“What did they tell you? Or, more exactly, what did you tell them that you don’t know you told them?”
“I told them I was having trouble concentrating, that I couldn’t get pain medicines off my mind, and that I didn’t want to use their sleeping pills very much.”
“Have you succumbed to some Percocet?”
“No,” Brian said, his face hinting otherwise.
“Congratulations. Have you thought about killing yourself?”
“Who could answer no to that question?”
Peggy thought that was an odd answer, but perhaps sharply truthful. “Have you thought about how you would kill yourself?”
“No.”
“Do they think you want to kill yourself or that you know how you would do it?”
“I don’t think so.”
“Do you want to kill anybody else?”
“Josh Menkowicz,” Brian said without the briefest pause. The answer hit Peggy like a handgun slug, nearly knocking her off her chair.
“Truthfully? Or a metaphor?”
“Less than truthfully, more than a metaphor.”
Perhaps the caregivers were concerned about this also. Hospitalization is indicated when the patient is a danger to himself or others. Maybe his caregivers were more worried about him hurting someone else than about hurting himself. In looking back, Peggy could remember bits of conversations in which the wellbeing or feelings of someone else did not appear to matter to Brian. Were that true, it would make Brian sociopathic, something Peggy had not considered, and something that would make the prognosis abysmal. You can’t fix sociopathy.
“Did they talk about special medicines or treatments they want to try?”
“Yes. They want to switch my antidepressants around.”
“Did they tell you they can’t do that with you at home?”
“No.” Brian shifted the conversation. “They talked to Emily. I think they told her I should take a few weeks off work until I get a little better, and not treat patients in the meantime. I don’t like it that all these people are talking when I don’t know what they are saying.”
“How can they talk to Emily without your consent?”
“JD made me sign some forms so that he and Emily can be sure I go to my meetings, make my appointments, take my medicines, submit my medication logs, and do my physical therapy.”
“Physical therapy?”
“For my knee.”
“Is it working?”
“I don’t think so. It makes my knee sore.”
“Did you take anything for that?”
“Some aspirin. It works pretty well.”
“That’s a good sign.”
“Do you think I should go in the hospital?”
“Yes.” Peggy wanted to reinforce the idea. “JD has spent his whole life researching and writing about opiate addiction in the workplace, and he certainly knows as much about it as anyone. Apparently his unit has national notoriety. I would follow his advice.”
“Well, this is the advice of one of the psychiatry hospitalists.”
“Undoubtedly with input from JD, right?”
“I don’t know. Maybe.”
“So, ask JD. Tell him you don’t have a clear idea of the value of a hospitalization and see what he says.”
“How do I do that? You can’t just call on the phone.”
“Email?”
“OK. I hadn’t thought about that. See, I don’t have the concentration, I don’t have the acuity. My distractions are strong. I am weak right now.”
“It is an amazing accomplishment that you are recognizing it. This is going to take time, not like an antibiotic for a bladder infection where you’re back to normal in three days. It’s going to be more like cancer of the pancreas or lymphoma.”
“You’re back to that, now?”
“I hope we never left it. I hope we are looking at this as a complex disease that is going need several approaches and numerous interventions. It’s going to have aggravating aspects and disappointing setbacks which you will manage for a lifetime. Like cancer and lymphoma.”
“God, did we just make a full circle?”
“Oh, heavens no. A major intervention is coming your way, like a marrow transplant for lymphoma or a Whipple operation for cancer of the pancreas.”
Brian’s face showed apprehension. “That sounds scary.”
Peggy fought back, “It’s called hope. You have hope for a future. It’s being offered to you for free. I don’t see that there is a downside.”
“I have to think about it.”
“Don’t think, just do it. I can pick you up and take you there.”
“Do you think it’s that good?”
“Oh, yes! Do you want me to take you now?”
“No, I need to go home and get some things. I can come back. It will only take me an hour or two. I’ll call if I need a ride.”
“Good, good,” Peggy stood, mostly out of excitement and encouragement.
Brian’s departure was abrupt, but typical.
Peggy was on call, and became busy with patients for several hours. She didn’t hear from Brian, but wasn’t concerned. Later in the evening, she called Brian’s cell phone which went straight to voicemail. Admission to a psychiatric hospital might mean giving up your cell phone. She took up reading a Danelle Steel novel on the bed in her call room, interrupted by only one phone call from Ann. When the book fell to the floor, she turned the nightstand light off.
“Peggy, I’m sorry to wake you.”
“Emily?” Peggy, jolted from deep sleep, had to orient herself. She was in the call room. At work.
“Peggy, this is Emily,” her voice cracked.
Peggy propped herself on one elbow and turned on the bedside table lamp. She didn’t usually do that for a nighttime phone call, but it was Emily.
“Peggy, they found Brian Yankton dead in his apartment late last night.”
“What? Brian Yankton is dead?”
“Yes. It looks like a suicide. The police are investigating.” Emily was whispering.
“OK. Are you all right?”
“No. This is awful.”
Peggy waited for more from her, but she didn’t say anything. “How did we find this out?”
Emily was silent for a moment. “He didn’t show up for his admission,” a yodel in her voice. “I don’t know the details, but Albuquerque Police Department did a wellness check and found him.”
“Oh, man, this is awful. Who knows about this so far?”
“You and JD Thompson. He’s the one who called me.”
“Do you need help informing everybody? It’s Ann, Haley, and Ricky on call here tonight.”
“Morning rounds is soon enough for them,” Emily thought out loud. “I just wanted to talk to somebody, and I knew you were in the hospital.”
“Somebody should call Josh.”
“Gosh, Peggy, I didn’t think of him. I thought of Faith, but we can’t tell her now.”
“I’ll handle Josh.”
“I wish I had done more about this.”
“You took care of him the best you could, Emily. There were a lot of people involved with him.”
She sniffled. “I just — ”
“Don’t go there,” Peggy warned. “It won’t help. Is anyone contacting his family?”