|The Dog’s Watch. Charles Francois Daubigny. 1857.
The Art Institute of Chicago.
“How ya doin’, Wayne?”
It had been some ten years, back in high school, since I had seen Wayne. I had returned to general practice in my small home town and I was not sure what Wayne had been doing during that time, but when I saw him again, it appeared the years had not been kind to him.
Wayne had been two years ahead of me in school. Then, at some time during high school, he was only one year ahead of me. He started appearing in some of my classes, apparently repeating them. I was never friends with Wayne, but I knew who he was; a burly kid with blond hair coming down below the top of his eyeglasses, strong but not a bully, and a poor student. He always reminded me of a big bespectacled sheepdog.
I do not even know if Wayne finished high school. I had not seen or given him any thought since. But here we both were in an unusual situation. I had been called to sign his commitment papers. I was in my office, doing nothing in particular, when one of the nurses came to the door.
“The jail just called and was wondering if you could come down and commit someone who is acting crazy,” she said.
“Is that something we do?” I asked.
“Yes,” she said. She told me that the other doctor in the clinic had signed committal papers several times in the past. “That’s why they called here. But since today is his day off, they asked if you would come. They pay $20 to have a doctor sign commitment papers. They say this fellow is a threat to himself and others, the way he is acting. That’s why he is in jail.”
“Well,” I said, “If the other doctor does it for them I guess it’s OK for me to do it too.” And while I did not know that much about psychiatry, I figured that since my clinic colleague did not know that much about it either, that this was how things were done in a small town. I drove the four blocks to the jailhouse, a square three-story brown sandstone structure built during the Great Depression by the WPA.
I can safely say that I had never been to the county jail before. I stopped at the desk and introduced myself. A deputy jailer escorted me up to the top floor where the person in question was jailed.
“Now what exactly am I supposed to do here?” I asked the jailer.
“Just talk to the guy and see if you think he is crazy,” he said.
“Well, OK.” I said. “Who is he?”
When the jailer told me who the person was, I immediately remembered him, his face, his looks, how he never paid attention in algebra class a decade ago. “He’s right in there,” said the jailer, pointing to a metal door showing several layers of paint through various chipped areas, with a small, square, barred window.
“Now you’re going in there with me, right?” I asked.
“Sure am, don’t worry,” the deputy jailer said. I was apprehensive as we walked to the room where Wayne was waiting. I managed a peep through the barred window, then the deputy unlocked the door. The room was small and dimly lit. A couple of light bulbs on the ceiling were the only light; and sitting in the middle of the room in a metal chair was Wayne, recognizable but gaunt and disheveled, not with the same harmless sheepdog looks as in high school. He stared at me with dark glassy eyes; where were the eyeglasses that I remembered him wearing in school? I looked at his face, his hair, and his nails. I thought about what he must have been through since last I saw him. Was it right to put this young man way? I spoke to him from the doorway.
“How ya doin’, Wayne?” I asked.
“I’m the Son of Man,” he said emotionlessly.
“Well, OK, Wayne, I’ll see you later,” thus ending the psychiatric exam. There was no need to continue the conversation or complete the mental health exam. Whatever the diagnosis was, I had seen enough to know Wayne needed help badly, help that was not available in our small town. I turned to the jailer: “Where are those papers to sign?” As I looked at Wayne one last time, I thought about his past and his future. I signed the papers that the deputy had with him.
Was my bedside manner in dealing with Wayne incomplete or unprofessional? What more did I need to see? My duty was not to diagnose, but to triage Wayne out of his jail cell to a proper mental health facility. Plus, I was afraid. Wayne did not look receptive to visitors, and despite the presence of the jailer, I was scared. I wanted out of that dungeon before Wayne had a chance to become violent.
Over the years I have revisited that short interlude. I think about Wayne and I wonder how things turned out for him. I was glad I signed the committal papers, because he needed acute psychiatric care. I was able to help him get the care he needed. I looked at it more as a referral than a commitment. But I knew that in reality the chance for him to live a normal life was poor. Multiple episodes of psychosis probably followed.
I could have never guessed while sitting in algebra class that I would one day sign commitment papers for a classmate. So perhaps that is why I carry in my mind two images of him; one is the troubled delusional man in a jail cell, but the other is a happier, more preferable image, a picture that I want to carry instead; the big sheepdog not paying attention in algebra.
GREGORY L. ROSE, MD, did general practice in his small hometown before going into anesthesiology. He is a professor in the Department of Anesthesiology at the University of Kentucky College of Medicine in Lexington.