After Hours (InterMix)(74)

“Shit, I dunno. Fifteen? That’s when I started smoking pot, anyhow. I didn’t do nothin’ worse until I was in my twenties.”

“And is that around the time the voices started? When you started smoking pot?”

“Maybe, yeah. I never really liked it much—the weed. But after I got told I was bipolar, this one doctor mentioned, just like, in passing, how some people with that got benefits from smoking.”

Dr. Morris’s professional façade fell away for a moment, an exhalation of pure annoyance hissing from his nose. “I see.”

“So I smoked a lot, the last ten years. It was cheaper than seeing a shrink.”

“Pot has been shown to ease some symptoms of bipolar disorder. But it’s also been shown to exacerbate those on the schizoaffective spectrum. Did your trouble with the law begin during this period?”

“I was never a good kid, but it did get way worse after the pot, yeah. And the voices got louder. And nastier.”

The interview went on for another hour, a conversational trip down Lee’s crime-riddled memory lane. He didn’t withhold much of anything as far as I could tell, but his flatness made it difficult to get any handle on his temperament. And temperament was telling, just as much as these illuminating anecdotes.

But one thing was refreshingly clear—he was one of the most self-aware schizo patients I’d yet encountered. And that could be the difference between an institutionalized life and a manageable one.

After Dr. Morris had heard everything he cared to, he shook Lee’s hand, and opened the door, calling for the nurse. She appeared shortly, and she and Kelly escorted Lee down the hall. I’d nearly forgotten Kelly was there. He knew how to make himself inanimate when that was what a patient needed.

“I look forward to talking some more this afternoon,” Dr. Morris called after them, then bade Darius and me to stand. “Let’s take this back to my office.”

We followed him out the door, waiting as he slid the Vacant plaque in place. After a pit stop for coffee, we re-adjourned to his stately quarters.

“Well,” Dr. Morris said, crossing his legs and glancing between us. “What did we think of Mr. Paleckas?”

Mercifully, Darius went first. He gave a long account of his observations and detailed an impressive list of treatment suggestions, many points of which I wasn’t familiar with or hadn’t thought of. Suddenly the line between LPN and third-year medical student was crystal clear, and I felt deeply lame, standing on my side of it. I hoped Dr. Morris might not bother asking my opinions. I’d lost all faith in them.

He checked his watch. “I know you’ve got an appointment with Dr. Fenton,” he said to Darius. “I won’t keep you.”

“Thanks so much, Dr. Morris.”

“My pleasure. Excellent work.”

Darius left, and I got to my feet as well, poised to say my own thanks and escape back to S3, where I at least felt halfway qualified to exist.

“Not so fast, Miss Coffey. I’m dying for your analysis as well.” He linked his fingers atop Lee’s folder.

I sat heavily, weighed down by dread. My face felt warm, my hands like ice. “Well . . .”

He smiled. “Just tell me what you think. Unlike poor Darius, my opinions won’t be making it back to your academic advisor.”

“Well, I kind of thought . . . I can’t tell yet. The paliperidone seems like it’s made him all flat. And tense. I’m sure the other doctor knows what they’re doing, but I kind of wish I could meet him on a lower dosage. It didn’t seem possible to get a real read on his personality, with the meds in the way.” A luxury we didn’t have, and I damn well knew it. Dr. Morris probably thought I was making up excuses to avoid offering my own treatment strategy, or that I didn’t have one. Which I didn’t. “Sorry. I’m not comfortable recommending a course of action if I don’t know what his . . . what his baseline personality is. I’m way too new at this to be able to separate the side effects from his normal affectations.”

“Can I share with you my own perceptions, Miss Coffey?”

“Of course.”

“Every patient who arrives here—every person you pass on the street, for that matter—is a complex recipe. Perfectly unique but mixed from a set number of ingredients.”

“Okay.”

“With the mentally ill, the symptoms are flavors, all mixed and mingled, shared between patients who are on a similar spectrum, but in all different measurements. Two patients might share a certain quality, say, paranoia. But one could be schizophrenic and the other merely anxious and under-rested. A third might be intoxicated. By itself, paranoia is a single flavor, found in a dozen distinct dishes. Like pepper if you will.”