The patient was belligerent. It took all three of us to get her down. She was only wearing a tank top and some kind of scarf around her waist. She was taunting us with her nakedness. She was telling us to shoot her.
It’s awful, her mother told us outside the ambulance. She keeps rotten food in the drawers. She doesn’t change her pads. How am I supposed to keep her?
I hung around the nurse’s pod as they entered her paperwork: Patient is thirty-nine; affect is tearful; speech rapid; thought loose, incongruent; severe anxiety.
There was this night nurse who was just so mean it killed me. Her name was Jackie. Black scrubs, lacquered nails so long I don’t know how she got her panties on, but she held a syringe like a spring crocus. She was the kind of woman who’d break a bottle over your head and make out with your girlfriend. I loved her.
Jackie told me the patient had just adopted a dog and had we seen it? I said, What does it matter? The old lady probably took it in. But Jackie looked at me like I was just some kind of moron and said, The patient’s mom kills dogs, it’s all here in her medical chart. And it was the worst kind of HIPAA violation, but I leaned over so I could see her screen and smell the hibiscus lotion on her shoulders. She scrolled back through prior admittances with long green nails to show me some, let’s say, incidents.
You wouldn’t believe the kinds of stories medical charts can tell, health being so contingent on circumstance. As in: the patient walked into the ER three other times in the last year. First time is an unspecified mental health crisis last April. Her mom brings her a puppy to cheer her up. It’s so cute the nurses let her smuggle it into the hospital. Patient is discharged same day.
Second time, she comes in alone with suicidal ideation. Nothing can live around here, she tells the nurses. Not the dogs, not me. Affect: flat, calm; thought content: fatalistic; speech: slow, monotone. Later she denies thoughts of self-harm. It doesn’t matter, she says. I’ll get a new dog. Discharged same day.
Third time: her mom brings the patient in late summer. Says the patient took a swing at her and ended up crashing into a glass door. The puppy’s dead. It got trapped in the dryer. Mom believes the patient closed the dryer door after Mongo wriggled in, listened to the poor little thing scrabble and suffocate in the August heat. Mom is quoted: At least she didn’t turn the thing on and ruin the lint catcher. According to the chart: Patient is a danger to herself and others and must be held for observation. Affect: angry, violent; thoughts: incongruent, expresses delusions of persecution by mother, by God. Mom treated for minor lacerations. Patient held overnight, discharged with antianxiety meds. Six months later, her primary care physician denies a request to write a recommendation for an emotional support animal, but patient finds another doctor across town.
Today makes four hospitalizations, at least one dead dog, and one missing.
I told Jackie it looked like the patient was the one killing dogs, not her mom. She bared her teeth, stained yellow because she smoked like a chimney—most nurses do. I would have burrowed into her gums just to feel her chew me and spit me out. I wanted to touch her dark red tongue.
That evening I took a walk in the north hills, where the grass is yellow all year long except June. This was not June. The clouds lapped back and forth like water in a stock tank. A little snow still clung to the frozen bike ruts and in the shadows between bunchgrass. I veered right and crunched up a low hill to the barbed wire that separated public and private land. Sometimes I saw coyotes crossing the hillside here, one after another, heading toward some unfathomable future, but across the fence today I only saw clumps of yellow grass in the snow, tilting up to the hog-slop sky.
With my back to the barbed wire, I could watch little people wending across the hills, their dark heads bowed, necks pink against their coats. The dirt paths branched and conjoined, and people stuck to them without deviating. They looked down. No one saw me. I raised my arms over my head like an orchestra conductor and remembered the CAFO I worked at outside Billings, where pigs followed a winding steel maze to the killing floor. How hot it was among all that steel and flesh. Up here, the land felt wild and cold. Somewhere out there were coyotes trotting a ridgeline in single file. For a long time, I stood with my arms outstretched, absolutely still.
After my walk, I felt maybe I should drop by the patient’s house after all and check on the dog. Mostly I had nothing else to do, and I had this idea that the dog, if there was a dog, might be roaming loose on the street, and if I scooped it up I’d score major points with Jackie, who had a soft side. Also, since I’d gotten sober, I’d been pulling the craziest stunts. Once you take out the alcohol, you still have to deal with the -ism—so says my sponsor and every old tweaker in the Friday night basement. So I told myself I was just going to drive past and check. But by the time I found the grubby yellow house with the peaked attic and the chain-link yard so beat down by heat and frost and chew toys there was no grass left, and also no dog in sight, I figured I had to knock.
The patient’s mom answered in her winter coat, so I knew there was no heat in the house. She looked scared. I said, Hi Missus, I’m sorry to intrude but I’m a resident with Providence Health Services assigned to caring for your daughter. I was wondering if I could collect a few of her personal belongings? We are trying to establish a baseline comfort level before we begin testing for mood disorders or possible psychotic conditions. That often yields more accurate results. And by the way, how are you feeling after your ordeal?
It was a trick I learned on the show House. He’s always sending his residents to break into patients’ homes and go through their medicine cabinets. When that doesn’t bring any answers, they notice a leaky pipe and realize the patient has mercury exposure or radon poisoning or something. I figured I could at least find a dog. Besides, I have some experience talking older ladies into letting me into their homes.
She said, Are you working with Dr. Ronk?
And that threw me for a second, but I recovered. I said, No, ma’am, I’m working under Dr. Jackie, a specialist in this field.
What field?
Psychiatric medicine, among others.
She seemed impressed and let me in. It was colder inside than out. I was still wearing my blue scrubs, which I believed lent me an air of gravitas amidst the room’s brown carpet, the floral wallpaper, the cheap grandfather clock—which was not a grandfather clock at all but a plastic box with a regular clock face and a chrome pendulum painted on beneath. I was scanning a list of possible redirections in case she asked about her daughter, but she didn’t seem interested. Instead, she led me to a white door stained with mud, as though a dog had stood on its hindquarters to scratch at the wood. Not everybody would notice details like that. Inside was a hovel, nothing I hadn’t seen before, typical shut-in stuff. Takeout boxes, underwear plastered on the floor, papers in various degrees of decay. No dog.
I made a show of picking up a couple of cleaner-looking shirts and shaking out a blanket so that crumbs fell from the stiff fibers. Filth doesn’t bother me. I said, She mentioned something about a dog, wanted to check in on it. Sweet girl, really.
No dog, said the patient’s mom.
Oh, I said, what happened?
Not been a dog since Uncle, she said.
What about Mongo?
I don’t know about any Mongo. Does it look like I can keep a dog?
Poor kid, I said. This happens sometimes. Delusions, short term memory loss.
The patient’s mom crossed her arms and her coat strained at her elbows. She watched me open a drawer and stare down at a pile of sandwich crusts. Just the corners, Tetris-stacked in neat geometric designs, some with dried turkey still peeling out at the bite marks. I closed the drawer.
Is somebody going to help me clean up this mess? She asked.
We’ll send a care team, I lied. I squeezed past her out the bedroom door with a dirty blanket and a couple of shirts in my arms.
That’s all she wanted?
Just some personal items. Something to make her feel at home.
The lady shook her head and beckoned me to the kitchen. I watched her reach into the top cupboard, behind a display of basset hound dinnerware, and pull down a small green mug shaped like a Christmas tree.
It’s got lead in it, she told me. The paint. We only use it for Santa Claus now.
Santa Claus?
On Christmas Eve. We leave him milk and cookies. We like to keep our traditions.
I’m sure she’ll be glad to have it.
Just don’t let her drink from it. Remind her.
About the lead. Got it. Thank you.
I backed out of the house into the cold front yard and decided it was warmer here. There really were chew toys scattered on the frozen grass. The blanket pressed to my chest stank. I focused on not dropping the special lead-painted mug. The patient’s mom stood at the doorway in her coat.
She’s thirty-nine, by the way, she called. She’s not a kid. When do you think that care team might be by?
I waved the little green mug in response.