On the bulletin board in the staff area is a notice. The notice reads, “All residents and fifth pathway students report to Dr. Beck’s office at 0700 today.” The whole gang of Doctors crowd into Dr. Beck’s small room with a huge brown desk. Dr. Beck reports, “Everyone must leave the complex by 1500 today or stay here the weekend. A huge winter storm will drop at least eight feet of snow tonight and leaving otherwise will be impossible and dangerous. Make all preparations for evacuation now. The clinic will resume on Monday or Tuesday when the snow blowers clear the roads. Any Questions?”
“What if you have no place to go?” asks Dr. Wracks. Dr. Beck says, “Anyone staying will assume the duties of the regular staff and remain in general quarters. The cafeteria will be open at a reduced level on standard meal times.”
Working in a Psychiatric hospital is boring. As long as a person integrates protocol into a mindless act, the rigmarole gets boring. Open the doors and make sure they are closed as a person exits. Genius experts evaluate each patient individually and place them on appropriate medication. What a clinical Psychiatrist does is watch for side effects of a particular medication and administer antidote or note overt change. Any dramatic change of a patient’s behavior in any way indicates failure to take the medication or evolution of florid psychoses mandating a change in pharmacotherapy. Most patients after evaluation and medication do not change very much and the evaluation of these patients becomes automatic and quick. The main exceptions are split personality, catatonic schizophrenia and undifferentiated Schizophrenia. A clinical physician treats all patients with these conditions gingerly, as stress precipitates psychoses with a violent outcome. Once a patient becomes violent he or she must be restrained, paralyzed with medication, and if no remission ensues ultimately terminated. To be a clinical Psychiatrist a physician must be highly intelligent to memorize the pharmacology of the medications and recognize symptoms, the side effects of the medications and the antidotes or remedies for treatment failure. A clinical Psychiatrist must be religious because mental patients in a high percentage are doomed to a precarious existence for life. Once a patient confines to a mental hospital, he or she most likely returns periodically until they die in an abbreviated and shortened life span. To realize most of your patients will die in a filthy or sordid way sobers even the most optimistic of human beings.
Most young doctors come from rich families. Only rich families can afford the lengthy and expensive medical education. By 1400, all the residents and fifth pathway interns are on the train out of Pookipsie or hook up into carpools to take them downstate. These people will have a tremendous weekend because New York City never sleeps. A bar, a nightclub or restaurant remains open 24/7 somewhere in the city, usually on the upper-class side. All it takes is mountains of non-olfactory money spent in a casual and frivolous way. Money remains the rate limiting factor in a Gibb’s free energy equation. Probably if Dr. Wracks had money he would float on a surfboard somewhere in the sun. Dr. W makes his rounds and heads to the cafeteria for the one plus one plus one meal. “It’s so you do not get fat,” she says. Dr. Lecter finds him there. “Why aren’t you gone,” Questions Dr. Lecter. “I have no where else to go.” says Dr. W. “I did not have anywhere to go either,” says Dr. Lecter. Here is the master key to all the wards. This key opens everything, anywhere on the complex. I want you to do morning rounds in our ward and again at 2300 hours before you turn in. We have a new patient from a wealthy family. He was a Viet Nam Veteran and forced to kill people with his bare hands. He was one of the last out at Da Nang. He has become violent and lies in a strait jacket in the padded holding cell. Pay particular attention to him. Remember; do not let chronic schizophrenics get between you and the door. I live close by and will remain in touch. Wear the key on your neck and sleep with it. If it is lost, all the locks in the whole veteran’s complex have to be changed.” “Goodnight,” he says as he walks off into the long corridor.
The Pookipsie Veterans Hospital is a huge apparition set in a park like arcade. The buildings link by means of catacomb tunnels with locked doors at each end. Large fluorescent lights hang in the long, cold, grey, concrete tunnels and sound echoes eerily and reverberates into nothingness. The environment is kind of like a Lon Chaney Frankenstein movie. It must be here where Lon got the settings for the movie. The Wracks walks alone here late at night in the tunnel leading to Ward 4. He sings and says words to see the ramifications of the reverberations. “Spooky,” Dr. W. says to himself. “Real spooky.”
When Dr. W.I arrive at Ward 4, everything is mundane. Drugs medicate the patients and they are asleep. The nurse, who looks overworked, stressed and tired, beckons to me from behind the glass blast shield. Dr. W waves back. Dr. W moves to the restraining cells and removes the shield from the glass porthole. As Dr. Looks into the cell Mr. shine looks him back eye to eye in the glass. Only one inch of hardwood door separates the two faces. Mr. Glitz looks more frightened then mean. He must be frightened because he knows that payment is expected for his violent behavior. He stands in a strait jacket in hospital bed clothes. Dr. W. introduces himself. “I am Dr. W. I will check on you periodically this weekend. Do not be alarmed, nothing changed. Dr. Lecter will see you Monday morning. Get some sleep, it is late.” Dr. W. then looks into the room of the catatonic schizophrenic. Mr. M sits in his chair, wrapped in his usual sheets facing away from me. Dr. R looks away down the hall and looks back in through the porthole. Mr. M does not sit in the chair; he moved out of view. Dr. W. instinctively checks the door to make sure it is locked. In ten milliseconds, Mr. M. senses the Wracks appearance and moves out of view. He could be juxtaposed behind the door if it is opened. Dr. W does not open the door and walks on. “Make a mental note,” Dr. W
says to himself. “Mr. M can feel me.” Dr. W. leaves Ward 4 and enters the tunnels. He walks alone through the tunnels. He makes sure the doors lock behind him. He enters the Residents lodging and his cubicle. Dr. W. hangs his white smock on the door. Dr W. heats water with his tourist prong and makes instant coffee. Dr. W. makes sure the key is around his neck. He adds powdered creamer to the coffee. Dr. W. lights a cigarette, opens his books and reads until sleep overtakes him.