The heat waves rise from the steam radiators inside the Veterans Administration graduate student housing. Revelry and reverie occur at 6 AM and the public showers lie too far away.  The Wracks settles for a sponge bath, a shave and then a tooth brushing.  The white smock covers the clearance clothes no one sees anyway.  In line at the cafeteria with patients in bedclothes and ragged edges for the sumptuous military repast.  One egg, one piece of toast, a pat of butter, a cup of coffee, and a glass of chocolate milk for desert exists as the morning fare. “Can I have another egg?” asks the Wracks?   The food server looks at him and she says, “No, it will make you fat.”   The Wracks moves on with the other residents in the cafeteria at a bunk table in a large hangar room converted to restaurant. Everyone smokes.  A patient dressed in a bathrobe and jeans comes over to Dr. Wracks and begs for a cigarette.  He gives   him two. He lights one up in front of Wracks, smiles, sticks the other over his ear on the side of his head, blows a smoke ring and moves on.  We meet today in the main observation area at seven hundred hours.

       Schizophrenics do not seem so bad.  For the most part they look the same as normal people, smile and wave to the Doctors as we come in.  There are exceptions.  The exceptions have private suites for everyone’s safety.   Dr. Lecter introduces me to a Viet Nam Veteran who is cross dresser and sits immobile for prolonged periods of time.  He is the one that broke Dr. Sheldon’s nose.  This patient is an afro American on the gaunt side.  He wears a long evening gown with a pearl necklace and earrings.   His hair is cut short Marine style.  Mr. O, this is Dr. W and he will be interviewing you today.  Should I have an absence, he will be the one interfacing with you. 

    “Hello Mr. O.   My name is Dr. W. How are you today?”

Silence

“Mr. O, be at liberty to tell me if your medication is correct and you feel well each day.  Should you desire more or less, let me know.  If your jaw clenches tight, let me know.  If you can not sit still, let me know.”

Silence

Mr. O smiles at me and says “I like you.  I hear you have good hands.”  Dr. W says, “thank you for the compliment.  If you have anything else to say or want me to write in my notes please speak now.”

Silence

“Good day Mr. O, I will see you tomorrow around the same time.”

“Bring me some cigarettes,” he says. “I like Marlboro too.”  “I will not forget,” says Dr. W.  Dr. W slowly, slowly, slowly rises from the interview chair and moves backwards keeping an eye on the patient at all times without maintaining direct eye contact. 

“What do you think about Mr. O?’ says Dr. Lecter.  “Undifferentiated, with catatonia and lack of affect.”  “That is what I think too.” Smiles Dr. Lecter.  “Now I want you to meet Mr. M.  Mr. M. is a chronic patient with catatonic schizophrenia.  He rarely moves in the presence of anyone.  The reason he is a chronic patient is because he likes to hang from the ceiling and fall on people.  He is a violent offender.  In his presence, move slowly and never ever take your eye off his body until you lock the ward door with your key.  Back away from him and never let him get between you and the door. When the lock clicks on the door, then you can turn away.”   Mr. M. sits in a chair, alone in a room covered with white bed sheets.  One arm hangs down low and the other is wrapped around his neck.  He does not move.  Like a statue, he sits there and does not move.  His breathing is imperceptible and his eyes never blink.   “How are you Mr. M.,” says Dr. Lecter.  Silence.   “If there is anything, I can do for your please let me know.” Says Dr. Lecter.  Silence.  “We are leaving now.  See you tomorrow.”  Silence.  We both back away to the door and Dr. Lecter takes the key hanging on his neck while the Wracks view the patient and opens the door.  As we slip outside the Wracks hears, “Goodbye.” From Mr. M.  When the door lock clicks he looks into the room from the observation window above the door handle.  Mr. M. has moved.  Both of his arms lay at his sides as if in preparation for a leap.  The chair has moved a quarter of a circle towards us.   All this happened in ten milliseconds of time.   “Let me remind you to never let him get between you and the door.”  The wracks nods and say, “I understand.”   “Let me now introduce you to a football player who occasionally becomes violent. He is a famous defensive lineman.  When he gets mad he picks up whoever angers him and throws them through a window like a softball.  Do not make him mad.  The reason he is here now is because he threw his wife and her family out a three story window into the street. I maintain him on an indoleamine alkaloid antipsychotic agent called Moban.  Use this drug for violent patients.  Moban works well.”  Mr. G. is a large afro American about six four or six five in height and extremely muscular.  He is famous for tackling fast running backs and hurting them.  “Hello Mr. G. how is you today?”  Mr. G says, “Fine, I like my Moban.  When can I go home?”  “When you are stable, we will send you home Mr. G.” says Dr. Lecter.   “I hope that is soon,” says Mr. G.  He pulls a cigarette from a package on his front pocket, lights it, takes a long inhale, blows it out and says. “See you later.”  He then walks towards the television set and watches the broadcast standing while smoking his cigarette.  “Interview your patients every day, write notes and advise me if a change occurs.”   “Do not change their medication without asking me.”  Says Dr. Lecter.   “See you tomorrow. I have to meet some private patients in my in town office says Dr. Lecter.  He walks off seamlessly and disappears into his office as the door clicks shut. We have missed lunch so the wracks go back to my room and review his notes and read again the notes Dr. Lecter presented to the group. He will see my comrades at six in the dinner line.  We all are dispersed in the many wards and places around the Veterans facility. Dr. Wracks locks himself into my little room and smokes.  I do not want to miss dinner.  Winter still exists outside and the cold seeps in through the cracks in the insulation.  The steam radiator radiates heat and a light mist escape from the relief valve on top of the unit.  Dr. Wracks has learned to quick dry shoes and underwear on the steam radiators. he pulls the reading lamp close to his face to illuminate the pages of my notes, his notes and medical texts.  Time goes by quickly and it is time to get the one plus one plus one dinner.  Main course plus a vegetable plus a starch and cool aid from the huge beverage coolers.   Food tastes good and tastes even better when a person is hungry.  Tomorrow will occur soon enough. He does not want to provoke it.  Now at night in Pookipsie, upstate, ensconced on the road to a career and maybe a new beginning, Dr. R sits by himself with his reading light and cigarettes.

Remember says Dr. Lecter, Proscribe your anti-Psychotic agents with side effects opposite to the patient’s overt behavior, not their diagnosis. If a patient gets violent administer 100mg of Benadryl I.M.   See you tomorrow.

The train to Pookipsie is a slow easy ride beginning in Grand Central station.  Underneath the huge coliseum of trains, the engine snakes and skittles across classic upstate countryside. Brownstones come into view and vanish and there is some green in-between the snowdrifts slowly melting in the end of a late winter and beginning of a beautiful spring blossom.  Somewhere near the classic town of Pookipsie, lies the biggest Psychiatric facility in the United States of America.  At least it was.   Now I hear the huge veterans’ facility near Pookipsie is closed down, shut up and the subterranean tunnels filled with snarling rodents and slithering serpents.  The classic tunnels were devised to connect the buildings for communication and transportation even during the heaviest winter storms. Now the Wracks is here and the Head of Psychiatry at the Veterans administration welcomes us for a ten-week tour of duty at a Psychiatric facility lockup. The chief of the facility is a tall handsome man with silver hair.  His looks are marred by Popsicle sticks protruding from his nose splinting it securely.  Unfortunately, the chief had a mental lapse and got too close to a florid patient.  The patient was a black belt in Okinawa Karate and smashed his nose to pieces with a powerful back fist strike. He could be our next president.   The Popsicle sticks did not impair his diction as he welcomes us.   He says he will be in and out of his office during the week and that our liaison and mentor during our intern rotation will be Dr. H. Lecter M.D. 

     We meet Dr. Lecter at his office.  He sits in a space with a huge desk, a couch and a library of a thousand books.  The books are like a bullet proof barricade shielding him from the outside and reality.  He turns to us and passes out lecture notes.  He says these notes will help us identify neuroses and Psychoses before the behavior eludes us.  We are to memorize the notes because the knowledge might save our lives.   The Veterans facility is a Psychiatric lockup.   At the end of each hall is a huge oak door with a large deadbolt   the interns are to enter a corridor and close the deadbolt before proceeding further.  During the week huge wrestlers acting as Psychiatric aids will let us in and out of each level as we identify ourselves at the small window in the middle of the door.  It is our responsibility to make sure the door is locked behind us as we progress and transgress the environment that will soon be ours. Any failure to maintain security overtly will result in instant termination as some of the patients are violent with criminal records. The majority of patients are Veterans of foreign wars.  The minority are horrible curiosities too dangerous or too strange to be allowed to live in the community. Dr. Lecter is a man of average height like the Wracks.  He has long straight jet-black hair, like the wracks.  He moves and floats across the room.  He assures us that what we learn and see here will remain with us for the rest of our lives.  We are to eat with the patients because they have to see us to trust us.  Other wise there exists no reason why they shouldn’t attack us.   In the main cafeteria, we eat in the Doctors area, immediately next to the patient area.  We are to wear our white smocks everywhere as they identify us as professionals.  We are to shave or trim our beards neatly and keep our hair short.  There can not exist any interaction with the patients in public.  All communication must be in a public area or consult where the cameras can watch and alarm security if a patient becomes homicidal. Dr. Lecter assures the group he will be near should some excitement ensue. He introduces Dr. Beck.  Dr. Beck has black hair but is tall and lean.  He must be the protégé of Dr. Lecter.  Dr. Beck looks too serious to fool around with.  I note this instantly and file the anagram in the dominant temporal lobe.  Dr. Beck states that if we have any problems to come and see him during weekday hours. Now we will meet the staff.  Two huge psychiatric technicians patrol the unit.  The nurses sit in a guarded station with bulletproof glass and a ticket terminal to distribute psychiatric drugs to inmates.  Both aides are wrestlers but work only nine to five during the week.  On weekends the staff is skeletal and the interns must patrol the unit to insure all patients are present and that no one is hurt or killed by another patient.  During the day in the winter most patients sit in the recreation room and play ping pong, deal cards or watch TV.  Most of these people are normal looking except for a cross dresser who sits inordinately still and a huge African American football player who plays on a national championship team as a defensive lineman. Most of the patients turn to the interns and wave in validation.  They are used to being surveyed, assayed and evaluated for their behavior that really is not their fault. These people are casualties of society and their behavior is too violent or exaggerated for them to continue to lead functional lives in the community.  Some are Viet Nam veterans who have a disorder called traumatic stress syndrome.  The affected patients have flashbacks to situations the soldiers encountered in the jungles of Viet Nam.  Psychologically the reason for the traumatic syndrome is the psychoses induced by being forced to witness the killing and torturing of hundreds or thousands of civilians close at hand.  Some of these soldiers were forced to kill thousands of innocent people because they harbored the Viet Cong.  Some soldiers who served our country in Viet Nam could never readjust to civilian life because of what they witnessed or were forced to do.  The soldiers with traumatic stress syndrome come and go in this Veterans facility and it is their second home and the Nation pays for the burden of the horrible destruction of a thankless war.  The interns move on.  Soon lunch arrives and we head to the cafeteria.  The long hours of internship are broken by a meal. Army style the interns get in line with the patients and we are given a ration of provisions that will maintain our health.  A sandwich, potato chips, and some raw vegetables are it but we can get refills of orangeade or lemonade from the coolers.  I ask the distributor of food why we are given so little.  “So you do not get fat.” She speaks.  A patient grabs my sandwich and walks by.  We eat together, the eight of us and then move to our quarters to move in.  We each have a little nook with a bunk bed like the quarters on the “MASH” show on television.  The wracks are expecting Hawkeye to appear out of nowhere and make him look ridiculous.  This never happens and he resigns himself to books, cigarettes, and packets of instant coffee to be used sparingly.  The facility sells cigarettes at the canteen for Armed services prices.  The quarter master, who looks like Napolean Bonaparte says he will sell me several cartons at this price because he likes me.  He looks like the general in the 20^th century and the wracks does not react and accepts the gift with humility and rancor.  Back in the pigeon hole, the wracks light up a Marlboro and begin to memorize the notes.  The Wracks is up late and his niche fills with smoke and he put out a butt and falls  asleep by himself, waiting for reverie at 6 hundred hours military time tomorrow.

A very successful man once told the author that the key to success in business is-the ability to turn chicken shit into chicken salad.   The guru of nuclear physics also said-get a map of all the bagel shops in New York state.  This verbal utterance leads the reader to the photoelectric effect.  This effect which won Mr. Einstein the Nobel prize of physics in 1925.  In the photoelectric effect, light of varied wavelengths that impinge upon alkali and alkaline earth metals of sufficient wavelength and magnitude, cause an electron to leave the outer orbital and fall to a lower energy state liberating energy.   In essence, light shining upon a pure metallic element creates a current when the substrate is hooked up to a circuit.   The wavelength and the metal chosen, in a pair, create an endless battery.   For example, visible light and metallic lithium in a circuit produces electricity.  The electricity can be used to power electronic devices.  In this study, radioactive waste, notably cesium 137 and Strontium 90 which are strong gamma emitters produce gamma photons that can cause a photoelectric effect in an alkali metal, when in circuit, and this becomes a natural battery.   High level radioactive waste, emitters with a half-life 30 years, can power spacecraft and other applications with an almost endless array of electricity, suitable for deep space missions. 

Like Thomas Edison said- genius is one percent inspiration and 99 percent perspiration, the correct metals can be matched with the appropriate wavelengths that liberate electrons and mankind has a battery that does not need to be recharged and last thirty years.  Battery powered robots can pioneer new paths in scenarios where the common man cannot live.   This gift might lead humankind into places thought unknown and uninhabitable.  Just like anything good, it takes a lot of work.  Just do it.  Start working.

Battery technology is not just lithium in a colloidal gel that explodes when it is overcharged.  Battery technology is more and in front of everyone’s face on the periodic table.  We just have to try and never give up, and an angel might speak the secret of the universal wave equation into someone’s mind and the human race can move to a new planet once the sun burns out.  

The temperate forest is green and un- impenetrable and blends into huge mountains and hidden valleys.  The sea undulates in greens, blues, greys and browns and boiling whites and seems to move on endlessly.   The vast deserts and plains lead to cities and nowhere under a tumultuous sun.  With all this beauty that surrounds us, it might be time to play with lasers and high energy electrons.  It gets old getting drunk and smoking pot and dreams exist on an expansive event horizon into eternity.    Gee Whiz, what’s on YouTube tonight?

At eleven P.M the nursing night shift arrives.  The charge nurse enters through the main door and the four nurses sit in the nursing stations and discuss the seven patients in the ICU.  The charge nurse leaves and within the next fifteen minutes the night shift evaporates to a small kitchen at the front of the unit near the main door.  They lock the door and draw the shades.  The fluorescent tubes glow within and the smell of coffee permeates the ICU. Dr. Wracks is alone, and on call as a surgical resident at the Amityville general hospital.  The clock shows 12 A.M. and his orders are to cover the surgical floor, the obstetrics gynecology surgical unit and the pediatric oncology unit here.  No one is in the ICU except Dr. Wracks. Sit with the comatose patients and watch the heart monitors. Watch intently.  Adverse reactions evidence on the EKG.  The heart monitors display their green lines and a red-light pulse with each heartbeat for each patient on the verge of life or death. The respirators puff at inspiration and gasp at the expiration as a filmy foggy mist exits the respirator regulators.  Dr. Wracks orders are to survey the patients and report any neurological disturbances that might herald death such as decerebrate posturing and agonal respiration through the thoracic muscles.  Normal breathing is diaphragmatic and using the accessory muscles of respiration signals anoxia and a consequent cardiac arrest.  Decerebrate posturing happens when the brain does not receive blood any more. Then the patient curls unto themselves and dies. Alongside the most critical patients is a crash cart. The crash cart is a metal box full of syringes, needles of varying sizes and a myriad of heart drugs, mostly epinephrine. The lights are low and one fixture pulsates with a dying light.  Dr. Wracks has to note this and tell physical plant at first light.  Dr. Wracks never really felt at home at the ICU because everything, all parameters were taken away and placed in God’s hands. During the day Dr. Wracks would have to rush in and take an arterial blood gas of a respirator patient and bring it to the cigarette smoking technician locked within a little room down the hall with three machines and a coffee urn. He would take the blood, blow smoke at Dr. Wracks, say thanks and then close the door.  The rest was in God’s hands.  Tonight, the fifth pathway student is alone, as he is always alone and left with a thankless job.  Every man must know his limitations and his limitations are that this body requires much sleep that he has not gotten in six months. He is on call every third night and call begins at 11 P.M. He must visit all units at least once during the shift and catch what sleep he can.  Dr. Wracks never really sleeps because fate wakes him up before he enters REM sleep and he is never satisfied.  Most surgical patients require a sleeper medication and those pre-operation and post- operations are at risk for respiratory arrest if Dr. Wracks give too much.  The anesthesiologists caution him before to be prejudicial and withhold medication. The patients moan and look at Wracks with wide scared eyes and beg to be put to sleep.  Oxacepam does not work as the books state.  Dalmane is the only thing that works and 5 mg may not be enough and the patient begs for more; Dr. Wracks signs a requisition and give five more.  The nurse administers it in his presence.  Wracks leave and try to get more sleep. He is tired of smoking cigarettes and drinking coffee, especially at night because he becomes irritable and short tempered. he exits to my call room, close the door, and barricade it with furniture so no one can enter silently.  Sleep is always short and a nurse bangs on the hardwood door until Wracks emerges. Now is the second run through the hospital and the Wracks enters the ICU.  It must be two AM, and the lights are dim, and the respirators puff, the monitors skew and the red lights blink.  Sometimes He imagines a dying patient turns to me and smiles out of the corner of his eye. He turns around and they are asleep once again. The quiet deafens, the red lights blink and the respirators puff.  The nurses lock themselves in the kitchen. Another patient seems to open their eyes and beckon to the Wracks but when he turns around, they are asleep.  Once a human being is at deaths door, they ask everyone around them not to bring them back, and when there is an arrest, a surgeon moonlighting in the Emergency room appears and starts the procedures.  They inject epinephrine, calcium and more and use the shockers to start the heart beating again.  When the patient dies, they all seem to have a wan smile on their face because they know their will be no more, pain; anguish, despair, or disappointment and Dr. Wracks says a prayer and wish them God speed. Nothing is going on in the ICU tonight.  Dr. Wracks has not met God and he does not think he wants to.  The eerie glows and the shadows and the weird feeling that appears at night here are an effect of hopelessness and finality.  He exits the unit through the front door and wait in the hall for someone else to come out or enter.  No one does.  He is told to use the stairway at night.  The wracks do not know why. He does not want to know why.  Entering the pediatric Oncology section, he lingers as to make sure the poor children condemned to suffering are comfortable and not vomiting.  If they are, Dr. Wracks contacts the oncologist attending by hall phone and waits until they arrive. The kids are at rest and a single nurse sits in the station reading a book. She smiles at Dr. Wracks wave and walks by.  Back to the surgical ward on floor three Dr. wracks looks for a bag of tea and put a traveler boiler probe in the cup with it.  A tall man with a small black book enters the unit. He is greater then six feet and wears an expensive suit.  He looks at the book, then at the room number and enters a suite. Dr. Wracks follows him in.  He is sitting next to a surgical patient.  The Wracks walks over and examine his badge that he wears on his left lapel.  Everything seems to be in order.  He is a bonafide licensed member of the hospital. He looks at the wracks and gestures as he looks at my badge too. He does not know what he does but the credentials are in order.  Rocking the boat will get him trashed. He departs.  He enters his call room and barricade the door with furniture.  the watch says 3:30 A.M. He takes his pager and pulls the batteries out of it and set it on the bureau.   He hangs his smock on the door and crawls into a small bunk bed.  He pulls the covers over his head and says a prayer.  Now I lay me down to sleep……  Surgical rounds begin at seven A.M and dr. Wracks will be in surgery from eight A.M. to at least 2 P.M. non-stop.  he wonders if this is the life He really want and if he will make the cut. Sleep overtakes him again.  As he drifts off, he imagines he hear a hand trying to open the handle on the door. Then he is asleep.  The silence, the unduly silence pervades and detracts, the nurses hide, red lights blink, someone dies, someone lives, and in the quiet life begins again.  The ICU can wait, and the chief of staff who chose Dr. Wracks to command the ICU during his sabbatical is a fool.