Chapter 1 It was early morning, and the patients were in the process of getting breakfast.

After making sure that my ward had gotten into line, I stepped back to where some of the other orderlies were sipping at their coffee. We were required to eat before coming in to work. This was both to pay better attention to our charges, and so that we weren't subjected to theI shudder to call it food that the patients were subjected to. Today looked like something that might resemble eggs, if you crossed your eyes just enough. One of the orderlies came up to me. "You're still on probation; shouldn't you be up there with them?" He took a drink from his thermos. "If they act up, you're out the door." I shrugged. "From here, I can see all of them easily. If I were up there, I wouldn't be able to focus on more than one at a time. Not all of us are in wards where an orderly only has one troublemaker." He snorted into his drink. "True, not all of us are stuck with the lifers. Jake in particular." He looked over to the food line. "He seems particularly talkative, at least more so than I've seen him in a while." "That'd be nice, if not for the person he was talking to." I followed his gaze over to the end of the food line, where Jake was getting his milk. Jake was a fairly average sized guy. Like all of the patients at the hospital, his hair was kept short. Directly in front of him was Chris. Chris was tall and lanky, easily distinguishable in a crowd. The two were talking, and both of them were smiling. That smile worried me. I hadn't seen Jake smile once in the two weeks I had been here. Chris, I had seen smile several times. The more teeth that were showing, the more trouble it would be. Chris was smiling from ear to ear, as he left the food line and started moving away from my ward's assigned table. I put down my cup of coffee, and stood up to head towards him. Some of the older orderlies stood up as well. I think they might've had an idea of what was to happen next. Chris stopped walking, looked back at the food line, and then let go of his food tray. The moment the tray hit the ground, he collapsed, convulsing. I ran over to him, as did another orderly. Some of the patients were screaming and spasming, and the rest of the orderlies finally sprang into action. I took a moment to look over to my table. Apart

from Martin looking horrified, the rest of my ward appeared calm, if not a little shaken andwait. There was no sign of Jake! I looked over to the food line. Jake's tray was still at the end of the counter, but Jake wasn't. Where could he have gone? The security was still standing at each of the exits back into the hospital, so there were no other ways out besidesthe kitchen! I looked down at the orderly restraining Chris. "Keep an eye on him!" The orderly nodded, and I sprinted into the kitchen, knocking both patient and employee aside to get there. Once inside, I saw Jake. He was holding one of the kitchen knives, and the chef was begging him to put it down. Jake slowly moved the tip of the knife onto his forearm, and pushed. A small trickle of blood streamed down his wrist. "Jake!" He looked up, and I held my hand out. "Give me the knife." He took a step backwards. "No." "Please." I said in a softer tone than my first request. He shook his head again. "Sorry." He pulled the knife down along his arm, tearing a huge gash. As he began to move the knife to his other hand, I tackled him to the ground, and kicked the knife away. "I need a towel!" I yelled to the chef. He stared at me and at the blood. "Get me a towel NOW!" The chef finally moved, running to the back of the kitchen. He returned a moment later with a handful of kitchen towels. I folded one up and pressed it against his arm, then used a second to tie it in place. The towel was already dampening, slowly turning red as the blood soaked through. I grabbed for another towel, and started to fold it up. "It would be more productive to stop the blood flow, I think." The voice came from behind me. Doc had just entered the kitchen, and was removing his tie. He handed the tie to me, and I used it to tie a rough tourniquet at the base of his elbow. It was as tight as I could get it. That done, I put another towel over his arm and applied pressure. It seemed like the tourniquet had done the trick! I looked up at Doc. "The physician is already on his way?" Doc nodded. My eyes went back to Jake. Over the course of the past minute or so, his skin had gone quite pale and clammy. However, he had remained conscious during the entire incident. I leaned down to Jake. "You'll be fine, the doctor will be here soon."

Jake sighed and closed his eyes. "That's unfortunate."

--After the physician arrived, I went back and got my ward together. We walked back to our wing in relative silence. I say relative because Zeke was "talking" on his "phone" for the entire walk. Zeke was an interesting case, in that he was labeled as a paranoid schizophrenic by Doc and the orderlies. However, his schizophrenia only occurred in the presence of the disconnected telephone that he carried around with him. He was perfectly normal apart from the occasional need to answer that phone and have prolonged conversations about random topics. I made note of what he was talking about (today it happened to be a discussion about the World Cup and how England was a shoe-in to win. I thought it ridiculous, but Doc wanted to know as many of Zeke's conversations as possible to try and figure out what was causing them), and added it to the list of things to discuss with Doc this afternoon. Given Jake's condition, he was probably too busy to stop by this morning. Once we got back to the wing, most of the patients went their separate ways. Chris, however, hung around for a bit. He stretched while waiting for everyone else to head off, then walked over to me. He smiled, "So, I take it that he's gonna be fine?" "Yes," I snapped. "No thanks to your antics. I already have a hard enough time keeping you guys in line without you mucking it all up." I walked up to him, clipboard at my side. "If you ever do anything that can help Jake attempt suicide again, I will slap your ass in a straight jacket and dump you off with the boys in Solitary." Chris looked at me with a sly grin. "Didn't know you felt that way about me, doc." He turned and went down the hallway, blatantly swaying his hips as he walked. Before he rounded the corner, though, he looked back. "Sorry, but I don't swing that way." Then, he was gone. It took me a second to process, but I shuddered at the thought that had just gone through Chriss head. He had a flair for the theatric, I had to admit, even though his methods were a bitcrude for my taste. I added Chris to the discussion list for later, and went to my office. I grabbed a piece of paper and loaded it into the typewriter. Doc

was going to ask for a written report eventually. It was probably best to do it sooner rather than later.

--So, as you are probably aware, Doc said, looking up from the report, your ward will not be allowed to have meals in the mess for a while. The other orderlies were adamant about it. I nodded. It made sense the other orderlies didnt want to have to be responsible for any more work than their own charges. If I couldnt keep an eye on my ward in public situations, then they didnt want the job to fall on them. Well take our meals in the ward. Ill have Zeke pick trays up at mealtimes. I have already arranged for that. A security officer will be by fifteen minutes before each meal to escort Zeke to and from the dining hall. Someone will be by to retrieve the tray later on. And Jake? Hell be in the infirmary for a few days. The doctor wants to keep him under surveillance before releasing him to you. Doc sighed. Although I wish you had acted more forceful than you had, Im glad that you appraised the situation so quickly. Working in Ward 7 requires quick, clear thinking. The last orderly assigned to that ward had too narrow of vision to have seen beyond Chriss antics. I frowned. More forceful, Doc? Yes, more forceful, especially when dealing with Jake. Although I know that you were taught to attempt to talk wards down from doing...irrational things, Jake is adamant about this. If given a chance, he would gladly end his own life. Cant we give him some medication for that? Reserpine, or maybe imipramine? Doc shook his head. You are aware of my philosophy regarding medications, correct? But when dealing with such strong cases of psychosis, isnt it best to reduce the triggers that may be present in the patient? If we can try and block transport of epinephrine

Firstly, we are dealing with a depressed patient. Did your professor have you read the Lemieux paper on reserpine from a few years back? I shook my head. It is believed to induce depression and suicidal thoughts. We dont want Jake more depressed than he already is. In addition, we should be focusing on identifying the source of his psychosis, so that we can help him cope without the need of medication. Again, Docs statement made sense. I couldnt argue with his logic, despite his desire to stick to a more psychoanalytical method of treatment. So, how is Jake doing? I heard that they were able to stop the bleeding, but has he been acting up any? No, after a failed attempt, he has generally acted sullen for the few days afterward. I doubt that he will give the psychiatrist any problems, but you are welcome to stop by and check up on him when you get the chance. Ill be doing that after this meeting, Doc. I had one last thing to discuss, if possible. Doc nodded. Why is Chris around? From what little time Ive spent with him, I cant imagine that hes going to attempt to improve. Given this institutions reluctance to administer any psychosis medication, we should have him transferred to another institution or released back into the general populace. Hes just wasting time and money by being difficult. I do not disagree with the fact that he refuses to cooperate, but we cannot just throw him out onto the streets. Given the circumstances that got him here in the first place, Chris will cost much less as a patient than he would back home. Doc stood up, and opened the file cabinet behind his desk. Reaching into it, he pulled out a manila folder and handed it to me. Here is the report on Chris, as well as a transcript of my last interview with him. They might help you with dealing with him. He sat back down and pulled the telephone to him. Now, if youll excuse me, I have a few calls to take care of. Yes, Doc. I stood up, and left. --So, how is he? I asked the physician. He gave me a dirty look, and continued what he was doing. I followed him into the next room. How is he? I asked again, The physician audibly hissed as he walked out of the room, several clipboards in hand. My

own fell to my side. The physician knew who I was or more importantly, which ward I worked for in the hospital. Why he couldnt answer a simple question was beyond me. I walked to the pharmacy. The pharmacist wasnt at her station, so I rang the bell twice. She rolled her chair from around the corner, novel in hand. Seeing who it was, she walked over and beckoned me to lean in. As I did, she whispered, Dr. Anderson is angry at you somethin fierce! She looked to make sure that the physician wasnt around, and continued. Hes been running around from ward to ward all morning dealing with patients wiggin out. He didnt even have any time to check in on anyone in the infirmary. Oh. The freakouts were all probably a result of Chriss actions this morning. Sorry about that, Ashley, Im guessing that you were running around a ton as well. Not really. Ashley shrugged. It was pretty fun, actually. The pharmacy is always so slow cause of Docs rule on medicating patients. She put a hand on her face. I wonder if Dr. Anderson asked permission before administering all of those sedativesanywho, thats why hes ignoring you. What did you need? Im just trying to check in on Jake. Have you heard anything about him? Is he doing alright? As far as I know of, hes fine? She pointed at one of the rooms. He was brought into room 3, you can go check for yourself. Have a nice day! She said, pulling her chair back around the corner. I hit the bell one more time to aggravate her, and then walked down the hall. Entering room 3, I saw that Jake was the only person inside. I grabbed his charts off of the foot of the bed. It seemed that Jake was doing fine. Dr. Anderson had quickly closed and stitched up the wound, and applied some strong sedatives via saline drip. He was going to be kept under observation overnight, and then released back into my care the next day. Jake sat up in bed suddenly. Was he pretending to be asleep? I sat down next to him. How are you doing? I thought youd be out for a while. He shrugged. Nah, their sedatives dont work too well on me. Ive asked for something stronger, but its never good enough. Im always awake an hour or so later. He looked down at his arm and frowned.

Jake, the doctor says that youll be out in a day or two. Youll make a full recovery. Thats unfortunate I faked a smile. Hey, dont act like that. I know that you dont like it here, but youll be alright aft I couldve been better, no thanks to you. Jake began to lay back down. What do you mean by that? Exactly what it sounds like. He turned over, laying with his face away from me. I was at a loss of words. I tapped my finger on the clipboard before tossing it on the bed. I then left the room without a word. I had more important things to attend to.