Chapter 1

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The police brought him in handcuffed, the royal treatment usually reserved for those truly deranged or violent. Within minutes, ER was calling psych assessments.

“Are you expecting a patient?”

“Nope,” I snapped, glancing at the referral board. “What have you got?” I was hoping for a drunk or a psychotic female, just someone I could quickly assess and pass on. The sun was setting, ER was packed, and a pint of Jack Daniel’s was calling my name.

“Seventy-six year old delusional male,” replied the ER triage nurse. “I told the cop to take him on to the back and put him in one of the seclusion rooms until you got there.”

“I don’t need this…”

“His wife’s with him and pretty upset. Can you talk to her?”

I slammed the phone down and grabbed an assessment form. Before I could get out of our broom-closet office, the phone rang again. The drunk I longed for was on the line, plastered, yearning to tell me his life story. I cut him off. “We don’t send vans out to pick people up. You make it to the liquor store every day. Surely you can find someone…”

“You sorry son of a bitch,” he stammered and hung up.

“Get a life,” I mumbled as I scurried out the door and down the drab Faith General ER hallway. I placed my security key into the wall lock that activated the steel-enforced security doors leading into the back portion of the ER known as the psychiatric assessments department. Dead ahead, approximately thirty feet, a sheriff’s deputy stood blocking the doorway to one of two seclusion rooms, both twelve-by-twelve, identical, beige boxes with built-in mattresses and mounted cameras, allowing staff to monitor patients sleeping, pacing, urinating, stripping, or if truly agitated and combative, locked in for safety’s sake. On either side of the seclusion rooms were two barren interview rooms, each with a smattering of mix-and-match hand-me-down chairs with club-like arms dying to break free and into the hands of some deranged or drunken patient threatening to bash my skull if I don’t let him out to smoke.

The deputy saw me and stepped into the hallway.

“What’s up with this one?” I asked as I visually assessed the patient, who sat stoically in handcuffs. His wavy white hair was neatly combed, his blue Polo shirt appropriately buttoned, his Dockers creased, shoes clean, socks matched and actually pulled up, revealing no skin. Definitely not disheveled or unkempt as was often the case with demented and delusional geriatric patients.

The deputy glanced back at the elderly man. “He took a swing at me, not to mention what he tried to do to his wife.”

“She call you guys out?”

“A neighbor called 911. Said she saw him on their back deck threatening his wife with a butcher knife. She doesn’t know what’s going on. It’s like he turned into a madman of sorts for no apparent reason.”

I nodded to the deputy and stepped into the seclusion room. “Mr. Dalton?” I looked into his eyes, hoping to make some type of connection. “Mr. Dalton, my name is Michael. I’m going to ask you a few questions, okay? See if we can get you some help.”

He looked up and straight through me as if I didn’t exist.

“Mr. Dalton, do you know where you are?” I asked, easing my weight back on my left leg.

He looked my way, only this time something clicked. “You’re the one!” he cried, lunging full force.

I pivoted back, providing the deputy plenty of time and room to bear-hug the wild-eyed man back down onto the mat.

“What’s next?” the cop asked with a told-you-so smile.

“Guess I’ll try the wife,” I said. “Security is on the way. Thanks for helping us out.”

I keyed the wall lock, hustled back down the ER hallway, and entered our meet-and-greet triage room. I took a deep breath and opened the door leading out to the ER waiting room. “Mrs. Dalton?” I called out to the dead-eyed mass of faces that always turned my way, yearning for their names to be called. I stood in the doorway scanning the room, looking no one in the eye, all the while hoping that the wife of my patient would appear and fast.

“Yes!” A voice cried out among the mumbling throng.

I saw a frail hand rise among the standing room only crowd near the main entrance. “I’m Ms. Dalton,” she announced and walked across that dingy waiting room floor with an air of down-home sophistication and humility, an endangered combination these days. “Maggie Dalton,” she said to me, extending a firm handshake and a deep gaze into my eyes that froze me for a split-second. “Do you need to speak to me about John?”

“Yes ma’am,” I said, yearning for a brief interview and a Medicare card, knowing her husband needed to be hospitalized on our geriatric psychiatric unit for observation, if nothing else. If he had regular Medicare, I wouldn’t have to call and fight to obtain the authorization to admit, as was always the case with HMO Medicare, Medicaid and private insurances. I could simply admit him once I completed all of the paperwork, paged the on-call psychiatrist, and gave verbal report to the unit RN. I still had a shot at clocking out in forty minutes.

With the ER packed and our interview rooms occupied, I led her to the grief room, a postage stamp space with an oversized cloth couch, vinyl loveseat, and plastic table barely big enough to hold a hideous lamp and phone. The grief room was ER’s designated area for families and loved ones of patients who’d died for whatever reason. It didn’t happen that often. Faith General’s ER spilled over most days with far more wayward souls than heart attack victims.

I directed Maggie to the couch and watched her sink into its gaudy green-plaid upholstery. She took a deep breath and sank even further, the wind slowing fading from her sails.

“Are you okay?” I asked. I was nervous. I was always nervous around elderly patients and especially their spouses. What do you say to them? Gee, I’m sorry your husband is delusional and urinating in the sink. I can empathize with what you must be feeling. How can I even begin to understand what it’s like to live with an elderly delusional spouse? I couldn’t live with a 37-year-old sane one.

Maggie Dalton looked up and smiled, as graceful a look as I’ve ever seen. “What was your name?” she asked.

“Michael.”

“Yes, Michael, I’m hanging in there.” She looked down, as if fighting back tears.

My gut told me she wasn’t about to cry. The look in her hazel eyes — an intense yet mellow look — revealed too much intestinal fortitude and class to lose it with a total stranger.

“What happened today?” I asked, still counting on a quick interview.

She sighed. “Fifty-six years…” She closed her eyes for a brief moment. Her silver gray hair was cropped close to her head, giving her a look much younger than her seventy-something years on this earth.

“May I call you Maggie?” I asked, readjusting my Wal-Mart reading glasses.

“Fifty-six years…” She looked at me with an eerie smile.

“Maggie?” I tried to re-focus her attention. “I need to ask you…”

“Yes,” she interrupted.

“Yes?”

“Please call me Maggie.”

“Maggie, what happened at your home today that the police had to come out?”

“Michael, are you married?” she asked, ignoring my question altogether.

“Divorced,” I reluctantly replied.

“Any kids?”

“One boy. Actually, he’s a young man now,” I said. “Twenty-one years old.”

“Are you close to him?”

That one caught me off guard, as if I was the psych patient and she was assessing me. I stared down at the blank assessment attached to my old clipboard, not wanting to face her motherly wrath.

She waited on me to look up. “Well, are you?” she demanded.

“No, I’m not.” I reshuffled my clipboard, hoping again to redirect her and regain my rattled composure.

“Don’t let this happen to you before you get things right with your son,” she said, her eyes fierce. “Do you understand Michael? Get things right with your son before it’s too late.”

“Yes ma’am,” I replied, “I will.” Suddenly, I was the deflated one. Maggie’s words stung me, much like my Mom’s declaration the day I left Knoxville, challenging me to get off my pity pot and make things right with “my boy,” or I’d live to regret it.

“Before I tell you what happened today,” she said, again waiting on me to make eye contact, “please allow me a few minutes to tell you a story. Or, if that’s asking too much…”

“No…” I laid my clipboard on the table, trumped for the time being. “Not at all.”

My best friend, Jack Daniels, would have to wait.