Where is everyone, asks Dr. Wracks.   I saw them at breakfast in the cafeteria

They are in the outpatient venue says Dr. Lector.   They have enough to do.

Don’t you think it is dangerous, just you and me in a lockup with twenty-five patients?

There is plenty of staff, and the nurses sit behind bulletproof windows. Says Dr. Lector

I don’t mean them says Dr. Wracks, I mean you and me.

Remember what I said about inappropriate comments, says Dr. Lector.   If you are sick, they can sense it.  Just don’t say anything or make noises and you will be OK.  Stay close to the doors.  You can see it in their faces before they turn.  Be smart.  I have a new admission I want you to work up. Says Dr. Lector.  He is from a wealthy family, and he became a marine and went to Vietnam.    He is one of the few survivors of the Tet Offensive and his superiors don’t know how he survived. He is back in the States now and got into a bit of trouble.  It seems someone gave his sister a venereal infection so he broke into their house in broad daylight and beat them all into unconsciousness, all five of them.   The perpetrator he beat into the ICU with a phone book. He is on a respirator.   He says he did not want to hurt his hands.   His lawyers have commended him into my care until the judiciary decides what to do with him.  He is five feet eight inches tall but he can move very quickly.   Follow me, I will show him to you.  He is in a padded cell.

Dr. Wracks and Dr. Lector move to the holding area of the building.  On a large oak door is a port hole with a door on it.  Dr. Lector opens the port and behind wire bars, a leering face with widely dilated grey eyes stares at the two outside.  

Mr. Carl, it is Dr. Lector.   I have a resident from the general hospital here to evaluate you.  Will you accept his care?   The patient nods his head slightly.   He will see you in the interview room after lunch.  His name is Dr. Wracks.   He will see you in two hours, and he slowly closes the porthole.

What else do you have on him asks Dr. Wracks, so I can be prepared.

He is maintained on 100mg of Thorazine twice a day, with 100 mg of Benadryl to sedate and prevent an extrapyramidal reaction.  He is a middle-aged nourished male with good conduct issued by the military.   His lawyers want to learn whether the attack was provoked and if there is an underlying drug addiction.  If you think there is an underlying physical or metabolic condition please transcribe it to your notes.   On the front lines in Vietnam, often the soldiers would mainline heroin to desensitize themselves from the constant shelling and explosions.  Please note any physical manifestations of addiction.   This man is a decorated soldier.  Put your file in my office and I will peruse it this afternoon and contact his attorney.  Have a good day Dr. Wracks.

Dr. Lector gravitates away and disappears.   He is never around but always appears when needed.

The interview room is well-lit and white, and Mr. Carl sits in a foldout chair, at a foldout desk, facing the door.  Good afternoon, Mr. Carl says Dr. Wracks.   I am an internist doing an internship here at the Veterans’ Administration for eight weeks.   May I interview you?   Yes, says Mr. Carl.     Is the facility giving you adequate care here at the Veterans facility?   Yes, Says Mr. Carl.  The medication you are now receiving is sedating and this means that any anger you still harbor will be abolished and soon eliminated.   How is the medication working for you?  Fine says Mr. Carl, except it makes me slur my words.   That is to be expected says Dr. Wracks.  The medication will make you less angry.   Do you feel like running around or having to walk around, this is called akathisia, and this is a common reaction to the medication.  No, I am fine.   Time passes by with ominous silence.   His pupils are dilatated but not fixed, and he is not salivating, shaking, or exhibiting autonomic mannerisms.  He dresses in denim jeans, sneakers, and a linen, buttoned, plaid shirt, in earth tones.  He is not talkative.   Would you like a cigarette, asks Dr. Wracks.   I don’t smoke says Mr. Carl.   If you have any questions or any other problems, ring the charge nurse and she will call me.   I will be checking in on you.    Wracks turns to the door and a muscular attendant opens the door for him.  Wracks edges out back first keeping his eyes on the patient.  The door closes and then locks.

In his evaluation, Dr. Wracks writes: that the subject is a well-nourished male in mid-life.   He is of average height and build.   He sports brown hair, and grey eyes, and seems of European descent.  Pupils are dilated, sclera not erythematous or injected, and there is no evidence of intravenous drug abuse.  A urine methamphetamine assay ordered.   Order head x-ray, frontal, lateral, and Townes view.    Standard blood profile indicated.   Will monitor for medication side effects.   Acyl phenothiazines are anticholinergic and sedating, and this patient does not manifest overt sedation or drowsiness.  Evaluate for sympathomimetic drug abuse and occult intracerebral neoplasm by the neurologist.  Suggest continued holding and evaluation until stable. The district attorney should be comfortable with these results.  The only psychiatric mannerism noticed by the evaluator is that the subject remains perfectly still but not catatonic.  Continue patient care. 

Dr. Wracks is done for today until afternoon rounds.   He is to sit with the incarcerated schizophrenics and observe their behavior.   He is to inform the pharmacist staff If extrapyramidal side effects manifest in any of the patients or if there is a violent acting out.  Then he will go to dinner and sit in his little room with a bed, a table, and a chair and sleep until tomorrow if it comes.  It is today’s world, one day at a time.

A storm blows into upstate and snow covers the facility with ten feet of snow.   More is on the way, and the radiators are hot, and steam blows out the vent holes in a whisper, night overtakes and the Wracks end the day with a prayer.