"Doctor Messing's Patient" - a WIP

[Gil Hamilton]

This is a bit of fiction I've been batting around in my head for a while. I'd like to keep writing it in my occasional bouts of free time, but I figure I'd post the first part and add to it as I had time. In the mean time, feel free to comment as to whether or not this sounds intriguing enough or whether I should stop with my dignity.

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Doctor Messing's Patient: Part 1

“So, Steven, how are you feeling this evening?”

The portly psychiatrist smiled warmly at the man sitting uneasily in the squashy metal framed chair. He drummed his mechanical pencil on the manila folder of Steven McMahon’s case file, before jotting down a short description of the physical state of his patient on the note pad in his lap without breaking eye contact. He didn’t look so good, but he never did. However, his clothes and person showed signs of seeing a Laundromat and some grooming, which was an improvement since his last visit. Being somewhat hunched inward while sitting, cradling his left arm where he took his meds and the rocking were all normal.

“Good, Doctor Messing. Doin’ good. I… I got paid the other day…”, Steven shakily said, rocking a bit more. Doctor Messing’s smile broadened encouragingly.

“Excellent, Steven. So you are doing well at the gas station?” The doctor flipped through his notes to the previous meeting where his patient told him he got a job as the overnight attendant at a 24/7 Sonoco filling station. He was extremely proud of himself and Messing was proud of him too; it was extremely hard for men with his condition to find employment and rarer still for them to be able to keep a job for long. Theoretically, it was illegal to for employers to discriminate on the basis of their medical history, but it was also illegal for the prospective employee not to report their condition, which often was the end of the conversation.

“Oh… yeah, yeah… my boss, Mister Anderson, says I’ve be doin’ really good. Mister Anderson says he wished he had more of me, ‘cause I do such a good job of keepin’ the place clean. Can you believe that?” Steven looked nervously at slit where there would be a sidewalk level window looking out onto the city street, but it had been covered with blackout material for antsy patients who didn’t like openings.

“I gotta tell you, Doctor Messing, I really like the gas station. Ain’t no one really comes around most nights, ‘cept some of these hobos, but I… I… uh…”, Steven stopped, and went to marshal his thoughts.

“Go on, Steven. What about these men?”, Messing gently asked.

“…Uh… some of them, like, some of them came around for a while, ‘cause they thought I might be a junkie an’ have some drugs an’ I could like give them some. I told them that I didn’t do that shit and they should get out or I’d call the cops on them. I could smell ‘em hangin’ around so I called the cops cause’ I couldn’t think with how the one smelled… uh…” The patient coughed and looked nervous. “I didn’t do anythin’ to him. You know that, Doctor Messing, I didn’t do anything to him”, he finished with emphasis.

“I know you didn’t, Steven. However, did you have your nasal spray with you?”

“Uh… I had run out an’ I needed to get paid before I could get more… sorry…” Steven balls his fists to hit his skull, but stopped a jittery inch short before forcing his hands back into his lap. His voice was desperate “I didn’t hurt no one, you know that? You’ll write it down?”

Messing sympathetically nodded and duly wrote on his note pad about Steven’s concern. “Of course. No one thinks you have.”

“I’ve been doin’ really good. Like… uh… Saturday night, I was at the counter and I was watchin’ the TV the boss got. It hurt to watch, like, it was one of those flat panel job that I can’t see really well, but I wanted the white noise, you know?”

“All a’ sudden, headlights came in an’ a car pulled into one of the pumps. Then this like woman came rushing in, wanting to put twenty dollars of gas on pump number five. She was really pretty and even though she looked kinda tired. Like her hair was messy an’ I could see she had some kids and luggage in the car. I told her she was pretty and asked he where she was goin’ with her kids and luggage at 2AM, but she just rushed out.”

Steven stopped rocking and looked Messing right in the eyes with a deeply intense look. “She left an’ all of a sudden I realized that I didn’t want to hurt her! She smelled all pretty an’ that, but it didn’t like occur to me!” He broke out in a big toothy grin. “Ain’t that great, Doctor Messing?”

Messing clapped his hands. “Bravo, Steven, it sounds like you’ve been doing great! So, you’ve been taking all your meds, then?” He posed with his pencil, and scribbled a note to himself that Steven seemed to be responding well to the increased dosage of the CCK promoters and to keep him on 100mg.

“Yeah, every day. Every day when I get up I give myself the shot.” Steven held up the inside of his arm to show where repeated needle marks completely scarred the inside of his arm that he normally cradled.

“Very good, but the new dispensers they have don’t leave a scar. You are still using that syringe?”

“I… uh… em… sorry, doctor… you know…”, Steven muttered, rocking harder.

“May I ask why you still use it? No one would see those nasty scars with a dispenser.” Messing said this as carefully as possible, trying his hardest to keep judgment or implied judgment out of his voice, a skill carefully cultivated over three decades of being a psychiatrist. Instead, he let in only mere curiosity.

“Um… you see… I… I…”, the patient stuttered and gulped. “It’s easier. Like, it’s easier cause people like see me shaking an’ the needle marks and they think ‘He’s some fuckhead junkie’, you know? They don’t ask questions an’ they leave me alone, but they are only worried I might try an’ grab their purse or something or they feel bad or something. They… uh… they don’t think I’m gonna hurt them. They don’t know.”

Messing slowly nodded and compressed an entire thought and apology into “Ah” He then moved the subject along. “How many days of meds do you have left?”

Steven counted on his hands, balled his fists a couple times, and looked frustrated. “Like… uh… I… eight? I think.” He continued staring at his hands, trying to remember if he had eight or nine more vials of red liquid.

Messing pulled over his laptop. “I’ll put in a scrip for two months. You seem to be doing really well on the 100mg of VN promoters and the scent suppressant, so we aren’t going to mess with success”, he said, pulling up “McMahon, Steven” on his computer and feeding his personal information into the order form. “I’ll send this to the Giant Eagle on Murray and Loretta, so you can pick it up there. Be sure to bring your medical identification card this time!”

“Yes, Doctor Messing, thank you. Thank you…”, Steven smiled and then looked back down at his hands again. “Look, I gotta go. I gotta get to the gas station in an hour. Mister Anderson let me come in late today but… I really need to keep this job.”

“Of course, it was good to catch up and make sure you are doing alright. Please speak with Missus Jones to schedule another appointment for maybe a month from now? There’s a good lad.” Messing somewhat violated normal practice by patting Steven on the shoulder on the way out his office door. Steven jumped a little under the physical contact, but ventured a smile. Doctor Messing stared at the back of the man’s wrinkled attendants uniform as he walked down the hall and turned the corner to the receptionist’s area.

The psychiatrist began typing the new set of notes and impressions from this visit into the file “McMahon, Steven”. He certainly hoped that Steven would do well at the gas station. This would mark the first four weeks of steady employment the man had in thirteen years, not counting the meager amount of money he earned stuffing envelopes during his last involuntary stay in Western Psychiatric’s mental ward for dangerous patients. That was lucky. He only avoided being sentenced to transportation to Sing Sing colony due to the fact that his victim, a girl of twelve, managed to survive uninfected when he built up an immunity to the appetite suppressors he was on at the time.

In fact, it was only a matter of time and because of that, Doctor Theodore Messing himself was on antidepressants from the stresses of his job. To date, no medication has been invented that suppresses the effects of Steven’s condition indefinitely. Every single drug and chemical tried eventually stopped working after a couple of years and unfortunately, vampires last quiet a big longer.

[Lagmonster]

Very good way to lead into it; a procedural and mundane situation that is being used as a veneer over a more violent one. You have to build a story, now that you've established the environment.

[LadyTevar]

I agree with Lagmonster -- this short story could be continued, fleshed out a bit more.

Right now, we have hints that Vampirism is a medically known condition. It is one of those thing that an applicant to a job *must* mention, and it's illegal not to inform authorities when you are a vampire. However, like other mental disabilities, it can be treated with proper drugs and a good psychiatrist.

On the down side, we see that drugs don't always work. We get a hint of what punishments await Vamps who lose control or don't take their drugs. We see that it's 'easier' to be seen as a junkie than as a vampire in society. We see the toll is also on the poor man (men?) trying to help Vampires function in human society.

What we don't see if there's a physical as well as psychological component to Vampirism, other than references to 'smell' and 'appetite' triggers. We don't see the average John Q. Public's view of Vampires.

This could be a great series of short stories, if the universe is built properly. I look forward to where you might take it.

[Gil Hamilton]

This was getting out the idea that I'm developing, which will be about Doctor Messing as much as Steven. This is mostly me typing something and seeing how much more I want to develop with my time.

In this the near future vampirism is a medical condition but also a supernatural one. How John Q. Public sees vampires will be definitely expanded on as will the nature of vampirism, but in the limited text I've generated above, I've baked in things.

Vampires are extremely light sensitive to ultraviolet light and intense light, but also polarized light. This is why Steven has trouble looking at LCD displays, which, of course, use polarized light extensively in their function. It's also the source of the problems with vampires and reflections, though oddly enough, an actual silver mirror won't hurt them (metals don't polarize light on reflection), however reflections from water are polarized. Why they respond strongly to polarized light is not known.

The requirement obliging vampires to inform their employers of the nature of their medical condition is an issue I wanted to explore. How do anti-discrimination laws for people with medical conditions interact with individuals who by their very nature are a significant risk of violently assaulting someone and drinking their blood, a condition where treatment only allows them some willpower to suppress their powerful anti-social urges, and for which treatment will ALWAYS become ineffective at some point. My conception is that the only way to sate a vampires hunger is human blood and it must be taken unwillingly from the victim (this is a supernatural aspect); eventually no amount of medication will compensate for their hunger and no matter how much chemical spray they shoot into their nostrils to suppress the smell of human blood.

Vampirism is a powerful thing. People often use it as a metaphor for sex (or rape), but I think it's more profoundly disturbing clinically. Anyone who grew up during the 80s remember how scared people were of HIV. I remember being eight when they started telling us about a disease that was 100% fatal and they weren't even sure how exactly it spread, except they had absolutely no idea to treat it. How awful! How combine it with the poor relationship that society has with people suffering from mental illness. Half of time you can't even convince the public that they ARE suffering from an illness, that it isn't a moral failing or a lack of willpower. AIDS combined with the worst sort of psychosis and immortality? It's that knot in my stomache that makes me want to write about it, both from the perspective of someone suffering from the condition, a person desperately trying to treat it, and of society on both.

[Gil Hamilton]

Part 2

Pittsburgh, Pennsylvania. June 11, 2024, 18 years before present.

Paul Messing car silently rolled down Forbes Avenue, bathed in splotches of sickly orange of sodium street lamps through the branches of the maple trees lining the road. Normally, at this time of night and this close to one of the universities, the road would have been filled with traffic of people coming out of work or school, or heading to the bars and clubs closer to the city core. Things weren’t normal; Messing was the only person driving on the road and the complete lack of normal city noises was deafening in his ears, with only the noise of his car’s electric motor and the occasional barking of a dog breaking the silence. As he approached the Carnegie Mellon University campus, the police had put up barriers across the road. He slowed down just as several police officers flashed their torches at his car and a squad car appears behind him, flashing its lights. Messing nervously made sure his UPMC hospital badge was clearly visible and put his car into park.

“This is the police. You are in violation of curfew, put your hands on the steering wheel of your car and await further instruction while we ascertain your identity”, a voice over a loudspeaker buzzed. Four police officers approached from the barricade, one holding pen camera pointed as his car. Another came up against his driver’s side window and shined his heavy torch right in Messing’s face. He blinked hard, but kept his hands firmly on the steering wheel. The police officer who shined the light in his eyes shook his head to the others and rapped on the window.


“Messing, Paul?”, the officer asked, glancing at his head’s up display before looking back down. “You are in violation of curfew. Why are you on the road, sir?” He was direct and blunt. Messing noted the large amount of stress and the undertone of fear in his voice. Messing held up his hospital badge.

“Officer, I’m a neuropsychiatrist working for the University of Pittsburgh Medical Center. I’m on my way to Presbyterian Hospital on critically urgent business and they are expecting me shortly”, Messing said, careful to sound respectful. This was a desperate night and he couldn’t afford delay. Flashlights were covering him now. The officer looked to the others and the one marked as a sergeant nodded.

“Sir, please wait while we call ahead.” One of the police walked back to a squad car. The others kept a careful eye on him. Messing saw the curtains of a house to the side draw and a man look out. The only sound was the omnipresent hum of current from his car’s motors in idle. A minute or so later, the officer who went to the squad car returned.

“We’ve transmitted your VIN to the rest of the police on duty in the Oakland area, so you won’t be stopped again, sir. We can’t spare men to escort you, so please proceed directly to Presbyterian hospital without stopping. If you see anyone on the street who isn’t wearing a police uniform, keep driving, even if they attempt to block your car.” The men were moving aside one of the metal barricades so he could continue. “Sorry I flashed you before. We had to check.”

Messing pressed the transmission of his car into drive and went to press the button to raise his car window, but the officer with the torch put his hand on the top of the window. “Doctor?” Messing stopped.

“Yes?”

“You know what’s going on, don’t you? What’s wrong with them?” Fear seeped to the surface when he emphasized the word ‘wrong’. This was the same sort of tone he recognized from small children asking why their siblings are always screaming for food and breaking things when they don’t get it, conveying the notion that someone is terribly wrong with the world but they don’t understand why. To hear it from a large uniformed police officer meant to him that it must be a lot worse for law enforcement this past month than the news networks have implied.

“My job is to figure that out, son”, Messing said, quietly, attempting a smile but only managing to twitch his lips. He released the break and drove past the men. In his rear view mirror, they were replacing the barrier.


UPMC Presbyterian Hospital

The entrance hall to the trauma center was a scene of bedlam. The waiting room was packed with people; adults clutching injuries, parents with crying children, orderlies and nurses with bandages and clip boards moving amongst the masses giving impromptu interviews in the lobby. Every once in a while, a nurse would suddenly look up and motion to large male orderlies to escort or carry a patient through a set of double doors. Standing in the corner attempting to be out of the way as possible were armed police men. As Messing passed by, he saw an orderly rush past him with a small boy with a gash on his neck while another restrained his frantically struggling mother from following.

He recognized walking briskly up to him was one of the hospital Attending physicians whom he had met previously when he was recruited for this, Doctor Jamaal Kingman. Messing held out his hand to shake, but found that Kingman had shoved a flexible electronic chart into his hand and gave him a look that managed to convey that if Messing wasted his time with pleasantries, he’d quickly find himself ejected from the nearest convenient door or window. They turned a corner and joined a group of medical staff rushing a stretcher past them.

Kingman followed behind them a few steps and turned, “Come on, Doctor, this one will be one of yours.” They hurried to catch up to the gurney. Strapped to it with five point restraints was a girl who couldn’t have been older than sixteen. Her clothes were badly torn with splotches of crimson splattered on it. Covering her face and chest were purple semi-circular bruises, while a nurse pressed a blood soaked compress to her neck. Stick on leads connected her chest and temples displayed her vitals on a monitor clipped to the front of the gurney, and Messing saw that from beneath the sheet they had draped over her hips and legs, a catheter lead to a urine filled bag that one of the orderlies was holding.

“Patricia Deborah Miller, age 15, from Brookline”, Kingman read from his head’s up display to Messing. “She was violently assaulted while putting out the trash by an unknown male about eight forty tonight. We just got her. Multiple bites to her face, neck, and chest, in addition to trauma to the back of the skull and arms from where she was thrown to the sidewalk. Her left sterno-mastoid muscle has been severed and she’s bleeding heavily from her external jugular.”

“Jesus christ…”, Messing whispered, staring at the girl in wide eyed horror. Then his clinical mind clicked together. “Doctor, those bite marks… surely they are more than an hour old?”

“They’ve been healing rapidly since the paramedics first picked her up. They were openly bleeding, but have sense sealed themselves. She’s been peeing like a racehorse the entire time, which we think has to do with the accelerated healing of her injuries.”

“She’s been infected then?”, Messing asked, knowing the answer from the medical notes he memorized in the last two weeks.

“We believe so.” Suddenly the gurney turned and the doctors pushed the gurney into an operating theatre. Before they could transfer her to the operating table, the electronic monitor at the head of the stretcher screamed loudly, and he could see flashing on the resident doctor and nurses HUDs. Messing was pulled by Kingman into a side room to watch on a monitor.

One of the nurses, holding the compress to the girl’s neck called out, “She’s crashing!”, as girl began to convulse against her restraints and attempt to swallow air. The resident pointed to one nurse. “Get a dispenser loaded with the 800mg ketamine/diazepam mix ready!” as he began grabbed a pair of defibrillator pads from the wall. The nurse pressing a mask to her face pulled it away and they stood clear as Patricia’s body lurched from the current shot into her. The vital read out started to display heart movement just as the nurse returned from the wall slot from which a container with the drug mixture had emerged.

The resident shouted, “Stick her!” The nurse pressed the dispenser tip to her shoulder and clicked the button at the top. In the other room, Messing looked in disbelief.

“They are sedating her now? And such a dose!”, he uttered, aghast. Kingman scowled.

“It has to be now, we need the ketamine and diazepam introduced into her system while her heart is still pumping blood or it won’t reach her brain”, the Attending said, matter of factly. He added “Now shut up and watch” as the monitor blared again. After a minute of emergency resuscitation, Patricia laid motionless on the table. The orderlies and nurse began tightening the restraints and placed a sixth across her forehead.

“Why is the resident not calling her time of de—“, the psychiatrist started before Kingman held up his hand. In a few seconds, Patricia Miller’s eyes flew open and she emitted an ear-splitting shriek at the top of her lungs. Her eyes darted wildly from the staff that had backed away from her in horror and she began to snap her jaws as she futilely struggled against the thick nylon bands holding her to the gurney. Two orderlies rushed forward to prevent the gurney from falling over with her on it. A thick spot of urine spread through the bed sheet from her crotch.

Messing reached into his pocket and pulled out a mechanical pencil and notepad. Using the skills he developed with working for his professional career with children, he began scribbling notes on the notepad without taking his eyes off the screaming teenage. Patricia exhibits awareness of her environment and displays aggressive behavior. Biting at individuals and screaming, but hasn’t used language. Loss of bladder control. SOPD. Unconsciously, he underlined the acronym at the end.

One of the orderlies began moving her from the operating theater. There was a flashing on his visor and he rushed off with the nurses in tow. Messing ventured to ask, shaking and barely audible, “Where are they taking her?”

“They are putting her with the others, I expect. They are less hostile around each other than around non-SOPD persons.” Anticipating the doctor’s next question; “We’ve got one hundred and fifty six SOPD cases… one hundred and fifty seven, rather… in the last two weeks and we are running out of space and restraints to deal with them, from the people coming through the ER and including some of our own staff. Statistics are in the file I handed you. Anyway, we’ve got a few of the more coherent ones in observation, so you can pick the ones you want. Now you've got some idea what you are dealing with, doctor, let's meet your patients.”

Messing paused, then nodded and mutely followed.

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Note: SOPD is an acronym for "Sudden Onset Psychotic Disorder"

[LadyTevar]

I'm going to take guesses based on spotty medical knowledge here for my theories.

The patient shows advanced healing as the first symptom of infection, as well as massive dehydration via the urinary tract.
Cardiac arrest occurs approx an hour after infection; probably causes include blood-loss/shock trauma, excessive stress from advanced healing, and/or extreme dehydration.
Patient does not respond to emergency resuscitation and is clinically dead for approx. 1-3 minutes before self-resuscitation, at which point SOPD occurs.


Self-resuscitation after clinical death is not that unusual, although uncommon. Psychosis after any event where the brain is without oxygen for a period of time is also not uncommon. The excessive urine production could be the body's attempt to repel the infection; it however leads to extreme dehydration and thirst in the patient, which the SOPD fixates upon.

The extreme healing factor is the mystery. How does the infection super-charge the body's self-repair systems so quickly? Does the need for nutrients to power this rapid self-repair trigger the attacks, searching for a nutrient-rich, easily digestible food source?


More questions than answers, it seems... which always bring people back to a story to find out what's going on