The Nirvana Plague Read online

  Miles touched him on the elbow. “Yo, Rog? Roger?”

  Roger turned his head toward Miles. His eyes seemed to take a long time to refocus from the distant jets to the orderly’s face.

  Miles smiled a big friendly smile. “Hey, man! Gotta take your meds, pal.” He extended the little cup toward him.

  Roger didn’t even look at it. Still looking Miles in the eyes, he said very calmly, “There’s no need for it.”

  Miles kept the big threatless smile on his face, but behind it he was calculating how to respond. This was a different mood than he’d seen on Roger before.

  “Yo, Rog,” he said, confidentially, “Miss Mary-Lynn Stick-Up-Ass is ready to go home. You’re the only one hasn’t popped his pills. You know how it is.”

  Roger’s gaze turned back to the window. Then he said, slowly, like he was repeating a clever remark: “How it is.”

  He was so close to the window, the words condensed on the cold glass.

  “Rog, you OK, man?”

  As if in reply, Roger repeated it again, carefully savoring every word: “How. It. Is.”

  Miles gave up and walked away.

  Roger continued talking to the window, thoughtfully: “How is it? — It is. — Is it? — It is. It. Is. It is it. — How is it it? — It is how it is. — How? — How it is.”

  “He’s fine. Besides, it only encourages him.”

  In her unkempt apartment north of Chicago, Associate Professor of Biology Dr. Karen Hanover came from the kitchen with a relatively clean water glass and a fresh bottle of cheap California red, sank into her favorite chair, poured herself a generous drink, and flicked on the news.

  The news was not good. The news was never good. Good news is an oxymoron.

  She kicked off her shoes and folded her legs into the chair. She was a small woman, but middle age was filling in her figure. Blond hair, cheaply cut. Sharp features. Thin lips.

  Along with the wine she’d brought to her nest in the chair a bag of old-bay-seasoning potato chips. She didn’t know what was in them, but they were cheap, and they went well with wine, and they reminded her of school days in Maryland: cracking fresh hot crabs, drinking cold beer, arguing passionately naïve politics. In those days, things still made sense.

  The phone bleeped beside the bottle of wine.

  “Hello?”

  A woman’s voice said, “Mrs. Hanover?”

  “Yes.”

  “This is Dr. Marley’s office. Please hold for Dr. Marley.”

  Hold music. Caller didn’t even wait for a reply.

  I should have someone to put people on hold for me, Karen thought. Hello, Dr. Marley? This is not Dr. Hanover, but if you wait long enough she might come on the line. Do please hold.

  Fucking Edelweiss, that was their hold music.

  “Hello?” said a male voice, “Mrs. Hanover?”

  “Dr. Marley, I presume?”

  “Yes.”

  “Something about my husband?”

  “Yes, didn’t Beatrice tell you?”

  “No.”

  “Well, I’ve just had a call from the shift nurse at Joplin. Roger is refusing his medication. Have you spoken to Roger today by chance?”

  “No,” she said. “Not by chance. Why?”

  “I thought you might have some insight into why he is refusing to comply with his treatment regimen. I’ve never had a problem with Roger’s compliance before — not while in the hospital anyway.”

  “Did you ask him — by chance?” She didn’t like that crack about “not while in the hospital.”

  “I wasn’t there,” Marley said. “I’m in my office. I had rounds earlier today. Roger seemed fine.”

  “So you haven’t spoken to him about it?”

  “Not personally. I just got off the phone with his nurse.”

  Karen crunched a chip noisily into the phone, and continued talking while she chewed. “I’m sure Roger has his reasons. Why don’t you ask him what they are? He may be psychotic, but he’s not irrational.”

  “Yes, well, I’m sure he does have his reasons, Mrs. Hanover,” Marley said dryly. “But if we accepted his reasons for his actions he wouldn’t be in the hospital, would he?”

  Karen stopped a second chip just short of her teeth. Well, that was a good point. She toned it down a notch: “What is it you want from me, doctor?”

  “I want to know whether you want us to medicate your husband involuntarily.”

  Karen resisted the temptation to ask him why he needed permission to do something involuntarily. “No,” she said, “not until you’ve discussed the problem with him personally — yourself.”

  “I’ll see him tomorrow. But you know it’s important to maintain consistent blood chemistry levels. It’s not a good idea to skip dosages.”

  “I don’t want him forced to do anything. It’ll only frighten him. I’m sure that’s worse for his psyche than letting his blood chemistry slip a little.”

  A pause.

  She waited. She took another drink of wine, watching the muted images on the screen — something about oil rig fires in Brazil.

  Finally Marley said, “You’re right.”

  That stunned her a second time. In all the years this fellow had been helping Roger in and out of the hospital, she had never gotten to know him. One doctor was as a good as another and none them worth much.

  “Missing one dose won’t affect him too much,” he continued. “I’ll see him in the morning. And I’ll call you back and let you know how it goes.”

  On the television, an orange jet of flame shot into the heart of a vast plume of black smoke, dancing like a dragon through angry clouds.

  “You know, doc,” she said, “the world is going to hell in a handbasket. Who knows, maybe Roger’s world is a better place now than mine. Maybe that’s why he doesn’t want the meds. Maybe he doesn’t want to come back to the real world.”

  “Or maybe he just can’t tell which world is real.”

  “I wonder if any of us can.”

  She hung up and unmuted the television. Three oil wells had been blown up by suicide bombers in their struggle to bring down the US-controlled military government. What’s the difference between a terrorist and a protestor? she thought. When a protestor blows himself up, he doesn’t take anybody else with him. Or doesn’t mean to anyway.

  Chapter 3

  Marley scheduled Roger Sturgeon for his first interview the next day.

  Miles knocked, then led Roger into the small exam room. Marley was sitting in the corner, drinking coffee, catching up on his patients’ charts.

  “Morning, doc,” Miles said with a big smile. “Here’s Roger. He’s been a very bad boy.”

  “Thanks, Miles.”

  Marley stood and put out his hand.

  “Morning, Roger.”

  Roger took his hand and shook it once. He looked at it when he shook it, like a boy would — like it was something he wasn’t used to doing yet.

  Miles went out, leaving them alone.

  The little office had four comfortable chairs along two walls, no table or desk. Clean carpet, textured wallpaper, warm indirect light, a couple of neo-impressionist still-lifes on the walls. Cozy and impersonal.

  Marley sat down again. Roger stood where he was. Marley looked up at him, puzzled, but Roger just stared back at him silently.

  Finally Marley gestured toward the chair near him, saying, “Sit down, Roger.”

  Roger sat down with the same deliberation as his handshake. His gaze drifted away.

  Marley went straight into it: “The shift report says you didn’t want to take your medication last night.” He knew Roger well enough to know polite chitchat only bored or confused him.

  Roger turned his head and looked at him calmly, a half smile on his face, but did not reply.

  Marley wondered if Roger was registering. “Are the side-effects bothering you?”

  “Are?” Roger said. “Are…?” His gaze drifted away as he mused over the word. Then asserted: “
Were.” But then he corrected himself again: “No. Are.” And continued: “Still. But.” Each word was spoken like a complete thought, each thought extending the essential meaning.

  “But what?” Marley scribbled notes on the tablet with his stylus: slow staccato speech.

  “Mmm. Side effects. Effects.” He chewed on each word, digesting its sense. When he spoke the emphases fell in odd places. “There are no side effects. But do they bother me? Bother… Me.”

  “Have you been experiencing any adverse side effects to the medication?”

  Roger’s eyes came back to Marley’s. “Adverse.” Then drifted away again: “Inverse. Reverse. Obverse.”

  Marley scribbled, “semantic glossomania. presentation change. r/o rx etiology.”

  Roger’s eyes snapped back to him. “Yes,” he said. “I see.”

  “What do you see?”

  “You don’t understand what I say. I don’t understand what you say. We don’t understand what we say. We can’t say what we understand, that’s why. We settle for what we can say. Tricked. Tricking. Side effects.”

  “I think it would be beneficial to you to stay on medication, Roger.”

  “No need for that now.”

  “You understand the purpose of the medication?”

  “Mmm. Effects are not adverse.” This humming to himself now and then was a new tic.

  “We’re trying to stabilize your symptoms, so you can go back home.”

  Suddenly with real force: “You are not listening!” Marley was startled. Then quieter: “Not. Not.”

  “Do you want to go home?” Marley asked, scribbling “volatility.”

  Roger, looked at him again, saying very quietly, “Do you?”

  Here they both were. Dancing their dance in a sealed room. Roger was giving Marley the creeps. Marley tried for control again: “Roger, you refused your meds last night. Why is that?”

  Roger looked up at the ceiling, saying, “No need for that now. This is not the same. Not different. But not the same.” He nodded at the tablet in Marley’s lap. “What you can write down on your slate, that’s small.”

  “I’m just making notes. You know that.”

  Roger closed his eyes and did not respond for a moment. After a few seconds, without opening his eyes, he said, “There are no side effects. There are only effects. There are no adverse effects. Only effects. There is nothing bothered.”

  “I want you to stay on your meds, Roger,” he said, jotting “abstract speech patterns.”

  Roger’s eyes popped open again and shot into Marley’s. “You want something neat to scribble in the chart. Advised patient comply with treatment regimen. Stop. — You’re missing most of it.”

  Marley was getting tired of the criticism. “Just what do you think I’m missing most of?”

  “Of you.”

  “We’re not talking about me,” he replied, a touch too sharply. “We’re talking about you.”

  “No!” Roger shot back. “We’re just talking. Only talking. Not abouting. No abouting. Merely talking.”

  Marley became argumentative despite himself. “So we’re talking but not talking about anything. Everything we say is meaningless.”

  “Leaning toward meaning. Weaning from meaning. Preening with meaning.”

  Roger had always been very definite about what he thought was going on in the world, however bizarre it was. This emphatic indetermination was new — and very strange.

  “Roger, something has changed. You’re different. What’s going on?”

  Roger’s gaze started to drift again, as though he were following a slow fly around the room. When he spoke, he did not look at Marley; the words seemed to come from him spontaneously: “Difficult to determine. More difficult to say. Inexplicable. Inexplicable clarity. World is clear. Mind is muddied. Sullied. Mullied. Roiled is a good word. The sediment is stirred up. It’s out of place. But it settles. If it’s still, it settles. There are degrees of suspension. Mechanical suspension. Colloidal suspension. Suspension of disbelief. Eventually, everything settles.” His eyes swam back to Marley’s, and focused on him. A look of sorrow came into his face, as he finished: “I — it — can’t be explained. Too unsettled now. If there is still time, it may be better later.”

  If there is still time? Marley felt the hair on his neck stand up. He didn’t like it. He drummed his nails on his tablet several seconds. “All right, this is what I want to do. I’m going to start stepping you down from Psilobar and switch you over to another drug. In fact, I think we’ll try a less aggressive regimen for a while and see how you respond to it. However, you need to keep taking your medications every day, every dose on schedule.”

  Roger said nothing. He was looking around the room again as though he’d never seen it before. As though he didn’t quite understand what a room was.

  “Do you understand?” Marley said.

  Roger’s eyes snapped back to Marley’s. “Everything is chemistry. The whole world is chemistry. You drink too much.”

  Marley’s annoyance got the better of him. “You know what, Roger, fuck you.”

  Roger continued in an instructional tone: “The brain, is not separate from the body. The brain can’t be fixed separately from the body. This is not separate from that, and these can’t discuss this separately from that.” The way he gestured as he spoke indicated that “this” and “that” meant Roger and Marley. “It’s no mistake to see differences,” Roger said, falling into a singsong rhythm, “but it’s a mistake to ignore indifferences, samenesses, similarities. Reality distracts from dreams.”

  Marley drummed his tablet impatiently. “OK, I told—”

  “—But dreams are not not real,” Roger continued. “It’s a mistake to ignore the samenesses, the overlaps. Everything merges, Dr. Marley. But nothing disappears.” Roger looked at him hard, like he was calling on him, challenging him to comprehend.

  But Marley was tired of chasing Roger’s rabbit holes. “All right. I told your wife I’d talk to her after I discussed the matter with you. I’m going to tell her we’re changing your meds. Hopefully it’ll do you some good. Now—”

  “—Do me good. Mmm.” His eyes flicked back to Marley’s, and he said slowly, overpronouncing for effect: “The mind does not mind being out of my mind now.”

  Roger went out. Marley scribbled orders into his chart and posted them. The next patient came in. One up, one down. Next, please. But Roger had gotten under his skin, and it gnawed at him all morning.

  After the morning round of interviews, Marley went back to the nurses’ station on the ward.

  Mary-Lynn was at her desk, reading his orders on her screen.

  “What about Roger?” she said.

  “What about Roger?”

  “You didn’t change his orders. What do you want to do about his non-compliance?”

  Miles was there too, drinking a cup of coffee, watching the ward.

  Marley looked out too.

  Roger was standing very still by the windows at the far end, staring out.

  “Let’s just wait and see.”

  “Wait and see what?” Mary-Lynn said.

  “See what happens. He says he doesn’t need them anymore. Let’s see if he’s right.”

  Mary-Lynn gave Marley a sarcastic look. “If he doesn’t need his meds, then what’s he doing in here in the first place?”

  Marley glanced at her, but looked away again, answering into the air: “In the first place, this isn’t the first place. This is now. Sometimes things change. Maybe this is one of those times. I want to see what happens.”

  Mary-Lynn wasn’t having any. “You want to see what happens? Roger ends up here because he goes off his meds. Are you going to be here to help us clean up the mess?”

  “I’m sorry this is inconvenient for you, Mary-Lynn,” he answered, without a trace of compassion. “What would you suggest? Physical restraints and court-ordered medication?”

  “Roger,” she said, twisting his name viciously, “is a voluntary,
as you know very well, doctor. As a voluntary, if he doesn’t want to comply with the treatment prescribed for him, he can damn well volunteer himself out of here. Or do you think we should just let any patient who has half a mind to prescribe their own treatment regimen do so?”

  “They’ve all got half a mind, don’t they?” Miles said, not quite laughing.

  “Shut up, Miles.”

  Marley suppressed a smile, and finished the argument: “I am going to give Roger twenty-four hours to get his act together. You can enter your objections into his record, if you like. Now I’m leaving. Call me if anything changes.”

  After he left, Mary-Lynn said, “Yes, I will enter my objections in the records. And see if I don’t call you.”

  Later that afternoon, Miles sauntered back in from bedchecks and slung himself over a stool. “Hey, Mary-Lynn,” he said, looking out, “what do you think is going on with that?”

  Mary-Lynn looked out over her coffee cup into the ward. Roger was sitting at a table talking to two female patients — Chandra and Jeanette.

  “They’re having a conversation,” she said. “People do that.”

  Miles rolled his head toward her. “Yeah, people do. But Roger doesn’t.”

  “Maybe he’s feeling better.”

  “You think so?” Miles said. “You think maybe we should pull everyone off their meds?” She’d been grousing about Roger and Marley all day. Miles wanted to rub it in a little more.

  She mirrored his smirk back at him.

  “Don’t be a smart ass, Miles. I’ll make a note in his chart.” She picked up her keyboard and started tapping.

  “Well, I’m gonna check it out.”

  “You do that.”

  Miles went out into the ward and sauntered up to the table where the three patients were sitting in their scrubs. “Yo, you kids need a fourth?” he said, rapping the table with his knuckles and swinging a leg over the open chair.

  Jeanette blinked at him. “A fourth what?” Jeanette was another of the schizophrenics on the ward.

  “A fourth. For a game. What are we playing?”