“In other words, in your opinion I’m better off seeing a shrink on the outside than I’d be if I entered Graceland State as a patient.” There was a certain triumph in Carnell’s voice. “Well, it happens that I’m broke. I can’t afford to be psychoanalyzed by some hundred-bucks-an-hour private shrink.”
“That isn’t necessary, Mr Carnell. If you wish, I can make an appointment for you to be seen on a priority basis this Monday at your community mental health clinic in Franklin; Dr Liebman there is an excellent therapist. Or if you prefer, I can make an appointment for you at the medical school to be seen by the psychiatric outpatient service.”
“I’m a tax-paying citizen of this state, Dr Marlowe. Why are you refusing me treatment in a state facility?”
“I’m not refusing you treatment, Mr Carnell. I frankly do not believe that hospitalization would be beneficial to you. If you would prefer to receive treatment at Graceland rather than in your local community, I will gladly make an appointment for you to be seen Monday in our outpatient clinic.”
“Suppose I don’t care to wait until Monday for medical attention.”
“Mr Carnell, you must understand that our facilities here are limited. Our primary task is to care for the severely disabled patient, the chronically ill. Patients whose problems can best be dealt with without hospitalization are directed toward more appropriate community programs.”
“Dr Marlowe, I can’t wait until next week for you to shuffle me off to some community agency. I can’t keep going on like I have these last weeks. If I don’t get help now I’m afraid…”
He paused to make certain Marlowe was giving his undivided attention.
“Well, I have quite a collection of sleeping pills. Tonight I feel like taking them all.”
“I have some papers you’ll need to sign,” Marlowe said.
After 2 am Marlowe let himself into the employees’ snack bar. It was nothing more than a cinder-block room, walled with vending machines, furnished with plastic tables and chairs about the color of tomato soup that’s been left too long to cool. It differed from the patients’ snack bar in that the plastic tables and chairs were not bolted to the tiled floor, spectators did not gape at the machines in slack-jawed hopefulness, and the drugs that changed hands were of better quality. There was also a microwave oven.
The oven was Marlowe’s solace during hungry nights on call. Underhill was a town too small to support a single fast-food franchise — something of a blessing in that otherwise Allen’s Eat Good Food would no longer be serving home-cooked meals at family prices (the last Blue Plate Special known to Marlowe), nor would the Ski-Hi Drive-Inn still be making malts out of real ice cream and frying greasy hamburgers made of hand-shaped patties (all in a decor that left Marlowe humming medleys of Andrews Sisters Hits). Underhill was also a town small enough to retain a blue law, and on Sundays even the Fast Fare convenience store was closed. The employees’ cafeteria, in any event, closed for the weekend, and the outer world was closed to Marlowe beyond range of his beeper. On occasion Marlowe might escape Graceland long enough to grab a meal at Allen’s or the Ski-Hi, but on Sunday, the day Marlowe hated above all days, if he were to have a hot meal, he must cook it himself.
There was a stove and refrigerator for staff in North Unit’s administrative section, but Marlowe was one of those bachelors for whom cooking was a forbidden art. Marlowe had only hazy memories of a youth before college and medical school, and whether the food put upon his plate was doled out or paid for, Marlowe regardless had had no thought to spare as to its conception. In his office Marlowe kept a hotplate and various cans, the sins of whose preparation were concealed by virtue of a large bottle of Tabasco sauce. With the microwave oven, Marlowe felt a competence somewhat akin to the laboratory.
For this weekend, Fast Fare’s frozen foods counter (Marlowe understood two classes of foods: canned or frozen) had supplied him with a carton of Western Steer’s Hungry Cowhand Rib-Eye Filets. These Marlowe had retrieved from North Unit’s refrigerator and now fed to the microwave. He punched buttons at random, drawing tired satisfaction as the blocks of frozen beef stuff turned a pallid grey and began to steam. A clatter of quarters excerpted the last two Reel-Keen Cheez-Burgers from a vending machine. Marlowe filled each stale bun with a partially thawed segment of Hungry Cowhand, placed his mutant creations within the microwave. The cheese-food was just starting to melt when his beeper interrupted.
Marlowe ignored its summons until the microwave’s buzzer announced the perfection of his cooking artistry, then picked up the snack bar phone and dialed. It was North Unit, and he’d just made the seven-minute walk from there.
“Dr Marlowe, this is Macafee on the admissions ward. I’m afraid we’re having some problems with that patient you just admitted.”
“Which one is that? ” Marlowe had had eight admissions tonight, and they began to blur together.
“Frank Carnell, sir. The suicide attempt from Franklin.”
“What’s the difficulty?”
Macafee was a Nam vet and continued to regard doctors as officers. “Sir, this patient is non-cooperative and abusive. He’s objecting to the suicide precautions you ordered, he claims someone has stolen a cassette recorder he had with him on admission, and he demands to speak with you immediately.”
“D/W he have a cassette recorder when he was admitted?”
“No sir. Only a small canvas bag containing clothing and personal articles.”
Marlowe tried a mouthful of steaming steakburger, decided it needed catsup. “I need to stop in at the med unit, then do an admission at the ARU. I’ll try to look in on you in between. Meanwhile it might be best to place Carnell under sedation and seclude if necessary. I believe I wrote a PRN for p.o. Valium?”
“Yes sir, you did. However, Mr Carnell has refused medication. ”
“Then write an order for Valium 10 mgm IM stat, then Valium 5 mgm IM q 3–4 hours times 48 hours PRN agitation and anxiety. I’ll sign it when I stop by. You already have a PRN seclusion order with the suicide precautions.”
“Dr Marlowe, Mr Carnell claims that as a voluntary patient he should not be on a locked ward and that we have no right to force him to take medications.”
“An argument the patient advocates have often raised,” Marlowe said. “However, Mr Carnell is an involuntary admission. I suggest you observe him carefully for further signs of delusional behavior.” Late at night Marlowe owned the corridors. They stretched in fifty-yard sections from brick unit to brick unit. After 11:00 pm only every third fluorescent ceiling fixture was left on, leaving the corridors hung with darkness in between the flickering islands of light. The corridors were entirely of tile: discolored acoustic tiles for the ceiling, glossy ceramic tiles for the walls, stained asbestos tiles for the floor. Marlowe wondered how such a manufactured environment could still stink of human filth and hopelessness.
Marlowe paused, not breathing. It was 4 in the morning, the hour of the cockroach, an hour before the keepers of the graveyard shift began to prompt their cares into a semblance of reality to greet their breakfast and the day shift at 7. He listened.
The roaches here were larger than any Marlowe had seen since an age when dinosaurs were but a fanciful gleam in a tree fern’s eye. He could hear them as they scuttled along the worn tiles of the long long corridor. Some, intent upon a smear of feces lodged within a missing bit of broken floor tile, were reluctant to flee his approach.
Marlowe stomped at them, withheld his foot at the last instant. The roaches scattered halfheartedly. It was, perhaps, an old game. Marlowe heard the silky rustle of their reconvergence as he silently passed by.