seconds and then responded, I don’t know why I am here.

The young doctor drew a slow breath, tipped his head back slightly, began to look somewhat irritated, and then said, What do you mean you don’t know why you are here?

Softly, Dr. Anderson simply repeated, I don’t know why I am here.

Without changing his expression, the young doctor asked, How did you get here?

In a sheriff’s squad car, Dr. Anderson answered.

Then you came in on a detention order? he asked.

Yes, Dr. Anderson replied.

What type? the young doctor inquired.

Danger to self and others, Dr. Anderson answered quietly, knowing there are two types of detention orders: danger to self and others and being incapable of caring for oneself. One must be one or the other or both to be detained.

What did you do to earn that distinction? he asked.

After successfully completing an interview for a position at a local hospital, pending the resolution of my medicolegal problems, I walked over to the sheriff’s department and asked for a permit to carry a concealed weapon, Dr. Anderson answered.

Do you have a gun? the young doctor asked.

No, Dr. Anderson replied.

Then why did you ask for the permit? the young doctor queried.

I was going to purchase the gun simultaneously with filing the application, Dr. Anderson responded.

What do you want to carry a concealed weapon for? the young doctor asked.

I live in a farmhouse on a horse farm, a tenant house actually, the kind of thing in which farm managers live. I live alone. I have no electricity, and the house looks deserted after sunset. The house sits along a busy road two miles from town, and occasionally, vagrants and hitchhikers walk along the road. I also do not have the means to keep the grass cut, which further contributes to making the house look uninhabited. Additionally, there are frequently varmints around the house, woodchucks, fox, that kind of thing. It’s simply that I do not always feel safe there, Dr. Anderson answered.

Who issued the detention order? the physician queried.

Initially, I spoke with a young man, a deputy, perhaps twenty-eight years old. I told him exactly what I told you. He left the room, and perhaps twenty minutes later, a young woman of twenty-one years of age—she may have had a high school education, I don’t know—presented me with a broad smile and then flashed a green paper in front of me, which I recognized as a detention order. I was not allowed to examine the form or read it, so I am actually postulating as to type of detention I am assigned. The young woman, deputy, offered no further information or explanation as to the nature of the charge against me. She simply asked me to turn around and place my hands behind my back, after which she applied the handcuffs. The deputy then escorted me to a chair where I was directed to sit and wait for the escort deputies, Dr. Anderson described.

The young doctor did not seem to be impressed one way or the other with Dr. Anderson’s account. He looked up from his clipboard and, in a matter-of-fact tone, asked, You said you had an appointment prior to going to the sheriff’s department. What was that all about?

Dr. Anderson hesitated for a moment, realizing that it would be impossible to recount the mitigating circumstances of the last five years, which impinged so directly on the current events, or to provide his pertinent medical history, so he simply, briefly described his actions during the day.

I live in the country for reasons that have nothing to do with my vocation or employment. I am thirty-six miles from the nearest town of any size, and presently, my automobile is in storage—no choice of mine. The morning in question, I rode my bicycle to Greenberg General Hospital, which is a small, 110-bed general hospital in Greenberg. I went there to meet with the hospital director to discuss employment possibilities at Greenberg Hospital. I arrived soaked with sweat, and after apologizing for my appearance, I began to describe my medical training, my work in medicine, and some of the aspects of my current medicolegal difficulties. He clearly warmed to me as the interview progressed, and by the end of the hour, he was clearly accepting of me and basically said to come back if I could clear up my medicolegal problems, and the hospital would put me to work. We then left the office, and the director gave me a quick tour of the hospital. At the end of the tour, we stopped at the administrative offices of the operating rooms, and the director called the chairman of the department of anesthesiology from within the operating room. The director briefly introduced me to the chairman and then explained who I was and what I was seeking. The chairman was clearly glad to meet me, smiled broadly, shook my hand, and then immediately described the opening that was available. He apologized for being busy at the moment and said he must return to his operating room immediately, but he asked if I could return the next day at 9:00 a.m. for an interview. He then returned to the operating room suite. The director escorted me to the hospital entrance, thanked me for coming, indicated that he was pleased to meet me, and said he would be talking to me again soon. I then left, Dr. Anderson concluded.

The young doctor looked at Dr. Anderson as if studying a curiosity. He then asked, Is there some connection between going to the hospital and the sheriff’s department?

No, none at all. As I said, I live thirty-six miles from Greenberg, and I don’t really have any legitimate transportation. As a result, it is very infrequently that I get to Greenberg. While I was there, I also wanted to take care of a couple of items on my agenda. I needed to go to the county building to pay some taxes, Dr. Anderson answered.

Dr. Anderson paused briefly and then said quietly, All I did is ask for a piece of paper. They could have just said no. It’s not as if I threatened anybody or even appeared agitated in action or speech. I spoke with the sheriff’s deputies, just as I am speaking with you now.

The doctor leaned back and curled his lip into something of a disgusted look. He then directed his attention to his clipboard from which he began to read the prepared list of questions for the medical history pertaining to the physical examination. He then conducted a competent general physical examination in silence. As Dr. Anderson lay on the examining table with the young doctor palpating his abdomen, he realized this examination would be no different from all the rest. It made no difference what he had said. It made a modicum of difference that the doctor had at least been interested enough to ask some questions about the events of his day, but the interchange was in no way, shape, or form a psychiatric examination. Yet the fruits of this interview would be used to hold him here, possibly for months.

The doctor efficiently finished his examination and then mentioned to Dr. Anderson, that he could get dressed and that someone would be along shortly to escort him upstairs. He then left quickly through the examining room door.

Dr. Anderson dressed and then sat in one of the small chairs in the examining room. His head had sagged and was now held in the palm of his hand. In the earlier days of these sessions, such actions had been followed by intense feelings of controlled anger, which often transformed itself into a situational depression, one of the only diagnoses he had not been given. The previous anger had served no purpose previously other than to provide an energizing force to keep going. As far as Dr. Anderson was concerned, in his nonexpert opinion, he did not consider anger necessarily to be a pathological psychiatric symptom but rather a normal response to injury. At times, anger has within it a certain adaptive and survival component. But at present, anger had little to do with the situation. Anger now had been supplanted by pain. Dr. Anderson had never experienced the conversion of emotional pain to physical pain until he had been incarcerated. He had certainly heard of it in his medical practice, but often, he suspiciously thought of such descriptions as hypochondriacal. Yet his own experience had taught him that the singular act of being incarcerated could produce substantial abdominal pain accompanied by a tightening in the shoulder muscles and the hamstrings that could be so intense as to produce pain.

Dr. Anderson shook his bowed head in disbelief and self-castigation, condemning himself for the stupidity of what had now become something perceived as a stunt. Regardless of the external circumstances, many seriously ill psychiatric patients are conditioned to accept all responsibilities for their actions, whether there is victimization or not involved. If you get shot in a drive-by assault, you were standing in the wrong place.

It would have no relevance that the person issuing the detention order had not spoken with him, or that she was probably no more than a high school graduate. It would make no difference that movie stars and celebrities can ask for the same piece of paper without question and certainly without getting locked up. Also, it would make no difference that national political figures with histories of mental illness far worse than Dr. Anderson’s ever was can apply for concealed weapons and are subsequently lauded, much less incarcerated.

Dr. Anderson knew there was absolutely no future in pointing any fingers at the external world; in fact, to do so would only make matters worse as the examiner would simply claim such statements were a manifestation of the patient’s illness. Dr. Anderson had no real idea why the sheriff’s deputy had filed a detention order, but he actually suspected that it was not so much the fact that he had asked for an application for a concealed weapon, an innocent gesture in and of itself, but rather, his name had come up on the police scanner. It is a little-known fact that in the United States today, the most oppressed class of people is the mentally ill. The statistics are absolutely irrefutable in almost any category. Along with the horrid life that most mentally ill patients live is a societal attitude, that they are something slightly less than a common criminal, or occasionally more but most often less. As evidence to such a statement, if one has been admitted to a psychiatric institution, along with all the post-discharge notifications, one is also sent to the police. The person’s name is entered into the computerized scanner with all the other felons, robbers, carjackers, muggers, and rapists. From that time on, the name of a person with a history of mental illness that resulted in hospitalization will appear on the scanner next to the felons. Dr. Anderson suspected that his name had been run, and his previous hospitalizations noted. It takes little imagination to know what happens when a person’s name comes up on a police scanner. Dr. Anderson had not thought of the possibility until now. In fact, Dr. Anderson had not thought of any of today’s possibilities before entering the sheriff’s department.

Dr. Nick Anderson sat and felt the minutes tick by. Time was not a commodity with any attached value here. Other than the two daily mileposts of lunch and quitting time, time had no significance. Perhaps thirty minutes, or even forty-five minutes, after the doctor left the room, the door opened, and a hospital aide walked in and stood in front of Dr. Anderson. He recognized the man as an aide merely by his physical stature. The man was every bit of six feet three inches tall and easily weighed 260 pounds. He too was dressed in the new hospital uniform of a plaid shirt, faded blue jeans, and work boots. Aides in the hospital were trained in and hired for a singular function in the hospital—to physically subdue unruly patients. Dr. Anderson clearly recalled sitting in a small staff office adjacent to the dayroom of the ward on an earlier occasion. On the walls of the office were fixed many of the framed credentials of the staff. While waiting, Dr. Anderson began reading the certificates. Shortly, Dr. Anderson came across the credentials of one of the aides he had gotten to know. The aide had worked at the hospital since shortly after high school when he had given up a floundering career as a rock-and-roll musician. He had been there twenty-six years. The certificate read, Burton Larger has successfully completed certification in the nonviolent restraint of violent patients. That was it. There was no indication that he had ever been instructed in the rudimentary elements of diagnosis or treatment of mental illness or in basic pharmacology of the medications taken by the mentally ill or had had any training in the appropriate communication with the mentally ill. He was simply and purely trained in nonviolent restraint, and for twenty-six years, that was exactly what he did, sort of the ward’s bouncer, and there were a lot of them.

Other than hand out and collect shaving razors each morning, which the patients were not allowed to keep, and placing a can of juice on the table in the dayroom at 10:00 a.m. and 2:00 p.m., Burton simply sat in the dayroom with one or two of his partners, waiting for someone to make a commotion. Dr. Anderson shook his head in disbelief he had been here twenty-six years, and that was all he had been trained to do.

The aide did not have to say anything. Dr. Anderson stood from the chair and walked out of the door with him. As the two walked along the creamy-tan tiled hallway, Nick Anderson once again noted the apparent solidity of the building. It was stripped of any decorations or adornments. There was nothing loosely attached to the walls, no moveable obstacles on the floor, and nothing done to beautify the cold tiled hallway. Most startling to Dr. Anderson, however, was the apparent solidity with which the building was constructed. Tile and cement blocks and brick built into thick walls gave one the impression that one was in a stark fortress. The walls were so thick and solid, one could actually feel the insulating effect on a hot August night. Walking further down the hallway, Dr. Anderson realized there was absolutely nothing here that even remotely resembled a hospital.

The two approached an elevator at the end of the hall. The controls work only with a key that the aide had. The elevator was called, and the two enormously strong steel doors opened. The two were transported only two floors, where they got off and again walked down a bleak, inadequately lighted hallway. The steel door at the end of the hallway was large, something one might expect to find in a warehouse, and so solid Dr. Anderson suspected that it was more substantial than the jail cell doors in prisons. The aide unlocked the door, let Dr. Anderson into the room, and then locked the door behind him. The loud slamming of the door and the ponderous click of the heavy lock left Dr. Anderson with an uneasy feeling of finality. Dr. Anderson realized he no longer had any idea as to when he would next see the avenue of maple trees along the entryway to the hospital.

The aide parted from Dr. Anderson in the dayroom, leaving him to stand in the doorway. As the aide left, Dr. Anderson briefly reflected on the aide’s function and then sarcastically thought, with all the intelligent people circulating around this campus, no one seemed to recall the simple experimental principles taught in freshman psychology that the incarceration of rats, especially the overcrowding of populations, leads to increased aggression. People were not a lot different. The dayroom was filled with patients. All the chairs were occupied, and several patients were milling about the room aimlessly. An ancient television producing a distorted, incorrectly colored image was turned on at the side of the room, where six patients sat in front of it. In the middle of the room, four patients were playing cards at a table. Dr. Anderson simply stood, waited, and watched for several minutes. Shortly, a female nurse approached. Dr. Anderson recognized her as a nurse only by virtue of the fact that she carried a clipboard. She was heavyset with something of a pretty face and dressed in typical non-dress code apparel. She was wearing a brightly colored patterned rayon blouse, and for some reason unclear to Dr. Anderson, skintight black silky stretch pants looped around her feet. Dr. Anderson wondered momentarily if she knew where she was when he realized the clothes were the fashion of the day for every shape and form. She had no other obvious identification.

The nurse asked Dr. Anderson if he would confirm his name as being Nick Anderson. He did, and then she produced a plastic wristband with his name on it, and then she fastened it to his arm with a metal fastener. Nick Anderson knew that at this particular hospital, one usually learned the identity of the staff by asking someone else what a particular person’s name was. Although Dr. Anderson considered the basic practice of interrogating someone without introducing oneself first to be rude, the last thing he had on his mind that night was basic etiquette. Completing the attachment of the wristband, the nurse explained that the ward was overcrowded, and there were no more rooms available. Consequently, he would have to sleep on a rollawaycot in the dayroom. The nurse turned and left. Dr. Anderson thought that the intake examination the nurse had just taken was about what he had expected.

All the chairs were occupied, the card game was flush, and the television was surrounded, so Dr. Anderson stepped through the door and leaned against the wall next to it. He noticed the time was 10:00 p.m., and he knew from previous experience that all activity would essentially be over by 11:00 p.m. The lights had already been dimmed, as they were throughout the evening in an effort to reduce activity before bedtime. It was now impossible to read. Sadly, the conditions for reading were a nonconsideration here.

Dr. Anderson’s mind began to wander as he waited for the last hour to pass until it struck upon one of the taboo subjects of medical economics—the impact of payment on the type of medical care a patient receives. Noting that he would be sleeping on a cot in the dayroom was of no significant surprise to him, for previous experience had taught him that the hospital was always overcrowded, and patients were generally always sleeping in the dayroom. Although loud voices would always be raised in protest, Dr. Anderson considered the overcrowding purposeful and calculated. The reason was actually simple and had nothing to do with patient illness. Dr. Anderson had been fortunate enough to have been trained at a large well-known university where he had worked in every type of generic hospital in the United States: university, private, Veterans Administration, county, city, and clinics. Each type of hospital and physician has its and his own unique method of reimbursement, though basically, there are only two types. The first type of payment is fee for service under which the doctor and hospital are paid for each service they provide—consultation, surgery, etc. If the patient is satisfied with the doctor, his diagnoses, his treatments, and his rate of cure, he will generally continue to return to the same doctor. If he is dissatisfied, he will not return, and the doctor will lose his income. Hence, the reimbursement is directly tied to the quality of care the doctor provides. This reimbursement system is generally provided in private hospitals. In city, county, Veterans Administration, and state hospitals, the reimbursement system is very different. Payment is made to the hospital in large sums or grants based on capitation. The doctor works for the hospital and receives a flat salary for all his work. Since the doctor receives a flat salary, he does not really care if the patient returns as long as the hospital receives sufficient funds to pay the expenses and salaries. The capitation system consists of the government making a head count of all the patients in the hospital and paying the hospital a fixed amount per head. Thus, the more patients in the hospital, the more money the hospital receives to pay expenses and salaries. Additionally, the longer a patient stays in such a hospital, the lower the overhead of the hospital, because it is generally less expensive to take care of a patient for a long time than a lot of patients over the same time. Thus, in a capitation system, it is beneficial to fill up the hospital and keep the patients there for a long time. As a result, the physician’s allegiance is to the hospital director, who hires and fires him and pays his salary and not to the patient about whom he cares only so much as his ethics dictate. The patient, however, has little choice, because he is most often indigent and must of necessity return to such institutions. Dr. Anderson knew full well he was in a capitation system.

At 11:00 p.m., the lights were turned off, the cots rolled out, and the patients wandered off to their rooms. The cot was hardly a serviceable implement for sleeping. The space next to the cot constituted Dr. Anderson’s space. He undressed in the middle of the dayroom. Sometimes, when you are humiliated, you simply put up with it. Dr. Anderson had descended into hell, and he knew it.

CHAPTER 2

N ick Anderson laid down on the thin lumpy mattress of the rollaway cot through which he could feel the structure of the steel mesh below the padding. A sheet and thin blanket covered Dr. Anderson as he was lying flat on the cot with five other patients in the dayroom. Laying flat on his back, his hands were clasped behind his head. The room was bathed in a dim light as the lights were never fully turned off for security reasons. With the other patients having retired to their rooms, the aides and nurses had already taken over the central table and begun a game of spades, which would last virtually all night.

Dr. Anderson whimsically observed to himself that certain card games were almost certainly linked to specific social situations. If two couples were vacationing at a beach house, the games were hearts and euchre. If one was traveling, it was gin rummy. If one was in the Army, it was always pinochle. If money was involved, it was poker. At the country club it was contract bridge with strict rules. If it was in the mental hospital, it was exclusively a card game called spades. Dr. Anderson had never heard of the game until he was admitted, but he quickly learned the game, which was something of a variation on hearts in which spades were trump. It was the only card game played here by staff and patients alike.

Dr. Anderson could care less what the staff did in the wee hours of the morning, but the problem was that the dayroom was cramped with six rollaway cots that squeezed in between various pieces of furniture. In Dr. Anderson’s case, his cot was positioned in such a manner as to put the head of the bed at the corner of the card table. It was not that the staff playing cards were particularly boisterous or raucous, but the slap of the cards, the usual kibitzing, and the banter of the card game were in no way voluntarily restricted, and hence, they were enough to keep a light sleeper from dropping into slumber. To have the audacity to ask that the conversation be curtailed was to engender a strong look of disdain from the card players. The request was also never successful. Dr. Anderson lay awake on his cot as midnight approached.

Dr. Anderson’s thoughts began to focus on Niamh. Niamh Malone was one of the last people in his life whom he could implicitly trust. Niamh was a beautiful Irish woman whom Nick had met three years ago, and they had essentially been together ever since. Nick Anderson knew Niamh must be growing desperate. Since Nick had been transported halfway across the state of Virginia and was now some two hundred miles from home, telephone calls were long distance. The admitting clerk had not left him with enough change to make a call. Additionally, Nick did not have a calling card number, and Niamh, having moved into a room in a house, did not install a telephone; consequently, Nick could not make a collect call. For now, they were cut off. Nick Anderson had never known the pain of poverty until he had to deal with it during the last three years. It was filled with painful details that could never be understood by the status quo. He knew one of the first questions asked of him by a psychiatrist or lawyer would be, Why did you not telephone Niamh? To give the real explanation would be to invite a judgment of incompetence. Here, no matter how difficult it is to complete a task, the outcome is never gauged by the impact of external circumstances. Failure to complete the task is either incompetence or an indication of mental illness. In today’s world, it is not the magnitude of the tragedy or the circumstances of the tragedy that are deemed relevant, rather, how the patient handles the tragedy that counts.

Nick’s thoughts again turned to Niamh. Again, he thought it had almost been three years since they had met. They had met under somewhat unusual circumstances. Nick Anderson’s life had just recently been rendered asunder. Nick and his wife had been married for nineteen years, and they had known each other several years. They were married before Nick had started medical school, and thus, the two slogged through the financial hardships of medical training. More to their credit, however, they emerged from the medical training with two gorgeous daughters. Nick managed to land a position in a gold-plated private medical practice, and he provided his family with the fruits of a better-than-average medical career.

Four years later, Nick accepted a job with an academic medical institution that had earned an outstanding reputation. Even though Nick had to take a large cut in salary to work in an academic position, his family still enjoyed the income of a physician. They had purchased a beautiful, architecturally unique house, and they filled it with antiques, works of art, and paintings. The children were thriving and well-behaved. Life was peaceful, tranquil, generally fun, intellectually oriented, and committed to the medical profession. Nick thought he had a good marriage, a good family, and a good job. He worked hard at all three.

Suddenly, seemingly in the course of a day, it seemed to Nick that his wife had stepped outside and been bitten by a rabid dog. She had come home with the disease. Actually, the course of events had evolved more slowly over the last year of their marriage. Nick’s wife had become a fist-shaking, shouting feminist. She no longer wanted anything to do with marriage. She adamantly demanded to support herself and prove to the world she could hold her job, raise her children, and manage alone. Having metamorphosed, she was resolutely irreconcilable.

Nick and his wife had been attending psychiatric sessions for many years. Nothing was actually being treated during these sessions; rather, they were a sort of prophylactic observation. The problem Nick faced was that he had sought psychiatric counseling years before, and having done so, he was faced with a medicolegal problem more worrisome to the physicians around him than to himself. Nick worked in a field of medicine that garnered the highest risk of malpractice or, in some places, nearly so. The worry was that should he ever be faced with a malpractice suit, the first question to be asked would be that concerning his psychiatric diagnosis, and the second would be, Who’s your psychiatrist? The consensus was one better have a name. Obviously, it was a different standard from most would be required to meet. Nick thought that it should be somewhat obvious even to the layman, that one would not easily be able to accomplish what he had at work if he were, indeed, mentally ill. Thus, Nick and his wife adhered to the strict schedule of appointments.

During the course of the last year, when more anger was being introduced into the marriage, he began mentioning these arguments to the psychiatrist. The style of this particular psychiatrist was to listen exclusively. Generally, the only thing he said was, Well, I see our time is up for the day. I’ll see you both in two weeks. Occasionally, perhaps three times during the year, when Nick almost demanded an evaluation, a comment, some help, or even a diagnosis, the psychiatrist responded by saying, Well, we all know that both of you have been traumatized. Nick would simply look back at him with a blank stare, trying to understand the non sequitur.

Nick, at one point, perhaps selfishly, thought that his wife’s insecurity, or anguish, or whatever it was, was due to their different educational degrees. He had offered to send her to veterinary school, something she had wanted to do as a teenager. He offered to send her to medical school, but she flatly rejected both offers. She simply wanted to be independent, and Nick, by his virtual presence, was simply in the way.

Nick had come to believe the psychiatric sessions had become detrimental. They certainly were not addressing the problem at hand, and he sensed that the mere act of attending the sessions was bothering his wife. In the twelve years Nick had been attending these sessions, his wife had been accompanying him for six years. There was no end in sight. His wife almost never spoke at the appointments in spite of encouragements and leads. Even after six years, she seemed afraid. With a silent psychiatrist, it was left to Nick to fill in the silence—a role he disliked. Nick had begun to think that his wife felt stigmatized, socially handicapped, and afraid her friends would discover she had been going to a psychiatrist for six years. It was then that Nick conclusively decided that the sessions had outlived their purpose. There had been no problems in the four years they had been seeing this psychiatrist. Nick’s work had been exemplary. Perhaps it was time to terminate the relationship, before he lost something more important.

In February 1988, at their next appointment, Nick informed the psychiatrist that he wished to terminate the relationship. The psychiatrist basically gave no reaction. His wife gave no reaction and said nothing. As the two left the office, the psychiatrist turned in his chair and said, Sometimes these things end in divorce.

Great, Nick thought.

Nick had taken a calculated risk. It was a quiet ride home. When the two arrived home, Nick learned instead of solving the problem, he had handed his wife the detonation cap she needed.

Three steps into the living room, his wife turned and said point-blank, I want a divorce unless you go back to the psychiatrist.

Nick knew that what his wife had just said was not the reason she wanted the divorce but rather the excuse. Nick knew to return to the previous course would solve nothing. He did not answer. One week later, his wife presented him with the initial divorce papers. Nick packed his suitcase and checked into a downtown hotel.

In spite of the fact that very few of the professionals he would subsequently meet gave any credence to the effects of a nineteen-year marriage ending in a total unilateral rejection, Nick knew to the contrary and excused the opinions of others as an ignorance of experience. Given the papers in front of him, Nick had no choice but to hire a lawyer. From the combination of his country club days and through social interactions with his wife’s family, he knew many of the lawyers in town. Embarrassed beyond words by the current circumstances of the situation, he did not want to consult anyone he knew; instead, he chose to research Martindale and Hubbell, a reference to practicing lawyers. Shortly, he found a reasonable law firm with what appeared to him to be excellent credentials. The firm even had a Harvard Law School graduate, a rare commodity in a city where 95 percent of the lawyers came from the local university.

Walking into the Harvard graduate’s office, Nick was quickly seated. The attorney seemed to have a fixed look of half boredom and half disgust. He was waiting for Nick to open.

My wife has filed for divorce, Nick said.

I don’t like the law, the lawyer replied in a snapping tone.

He was referring to the Michigan’s no-fault divorce law. Michigan had been the leader in no-fault everything. Nick knew little to nothing about divorce. It had never been a consideration in his life. For at least two generations, no one in his family had sought a divorce. He had, however, through lip service, learned a little about divorce in Michigan. In Michigan, one could simply walk into court, raise his/her hand, ask for a divorce, and it was granted. One did not have to even have a legitimate reason; it was no fault. It now took almost more time to pay a speeding ticket than get a divorce.

What do you mean? Nick asked.

I don’t like the law, the lawyer repeated, adding, There’s nothing you can do.

Nick did not answer and silently wondered if he had come to the right place.

We will schedule a preliminary hearing, basically to present the papers. Most likely, it will be before Judge Nostrum. I don’t like the judge, he concluded.

Why? Nick asked.

He doesn’t like Harvard graduates, he said.

Great, Nick thought.

After the preliminary hearing, we will be asked to come to a negotiated property settlement, and then in six months, we will go back to court to finalize the divorce, he said in a matter-of-fact tone.

What am I supposed to do? Nick asked.

Pray, he said.

Nick did not like his tone.

Actually, I will need a current financial statement and an appraisal of all your property. We need that for the property settlement, he instructed and then added, Do you want this divorce?

No. I was hoping for reconciliation, Nick answered honestly.

Well, you have six months to reconcile. In the meantime, we have to press forward with these other matters, he said with finality.

The lawyer stood, signaling the end of conference. Nick could hardly believe he shook his hand as he left. During the next weeks and months, Nick tried on numerous occasions to telephone his wife. All such attempts to reestablish communication were greeted with hysterical screaming and admonitions to never speak to her again. As time went on, Nick’s calls became more infrequent.

The loneliness of being cloistered in a small room began to weigh heavily on Nick and did not really improve much after he moved into an apartment. As an antidote to his solitary confinement, Nick began to travel, partially to retrain himself. He traveled to medical conferences in Williamsburg, Virginia; Washington, D.C.; San Francisco, California; and the university in his hometown of Larriet, Michigan, and he had planned a later trip to Paris, France. To Dr. Anderson, traveling was somewhat therapeutic.

Halfway through his exile of separation, Dr. Anderson received a curious package in the mail. The envelope contained two glossy brochures and an application for an auto racing school. The school was slated to last three days in New York and consisted of learning to drive small open wheel, open cockpit Formula Ford racing cars. The invitation fit squarely into Nick’s childhood Walter Mitty fantasy. Without ever even attempting to answer why, Nick’s favorite athlete had always been the Formula One driver. Nick’s unexplained adulation had followed him through adulthood. In spite of the fact that Nick had played college football and had been on the high school swimming and golf teams, the Formula One driver had always remained the ultimate sportsman to him. Looking at the glossy brochures, Nick thought this might, in some way, satisfy his lifelong curiosity. He picked the application, filled it out, and sent it in with a check. The school was to start one month before his divorce was to be final.

Nick loved driving his BMW through the back country roads of Ohio, the mountains of West Virginia, and the rolling hills of outcropped rock in Western Upstate New York—an event he found far more interesting than driving a straight line along the concrete slabs of interstate. For Nick, he could not shift gears enough to keep his interest up. He drove straight through to the racetrack in Bridgemouth, New York, and in spite of being tired, he decided to go to the track instead of the motel, just to see if anything was happening. To his pleasant surprise, something was. A Ferrari club race was in progress. There was a scant crowd, mostly relatives and friends, watching, thus enabling Nick to drive his car up to the barrier guarding the inner portion of the track. He got out and watched for a while. He was dressed in a brown tweed sport jacket and brown wool pants, appropriate for the fall weather.

Unbeknownst to Nick, Niamh Malone was standing by the barrier several yards down the track. In watching the cars drive by, she had noticed Nick standing by his car. Her eyes lingered for a while and then concluded, Arrogant.

Reciprocally, Nick did not notice Niamh standing near the center of the straightaway. Tired from the trip, he left after work Friday evening and drove straight through, arriving Saturday afternoon. Nick got back into the car and drove to the motel.

The next morning, Nick drove to a small restaurant, The Oasis, in the middle of one of the many resort towns that dotted the area. The restaurant was full, and there was a substantial line of customers waiting. Nick slowly progressed to the head of the line. Turning absentmindedly to check the line, Nick’s eyes engaged those of a woman two customers back in line. It was Niamh. She looked at him with a gorgeous broad smile and then asked him, Do you know who won the World Series game last night?

Nick returned the smile and said, No, I’m sorry, I don’t.

The conversation was interrupted by the waitress who had come to seat Nick. He was seated at the counter next to two older men who were finishing their breakfasts. Nick had picked one of the thin free local newspapers stacked at the end of the counter. The restaurant was something of a workingman’s rendezvous, filled with local businessmen, shop owners, and some early-rising tourists. It was the sort of restaurant that had probably served a million eggs over easy, hash browns, sausage, and coffee. As such, Nick quickly ordered his breakfast, and as soon as he did, his coffee was placed in front of him. Silently, he began reading the local paper. Shortly thereafter, the two men next to him paid their bills and left. Within a minute, two customers were seated next to him. They were the women standing behind him. Nick diverted his attention from the newspaper and looked at the woman next to him. Her face was stunning, simply beautiful. It was a softly sculptured face with high cheekbones that were covered with flushes of pink skin that was otherwise ceramic clear. Her deep brown eyes gave her an air of mystery. Her hair was delicately tinted, short, and blond. Her smile was absolutely engaging, a gift of nature, producing an expression so powerful it drew one into her world.

What are you reading in the newspaper? she asked politely.

Nick half laughed, and then he said, I’m reading about whales. Hesitating, he continued. The whales. It seems here the local townsfolk are very conscientious about their whales. They count them every day and publish the count in the newspaper.

She looked at Nick coyly as if to say Is that the most exciting thing you can find to do?

They both laughed softly. Nick’s breakfast arrived, and the two ladies placed their orders. The woman next to Nick turned to her right and asked, What are you doing here? I can tell you are a tourist.

Nick smiled and asked, How do you know I am a tourist?

Because you’re not wearing a plaid flannel shirt, she added.

Nick laughed, and then he added, Right. You’re absolutely right. The truth of the matter is I am here for an auto racing driver’s school.

The one that starts Monday? she asked.

Yes, that’s right. How would you know about such a thing? No offense, please, Nick commented.

My brother is a professional auto racer, and he manages the track. Today they are having a Ferrari Club race, and Monday, the school starts. We came up for a change of pace, or change of life, or whatever you call it. Are you going to the track this afternoon? she asked.

Yes, I thought I would, at least for a while, Nick answered.

Perhaps I’ll see you there, she concluded.

Nick had finished his breakfast, paid his tab, and stood. Nick somehow regarded the encounter as an abstract, neutral meeting. The last thing Nick had on his mind was another woman. As Nick backed away from the counter, he smiled at the woman and added kindly, Perhaps I’ll see you at the track.

Yes, perhaps we’ll meet, she answered.

As Nick stepped out into the October sun, he noted the small town was magnitudes beyond quaint. There was not a hint of franchise stores on the main street. All the shops were unique entrepreneurial boutiques, gift shops, specialty shops, and antique shops. Nick spent the morning browsing through the shops and purchasing some early Christmas presents. He bought a cut glass bowl for his sister, two tall cut glass beer glasses for his brother-in-law, and an antique French perfume bottle for somebody. At noon, Nick returned to his motel and deposited the gifts in his room. He then left and drove to the track.

Nick parked his car in the same place as Saturday, got out, and walked to the inner track barrier. The cars were driving around the track in a somewhat haphazard manner, warming up. Nick had been standing at the barrier only a few minutes, when he noticed the two women from the restaurant approaching. The one with whom he had spoken to earlier was leading. The sun was configured almost directly behind her and caused her hair to sparkle in an array of glinting light. Once again, he found her stunning.

Hi, she said brightly.

Hi, Nick repeated, asking, Is your brother racing today?

No, not today. He’s here only in his official capacity as manager of the track, she answered.

Nick paused for a moment as the two stood quietly.

My name is Nick, Nick Anderson. Dr. Nick Anderson, actually, he said, stammering a little, and then extended his hand.

Arrogant, she thought again as she extended her hand.

My name is Niamh Malone. I’m very pleased to meet you, she said as she clasped his hand. His grip was warm and gentle, and feeling his grip, Niamh suddenly knew she liked this man. The two held the grip for a moment and then released it. Niamh turned partially and extended her hand toward the second woman, who up to this point had said nothing.

I’d like you to meet my friend Norma Cummings. She’s my brother’s girlfriend, Niamh said.

The two smiled at each other and shook hands.

Pleased to meet you, Norma commented.

Yes, very nice to meet you as well, Nick added.

Silent, all three turned their gaze toward the track and watched the cars go by, hitting their peak speed on the longest straightaway of the track directly in front of them. The loud whine of the engines made it difficult to carry on much of a conversation. It was relatively easy to identify the fastest cars as they were the most stable at the highest speeds. With the lesser cars, at top speed, the front ends began to wobble and waffle, destabilizing the cars slightly and causing the drivers to back off their acceleration. Niamh did not particularly like to watch all the cars accelerate through the long straightaway and would often turn her head as a car approached, which she did not like.

"Niamh