WOLF IN HIS HEAD

Chapter One

Okay, here it is. Just in time for October. This can best be described psychological horror and you’re looking for something light . . . better pass.

By the way, I’ve been in healthcare and behavioral healthcare for thirty years, starting with inpatient direct care, to outpatient, management, chief executive, and LLC consultant. Since 2003, I’ve focused on behavioral health systems integration models into the medical continuum and retired in 2021 . . . So, what does this have to do with anything? In the very first chapter, you’ll see . . .

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STORYTELLERS of this age, in fact everyone I know,

begin their tales with a poignant phrase or a very famous quote,

hoping to give weight to a common work and a moral to their prose,

dropping hints and giving keys as to where their fiction goes. 

Yet through all this you readily see whether it is pulp or epic poetry. 

But late at night, come, my friend, curl up with me.

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Chapter One

Portsmouth, NH

Friday, September 28, 2012

“Eric Koss is in the E.D. again.”  

She said it with contempt, Jen the social worker, as if forced to perform an immoral act. A failure of the system. Society undone. It’s what they do. They. Them. Men mostly with their sociopathy. Their entitlement. Holding us hostage. “Give me what I want, or I’ll kill myself.” Such power . . . Then God, let them do it (she doesn’t mean that). Especially Eric Koss. Crazy Borderline . . . How sad to be a Borderline. How painful . . . If this was Boston, he’d be hospital hopping, but on the Seacoast, there’s only us. Lucky us . . . Not that he isn’t ill. They’re all ill . . . They’re all . . . broken. She knew this as a LCSW; ten years in the field hadn’t robbed her of that.   But these few jerks – nasty and narcissistic, as if trauma is a pass. They belong in jail. Just because you’ve a mental illness doesn’t mean you don’t belong in jail – not when so many other people really want help . . . But she’ll evaluate him . . . again. “‘Will someone please get this psych patient out of my E.D.?’” the doctors will scream, and she’ll do her job, and they’ll most likely admit him. And she’s an accomplice. 

A huff to go unnoticed – who gives a shit about mental health patients?   

A bright little bunker, the P.A.R.S. Call Center of Seacoast Hospital, an afterthought tucked behind the adult inpatient unit. A workspace of migraines with its four phone stations with barely enough room for two. P.A.R.S. – Psychiatric Assessment & Referral Service – scuffed and chipped with hand-me-down laptops, stained coffee cups, dog-eared issues of PEOPLE, REAL SIMPLE and MORE, memos and pictures taped to every free space of wall under cold neon. Plastic water jugs, greens and pinks and clear. Like toddlers with their Sippy Cups. One must hydrate to fend off the nasties in the recycled air. Yoga, Reiki, Reflexology, organic vegetables, chi tea, past lives regression. Crackpot New England. “‘Studies say’ . . .” And no glutens. God forbid - no glutens. But Dunk’n Lattes and scallops wrapped in bacon . . .  “A dump,” the director says whenever he walks in, though they wished he’d never walk in as he makes their shift harder. The phones always ring. And now Eric Koss.

KOSS, ERIC, she entered in Meditech and took the call off hold. “I’ve got the information,” she told the E.D. nurse. “Yes . . . Yes . . . religious preoccupations, paranoid delusions, werewolves, demons. I can copy and paste . . . Right.” And she laughed.

“What did she say?” asked the clinician next to her, a middle-aged woman named Loraine.

“‘It’s a full moon’,” the younger social worker said, then listened on the headset and replied, “Yeah – an exorcism . . . Okay . . . Okay . . . Give us fifteen minutes . . . Okay . . . Thanks.” 

She hung up and turned to Loraine. “I can’t see him. I know it’s my turn, but he gives me the creeps. Why they let him in here in the first place? He’s on the Do-Not-Readmit list, he knows that. The E.D. should just call the police and have him taken down to Hampton. PCMH should know better too. Where the hell is his case manager?”

Loraine, a Licensed Clinical Professional Counselor (LCPC), splayed her ringed fingers. “PCMH can’t get a case manager to work with him,” she said of the local community mental health agency. “When they do, the person quits.”

“Can’t blame them.”   

“He used to get kicked out of Crossroads until he got a housing voucher.”

“Which apartments?”

 “The ones on Perrie near the industrial park.”  

“My sister used to live there. You never know who’s next door. Will you see him, Loraine? I think he wanted to grope me last time.”

Loraine took off her headphones. “Alright. I doubt he’ll try that with me.”

“You have a calming way with him.”

“You owe me one all ready?”

“I know. We’ll order from Kim Lai. I’ll pay.”

Loraine stood, her bracelets jingling. “He’s a sad case really. He was very functional at one time.”

“He’s a crazy, scary, dirty old man.”

Loraine picked an assessment packet from a vertical metal file; she was supposed to use a laptop in real-time. She paused and dialed the E.D. “Jackie? How long has Eric Koss been there? . . . Who’s the doc? . . . Franzblau?” She made a face. “Did he medicate him? . . . Zydis 10, okay . . . Has PCMH seen him yet? . . . When did you call them? . . . What’s he like? . . . When did you take him out? . . . Will he cooperate?” She looked at Jen and rolled her eyes. “Okay, I’m on my way.”

“Sorry,” Jen said.

“Police brought him, and they had to put him in four points. They let him out when the Zydis kicked in. Franzblau is screaming to get him out.”

 Loraine made her way through the back-alley maze, swiped her badge at the first door of the sally port, then the second into a locked unit that had seen better days – patients in johnnies and shoes without laces, some with Footies, others in street clothes, in the dayroom watching television. “Movie Night”, a convenient distraction while the RNs huddled in the nurses’ station. Another fifty feet to the next locked door, and another swipe out the back-sally port. Swipe yet again a third locked door to enter what used to be the Pain Clinic now closed because its patients were Medicaid and junkies. Out the other end through swinging doors – the magnificent glass atrium of Cardiology, like Dorothy into the Land of Oz, with its demilunes, polished wood and art deco sconces. If the hospital president had his way, ‘Psych’ would be down the street in an unmarked building so he could renovate the space. Better yet, to be rid of it altogether – all these ‘psych’ patients clogging the E.D . . . Then down the polished halls, past the bistro cafeteria with its organic salad bar, hot buffet, pizza bar, Neptune’s Cove and grill, past the Victorian hominess of Woman’s Health and through the atrium of the main entrance to put Cardiac to shame . . .  How rich one feels when in treatment . . . Down another hall to the Emergency Department’s back entrance.

“Loraine’s here,” an RN said, a Bluetooth in her ear, commanding the nurses’ station.

Through a maze of tech, quad after quad, Loraine paused before a heavy wood door whose weight and mass were its sole properties. Beyond, a pod with an observation desk and two lockdown patient rooms. A wiry facility tech in a Seacoast Hospital polo shirt sat behind the desk.

“Glad you’re here,” he said, anxious to get back to the boiler he was fixing.   

“You have to wait.” Her voice flat. “You know I’m not supposed to be alone in here with patients.”

Of course, he knew.

“Has he done anything?”

“He’s mumbling.” 

She plucked a panic button from the desk. “This shouldn’t take long. And you’ve not seen a PCMH clinician?”

“Haven’t seen them.”

She approached a dark room and knocked. “Eric, it’s Loraine.”  

On a psych bed, bolted to the floor, he sat against a “damage-resistant” wall that bore the scuffs and stains from the many ill-functioning customers. Rumpled and craggy with a three-day growth, in a three-day change of clothes, he looked older than sixty-four. And with his gut overlapping his belt you’d might think he’d say: “Y ’all.”   

“Eric?”

Hands clinched and eyes closed. “Who can separate us from the love of Christ?”

“Eric?”

“Forgive me of my sins.” A whisper.

“Eric, can I turn the light on?”

“No.” He opened his eyes. “I don’t need to be here. The police brought me in. I was only sitting on the bridge.”

“Which bridge?” 

“The Memorial Bridge.” He winced.  

She pulled in a plastic chair and sat in the open door with the clipboard. “Where were you sitting on the bridge?”   

“On the guardrail with my feet hanging over.”

“Why were you doing that?”

“One last time before they take it down. Before there’s no more proof of this town . . .

Maybe I’d take a ride up if a ship passed under.” He tried to smile.

“Any thoughts of suicide?”

“Always.”

She wrote on the form.

“Do you have a plan?”

“Many.”

More scribbling. “Do you have intention to act on your plans?”

“No,” he said clipped.

Loraine stopped writing. “Eric, you know I have to ask these questions.”

“I know. No – I do not have intention of acting on my thoughts. I do not have the means.  There are no firearms in my apartment, and I do not have access to one. I do not have homicidal thoughts, or plan, or intent. I’ve been taking my medications despite the fact that they never work other than giving me a headache and make me feel drugged.”

“Are you hearing voices?”

He paused. 

“Eric?”

His lips flattened and a voice in his head – Only the bullied are attracted to vampires. The weak that have no power. The men are masturbators and the women have rape fantasies . . .

“Eric, are you hearing something?”

He rubbed his temple. “Thoughts.”

“What thoughts?”

“Stupid thoughts.”

“Is it Christopher?”

“Christopher’s dead.”

Loraine put the clipboard in her lap. “Eric, is it Christopher?”

“No,” he said to Loraine. “No,” he said to the voice in his head. “Who can separate me from the love of Christ?”

You can.

He curled his fists. “I’m alright. Just the cycle. I’m so tired of it.”

“Me too.” She couldn’t help saying. “Like every month since I’ve known you. I think you were one of my first assessments –”

He twitched.

“Been keeping your PCMH appointments?”

“They’re a waste.”

“Still at Perrie?”

“Yes.” With disdain.

“Why stay in Portsmouth?” She shook fer head. “You’ve no family here.”

“Trying to get rid of me?”

“For your own good.”

“For your good, you mean.”

“This isn’t helping either of us. Have you ever thought about going back to Chicago?”

“Sometimes.”

“Wouldn’t you like to see your kids?”

“Who says they want to see me?”

“Who says they don’t?” He dropped his chin. “Eric, if I could arrange a voucher for a one-way bus ticket to Chicago, would you go?”

. . . The spirit of our family has always been bound in stories . . .

“It’s easier to stay here.”

“Because of Christopher?” His eyes narrowed. “That’s what you’ve told me.”  

Knees to his chest. “I don’t want to talk about it.”

“Christopher in your head?”

“Drop it, Loraine. Get this over with and let me go. I’m not going to hurt anyone. There’s no law against being crazy.”

“Okay, then.” She looked at the clipboard. “Smelling things?”

“No.”

“Things touching you?”

“No.”

“Tastes?”

“I’m having feelings that aren’t there.”

She paused. “What do you mean?”  

“Some of my feelings are hallucinations.”

“Can you explain?”

“Feelings I experience that are not there.”

She wrote it down in quotes. “Why did they have to put you in restraints?”

“Because I didn’t want to come. The police brought me. Some dumb kid with a badge who doesn’t know anything. I told him I didn’t want to come. If I wanted to, I know the things to say to get me in here. I was over at Immaculate Conception, but they kicked me out because of a wedding rehearsal. The priest said he was calling the police. So, I went to the bridge.”

“To throw yourself off?”

“I told you. They tear everything down and then it’s not real.”

“Why go to the church?”

“It’s an old place. A beautiful place.” BEAUTY will save the WORLD. “I wanted to sit with the angels. They protect me. If Confession was happening, I would’ve gone and had the priest say the magic. I’ve told you, haven’t I?”

“Yes, many times. And does anything ever happen? . . . Has anything ever happened?”

“I . . . dissociate,” he stammered.

A knock on the door and a short, middle-aged doctor with a runner’s trim poked in his head. “I need to see you,” he said to Loraine.

“I’m not done yet.” She stepped out with the plastic chair.

“When’s he leaving?”

“I have to make sure he’s safe.”

Psych-Speak to the little doctor’s ears. “Make it quick. I know this guy – a sophisticated malingerer. If he’s not safe, he belongs in jail. Otherwise tell PCMH that they have to get him in early next week.”

“I’ve got a plan.”

“About time someone did.”

“But you have to medically clear him.”

The doctor waved his hand. “He’s cleared.”

“All right. But he was in restraints.”

“When’s he not in restraints? Get him home or to the unit, or in jail. Just get him out before he starts screaming.”

“You don’t treat other patients that way. Just because he’s ‘psych’.”

“This has nothing to do with psych patients and everything to do with him and PCMH’s failure. Now we’ve a filled waiting room and are short staffed . . .”

“This isn’t my fault, Dr. Franzblau.” She grabbed the chair and went back in.

Eric with eyes closed. “Forgive me of my sins.”

“What sins?” she asked. “Hasn’t God done that?”

“I keep making new ones to bring him on. Otherwise, he’s silent. He’s never there unless I sin . . .” Then a smirk. “When I refused to believe, he hounded me. Now that I do, he’s gone.” He rested his hands on his gut and rubbed it. “It’s the cycle.”

“A hard three days,” Loraine said. “Have you been drinking?”

“A shot a couple of hours ago.”

“A shot of what?”

“Old Sterno.”

She wrote it down. “Any beer?”

“A tallboy.” And he smiled, his teeth yellow from coffee and cigars. “Three fingers of Old Sterno at 13:00 and a 16oz PBR and from there I went to church.”

“Are you drinking daily?”

“No,” he said agitated again. “I got my SSI today and it’s the beginning of the cycle. I had a drink for my anxiety. All three come at the same time. Can I leave now? Like I said: there’s no law against being crazy.”

“Can you go to your apartment and not make a disturbance tonight?”

“I can go to my apartment for a three-day bender like I do every month.” She looked at him over her glasses. “Yes.”

Loraine wrote on the form. “Eric, if I talk to our director, Mr. Gregory, about a bus ticket and fifty dollars, would you go back to Chicago?”

“Arlington Heights,” he corrected her.

“‘Arlington Heights’ – if we pay for a bus ticket, would you go?”

“The bus doesn’t go to Arlington Heights.”

She sighed. “Would you go?”

“Maybe.”

“I’ll talk to Mr. Gregory on Monday. She wrote on the back of one of her cards. “You call this number at 9:00 A.M. on Monday . . . I’ll call you in case you forget.”

“I won’t forget.”

She wrote more on the assessment. “Sure you’re safe?”

Safe? What’s safe? Is anything safe?

“I’m safe,” he said. “. . . I could’ve hurt you, Loraine, if I’d wanted to, but I didn’t.”

“I’m trying to let you go,” she snapped. “Don’t play this or I’ll put you in.”

He nodded. “Sorry . . . You’ve always been good to me.”

She felt the years. “The moon,” she said, as if they were both its victims.  

“Yes. But you know, it really doesn’t have anything to do with it. Not the way you think.”

******************

Misty night. The temperature dropped. A Nor’easter moved in. Eric crossed the hospital parking lot, the worthless discharge instructions crumpled in his hand. You were a Catholic priest in a past life, an Irish Catholic priest – a woman’s voice in his head from when he had visited a psychic. I don’t believe in past lives – his voice answers. But you believe in werewolves, don’t you?

He made for the road, his knees aching from the forty extra pounds gained on Zyprexa. A pinched nerve in his neck made it difficult to move his head. Still, he lifted his chin to the coiling night. “Are you with me?”  

Who can separate me from the love of Christ?

“I can,” he answered.  

Shame is a sewer.

He clambered over the low stone wall separating the hospital from its corporate neighbors, a mid-20^th Century industrial park that had seen better days and a contrast to Portsmouth’s evolving ersatz quaint. How well he fit with these dated buildings dead on this Friday evening. Though not so the food processing plant, which, on sticky summer days reeked of hot oil and fried fish that stuck in the nose miles away.

A grassy easement cut down the backside of the park, a row of high-tension wires running down its center. They buzzed from the mist. Walking under them, he imagined being zapped to cinders with one touch of their metal skin . . . It could happen – a mishap of grounding or an old fashion miracle – God having had enough of him.

He grabbed a footing.

Nothing, as he expected. The supernatural never reciprocates on his terms. And yet, a tingle – the same bristle one has with a revelation, just enough that it could be real. If he held on, would he tempt it?

But no. Get back and lock yourself in. Don’t come out. It’s trouble when you’re out . . . Trouble’s not the word.

Security lights appeared through the fog. The Terrace Apartments on Perrie. The End-of-the-Road-Arms. Crushed bags from Taco Bell and empty plastic vodka bottles marked the way.

The back-security door was prompt open with a rock.  

He padded up the back steps in the low-lit fuming hall, the building quiet: the schizophrenic woman upstairs must have gotten her Prolixin shot, her radio’s not blaring, the stripper and her abusive boyfriend across the hallway must be at the club, and in the apartment below, the bouncer’s Rottweiler’s not crying.

Be invisible. Be silent. He unlocked his door and turned on the light.

Books. Stacks and stacks of books. In fiberboard cases. Parading on desktop and table and stacked on the floor like drunks. New ones and old ones, retrieved from dumpsters: social commentary, philosophy, anthropology, history and science, biblical scholarship – Roger Penrose, Camille Paglia, John P Meier, Raymond Brown, bristling with yellow stickies. Art books, photography books, film books, novels – scores and scores of novels tabbed and underlined even more than the nonfiction. Spent yellow legal pads scattered about. Crucifixes and photographs on the walls, a pastiche of models in Pre-Raphaelite poses interspersed with Jesus on the cross. On a wall by itself, in a space of honor, a Bouguereau pieta.

He pressed against the door and locked it. Next will be the Johnny Walker Red; it’d been on-sale at the state store at the traffic circle. He’ll drink until he passes out. The best thing to do when it’s on him. Make it drunk too so it can’t get a foot under it . . . It comes just when he thinks it’s gone, the way it vanishes as is that was the final time and he’s no more than an ordinary drunk with a shot at being normal. Maybe Loraine should have put him in. But that would solve nothing; it would lay low and him a malingerer at a thousand dollars per day. It’s not that he can’t control it . . . Isn’t that what all addicts say? But it comes. The damage. The horror. Even if it’s in his head, he knows, and God knows.   

With a poured three fingers, he sat before an old Dell with a worn bible next to it, held together with Gorilla Tape. Holy cards marked places where he read.

In Loving Memory of

Richard R. Koss

July 26, 1918     May 9, 1984

Where can I go from Your spirit?

From Your presence where can I flee?

If I go up to the heavens, You are there.

If I take the wings of the dawn,

If I settle in the furthest limits of the sea,

Even then Your hand shall guide me,

And Your right hand shall hold me fast.

In Loving Memory of

MARILYN   “Georgia”   KOSS

Born  July 15, 1921

At Rest  May 30, 1999

I’d like the memory of me

to be a happy one.

I’d like to leave an afterglow

of smiles when life is done.

I’d like to leave an echo

whispering softly down the ways,

Of happy times and laughing times

and bright and sunny days.

I’d like the tears of those who grieve

to dry before the sun

Of happy memories that I leave

When life is done.    

‘Feelings not there.’ That the scotch knock him out.    

           

It’s ‘O-bun’ – the voice said. Not ‘O-Baaaaan’, you Chicago Irish Polock . . .

“Who’s an Irish Polock?” he said and downed the Johnny by half. He held up the jelly jar glass. “When was the last time I had fucking ‘O’Baaaan’?”

It stirred.

Behind the mist, a Harvest Moon.  

It stirred again, shaking off its sleep.  

Johnny Walker was the antidote though demon of its own. He downed it and poured another. “Jesus, watchman of my soul, closes when I sin, closes in my addictions.”

Picking up a thin-line Sharpie next to the bible, he stripped off his shirt. Covering his arms and chest, from scapula to sternum, all the way around as far as he could reach, he had written on himself lines and lines of small tight printing. He opened the bible to the page marked and began to write at the bottom of his ribs:

. . . hear my voice. Let your ears be attentive to my voice in supplications. If you, O Lord, mark my iniquities, Lord, who can stand? But with you is forgiveness, that you may be revered. I trust in the Lord; I trust in his word. My soul waits for the Lord more than the sentinels wait for the dawn . . .

He paused to take a drink. It moved, but the words kept it in . . . Because he let them.