Hunched over a patient file in a hospital a man of about 40, hair graying all over not just at the temples, rubs his eyes. Behind him an old newspaper declares we would never forget the tragedy of Sandy Hook Elementary. John had been trying to get caught up on charts, the patient files, all morning but he has found it increasingly impossible to do so because of the auras clouding his vision.
Auras are the visual hallucination experienced by the vast majority of migraine sufferers. They come in many different forms, from bright white light, to focus robbing blurs in the center of one’s visions, to what John has struggled with since his time in the military oh so many years ago, colorful ribbons of bright light which move from the periphery of his vision to dead center. Often these auras would be just outside his direct vision, on the side (either left or right) and do nothing more than be an annoying distraction. Occasionally they moved directly into his field of vision, as if hovering in space just in front of him, usually just before the migraine set in for the next few hours.
These annoying ribbons of light, long arching eyebrow shapes, don’t move or wiggle; “they are just there” he had told his doctor years earlier.
“They sometimes start off in the edges of my vision, are brightest when I close my eyes, and are at best annoying as hell, but sometimes they signal the most intense pain I have ever experienced.”
“But they don’t always lead to a migraine?” his doctor had asked, scribbling notes in John’s chart, “sometimes they just go away?”
“Yes,” John answered in frustration, “and the pain which comes is not always the same. Sometimes it feels like my eyes are being boiled from the inside out, like it would almost feel better to have them plucked from my head. Sometimes if feels……”
“John?” a voice jerks him back to reality.
“Umm what, I’m sorry what were you saying I was……” John’s voice trailed off. His face grimaced as he rubbed his eyes, staring at the person who had interrupted him. The source of the voice, and now the focus of his gaze was that of his good friend David. He had apparently been standing there trying to get John’s attention for some time.
“I’m sorry David I have just been trying to deal with these auras all morning,” John managed to say weakly, “what was it you needed?”
“I don’t need anything John, and you should really get those things checked out maybe your blood pressure is out of whack or something. Maybe you need a blood thinner or something to stabilize your blood pressure before your brain just explodes,” his friend replied.
John had met David when he was in graduate school 12 years earlier working on his doctorate in clinical psychology. John apparently was the only other student who understood David’s highly sarcastic and rather immature sense of humor and David was the only person who had immediately seen through the façade of John’s daily student life to see the troubled person who hid inside. David didn’t say it at the time but years later confessed to John that he could almost feel the pain he was in when they first met. John of course explained it away as the fighting which led up to the separation and eventual divorce because the true pain that was there and probably the source of his marital demise was more than he was willing to accept himself and certainly was not something he was going to share with somebody else. Not even his best friend.
The two had gone off their separate ways for internship, the last year of PhD studies, but happily bumped into each other on the floor of the new inpatient facility which had just been completed. The ironic happenstance of David, the psychologists already hired by the state to work in the hospital and leader of the tour of “famous” psychologists the hospital was trying to woo into applying for the numerous open positions, made them both happy and cemented the possibility John would be accepting their offer.
John never considered himself to be famous he had written a couple of papers while working a postdoctoral position at a university which had gotten quite a bit of notoriety, but he really considered them no big deal. John was never really comfortable with attention and discovered that he was even less comfortable with being recognized in his field for the “brilliance” he displayed in a paper written about the unconscious, that part of the mind which exists outside of awareness.
John had quickly grown weary of the dinners thrown in his honor, at having become the latest “groundbreaking theoretician” his school trotted out like a prized pony in front of potential donors, and had become especially weary of the question they all asked, “What will you be working on next?”
The donors and journalists weren’t the only ones asking this question, so were the deans of his university. When the school in their exuberance to having another groundbreaking project underway had lavished John with funding for any future research projects he squandered the money and produced nothing worth talking about, let alone publishing. When the university finally came to his office and demanded to know what he was doing with their “generous funding” he told them that he no longer wanted to conduct research, he was tired of the notoriety and wanted to focus on teaching. They had quickly reminded him of the old cliché which exists in academia, that one must publish or die, is not so much of a cliché as it is more of career advice.
They had suggested a vacation with his family would set his mind straight. They didn’t know the last of his family had left him in grad school. Oh sure they still existed, but they stopped returning his phone calls years ago and when last year his oldest son (in an email to his work account) had asked for money to pay for the wedding John had not been invited to, he had decided maybe they didn’t exist after all.
In a way John had chosen to die, not a physical death but a death of a still blossoming and promising career which could have led to fame and fortune. John found the pressure that he experienced intolerable and had chosen instead of continuing research into what he thought of as common sense and not groundbreaking to find a comfortable position somewhere where he wouldn’t be recognized so that he could live out the rest of his days helping those who could in complete anonymity.
The last thing this world needed was another pop psychologist on the radio or television telling people what they want to hear for money.
How ironic he had thought it when the state had sent him a letter offering a high level position in their new facility. The state mental health department, as well as those suffering from the disease of mental health needed forward thinking people like you, the letter had said.
This looked like just the thing that he’d been hoping for though management was something he had never really considered, he hadn’t told anybody what to do since that day in the Marine Corps, and really wasn’t sure that that was something he ever wanted to do again. When he expressed his concerns the state recruiter assured him that he would be managing a wing of a new inpatient facility as a doctor not an administrator and would be free to run his wing his way. The recruiter assured him that he would not be required to publish new research and at most may have to attend fund-raising dinners and political functions. With this reassurance, and a generous compensation package, he thought he would at least take a look. Seeing his friend there as the staff psychologist in charge of showing the group of potentials the new facility reminded him of something else that he needed but have forgotten about all, a friend.
The position had turned out to be exactly what he was looking for; a job he could leave at the end of the day. Only his day didn’t end, most nights he slept in his office as he had no reason to go home to his rather large but empty home.
“I’m healthy as a horse David,” John responded to his friends joke with one of his own, “you should be so lucky to be in as great shape as me.”
“What I had said not realizing that you are daydreaming trying to play off that one of your migraines coming on, really you’re such a puss, is that we have another Jesus coming in.” David could barely hide the excitement in his voice, of all the forms of mental illness that a person is capable of suffering the belief that one is Jesus or God was his favorite.
It’s not uncommon for a person to fantasize in things that aren’t justifiable or provable in any way. This isn’t delusion. In fact it is an important part of childhood. But when a person suffers the trauma of neglect as a child they feel unimportant, unworthy of God’s love (in this case God is mom and dad), and in some cases as a coping mechanism these fantasies turn to one of being a powerful person. They become a king, a queen, a prince or princess, and this becomes more than just a fantasy. It becomes an identity. Really a way of saying “I am not insignificant I am important I am the” fill in the blank important person.
These types of delusions of identity are well-written and well documented and go back for many, many years. Actually they go back farther than the field of psychology itself, but for some reason as of yet to be identified some people must have the ultimate form of powerful identity. Their delusion is not satisfied with the idea of being the president or Napoleon they must be the all-knowing all-powerful deity himself; they become God or his son Jesus.
Even that form of identity delusion is not that rare. John thought there were at least three other Jesuses on his wing alone and there were three other wings almost certain to have at least one Jesus each.
“David the only reason you like these guys is because that one patient called you King David the entire time he was here,” John managed to squeak a smile out of his voice as well as on his face.
“Oh you’re just jealous because he didn’t call you King John,” David was not just smiling but laughing now and John couldn’t help himself but laugh a little as well though the pain in his eyes was now quite intense and getting worse. He did not like the idea but he was going to have to go to the pharmacy and get something for his pain soon which meant he would be clinically useless for us to the day.
“Besides John you never know I might finally get an answer to the big question.”
“Oh and what would that be Dave, will I get laid tonight?”
“Oh ye of little faith John, I already know that I’m getting laid tonight. I want to know why Jesus showed up where he did. Why didn’t he save the Indians in North or South America? Why show up in Judea to a people who didn’t even recognize who he was?”
John sometimes forgot the glossy veneer of David’s sarcasm, women and dry martinis hid the heart of a true Christian Believer. David may not go to church anymore, but his children were baptized in the Lord’s name, even though he was never married to their mothers. In addition to the staggering amount of child support he paid David also sent money to his mother’s church every month. Buying his way in, he would often joke, might be his only chance at getting past the pearly gates.
“Do we know anything about this one Dave, or is he just another dirty homeless guy trying to get out of the heat?”
The question was not as judgmental as a probably came out, the state of California though spending more money on mental health facilities than ever before was building them where the real estate was the cheapest and that meant Fresno was where the new hospital was in the summer time Fresno’s heat was unbearable especially if you had nowhere to go. So many of the homeless people in the city would show up at their door faking some mental illness that they remembered from some television show, saying they were seeing people or space aliens, and begging for help.
John had been often criticized for the habit he had developed of helping these people out. Whenever there had been an empty bed in the facility, which really wasn’t as often as the administrators would make it seem, John had made a habit of letting these people in. So deeply had administrators of the hospital protested that John had actually gone out and secured grant funding to help offset the cost to the hospital for caring for these people who often just needed a place to sleep out of the heat and a sandwich.
At most the homeless folks would only stay for a couple of days before wanting to be discharged. Their symptoms would miraculously go away when the weather turned to cooler temperatures or around the first of the month whether Social Security checks would be coming in.
“No we don’t really know anything about this one, in fact he has been at community downtown for about a week. According to what I saw on the transfer request he actually hasn’t spoken a word since they picked him up,” as David said this last bit he handed John a plastic folder, this new patient’s chart.
John opened the chart and began reading. The official name of the patient on the chart was “J. Doe 040313” the first part representing the fact that nobody knew what his name really was, the second the date he was picked up.
The chart began….
Patient J. Doe 040313 was picked up and brought the facility, Community Hospital Downtown, apparently not responsive to external stimuli. Patient was discovered by Fresno PD in the Woodward Park area, in the middle of a busy street. Patient was unresponsive to Fresno PD attempts to communicate and thus transferred to Community Hospital Downtown for examination. Patient has not responded verbally or by manner of gesture to insinuate he understands or is capable of speech, though patient responds well to gentle physical direction and guidance…
As John was reading the chart looking for medications that had been administered to the new patient a noise caught his attention and drew his gaze from the chart. Actually it was a lack of noise which made him look up from the chart. The unit he worked on was where the majority of the psychotic patients were held. A psychotic patient can demonstrate a variety of symptoms from full-blown schizophrenia including delusions and hallucinations, to features such as rocking, crying and wailing or talking to themselves. In short this wing was the loudest wing in the hospital, except for right now.
John first became aware of the absolute silence broken only by the gentle whirring of the air-conditioning. He looked up and around; all the patients in the day room had stopped what they were doing and were looking towards the doors which separated this wing from the hallway and the rest of the hospital.
As he looked around him John became aware that all the other staff was also staring in disbelief at the patients staring at the doors. It was not unusual for patients to stare at the doors, or even stand by the doors, as this was the way that they were brought in and on some level they know this is the way to get out. Contrary to popular belief people do not want to be in an in-patient locked facility. Some part of them, a healthy part of them, always wants to grow always wants to improve and most importantly always wants to get out of here.
John was just forming the words, “what the hell,” when the doors opened and two very large men dressed in white orderly uniforms brought in a long-haired and bearded, very homeless looking, man.
As John stared at him the aura which had been off to the right of his peripheral vision quickly moved to the center of his vision causing shooting pain through both of his eyes straight back as if hot iron had been inserted through his eyes and pushed to the back of his brain. The pain was so incredible and so instantaneous he did not have time to even cry out but continued to look straight ahead at the new patient being brought onto the unit.
As the aura moved from the right to the center it seemed to gather around the head of this new patient and burn brighter than before but instead of burning in the usual rainbow colors the light which glowed gold.
The light and the pain flashed brightly and intensely causing John’s stomach to churn and threaten to return his breakfast burrito from its place of digestion to the counter in front of him and then was gone. He wasn’t sure but he thought he saw the patient dressed in white robes as he walked in but as the pain and the bright gold light faded he blinked and saw that the man was dressed in dirty blue jeans, had no shoes on, and did not have the appearance of having recently seen bathwater.
“Ah for fuck’s sake,” David was saying next to him, “they could’ve at least given washed him up before they sent him over here. They had him for a frickin week.”
John knew David was upset by the sound of his voice not the fact that he was cussing which was a usually part of his language even on the unit. Even though John had asked him not to, repeatedly.
John couldn’t get his vision of the new patient in robes with his now golden aura around his head out of his mind as the patient was led down toward the room where they did intake examinations. He actually shook his head to free his mind of the image. He had a unit to run and did not have time for this migraine and the visions it brought with it.
John turned to the nurse to his right and said, “Go get his vitals Maggie I’ll be there in a second to do the intake.”
“Yes Dr.,” Maggie replied, “but what was that other thing you said about?”
“I didn’t say anything else Maggie,” John stated flatly as the patient was escorted down the hall and past his position.
“Oh, I’m sorry doctor. I thought you said he was dressed for the part.”
“And what part would that be Maggie?”
“Jesus I guess,” she said as she walked down the hall after the new patient. “Do you want me to get him cleaned up before you come in?” she called over her shoulder, “he should be stable; he is fresh from Community and all.”
John didn’t recall saying anything about the new patient until he turned to give intake instructions.
Maggie’s questions and observations were as usual right on target and he was reminded of not only how much he depended on the nursing staff to keep this ship afloat, but how much he liked this woman. She had radiant copper hair and a smile which could light up a room, not to mention she had the type of body which made hospital scrubs look good and that was quite a feat.
“That would be great Maggie, thank you,” John called after her not noticing the way he was looking at her form as she walked away.
“Oh for fuck’s sake John, will you just ask her out or bone her or something,” David had finished whatever charting he had to do and was heading off the unit himself. His voice and his advice trailing off with him.