This has not been a good start to the morning. It’s never really sunshine and rainbows here, I work in a long-term care facility. Most days are depressing at best, sometimes scary, sometimes disturbing.
There are the good moments in between, when for a short time I almost feel like I’m actually making a difference for some of my patients. It feels good to see hope in their otherwise hopeless, over medicated blank stares.
Today is not one of those days. I am pulling a double shift, to cover for my colleague who is taking a “long vacation” due to the stress of this job. I doubt he will be coming back.
It’s unpleasant for both doctor and patient to have to go through the whole introduction and analysis process all over again, when they’re used to a doctor, they trust more than someone who might as well be a stranger.
Reading over Dr. Jacobsen’s notes to prepare for my session, I realize I have seen this woman before. Her name is Mary. You would think she was catatonic by the way she just sits all day, staring out the window that overlooks the courtyard. She rarely moves unless prompted and she adamantly refuses to go outside.
She was diagnosed with paranoid schizophrenia following a series of delusional episodes where she claimed she could see the future.
Skimming through his notes, one in particular caught my attention. It reads as follows:
“Monday, September 2nd: Mary is particularly animated today. She is usually non communicative unless prompted but her speech is fast and erratic. She is telling me she saw Nina out the window this morning, limbs contorted, skull cracked, twitching and screaming in pain. Mary said she died before anyone could attempt to revive her. She is clearly in distress; I am going to increase her medication.”
The note goes on to list the medication dosing.
Strange…. This was written on September 2nd of this year. September 4th of this year a young woman named Nina seduced an orderly and.. well.. bit him.. she stole his key card in his pain and confusion, made her way up to roof and jumped. She died in the courtyard, right below the window that Mary always looks out of.
I will summarize the next note of Dr. Jacobsen. He is telling Mary that when another patient confides in her about something as serious as suicide, or causing harm to another person, she must immediately alert staff. That he understands wanting to respect the privacy of her fellow patients but if she wants to help them, she needs to let medical personnel know next time. Mary insisted she had never spoken to Nina at all.
Of course, the doctor knew she was lying, but did not want to push her too hard and risk causing an episode. He just continued to tell her that if, in the future someone says anything of that nature to immediately alert staff. Mary agreed.
Another note that caught my attention:
“October 17th: Mary seems terrified today. More so than usual. She said she saw one of the patients out the window brutally attack an orderly. She said the patient jumped on the man while his back was turned and began ferociously biting into his neck, spitting out chunks of flesh while the orderly screamed. By the time anyone could come to his aid, his screams were no more than gurgling sounds as he choked on his own blood. He was pronounced dead by the time the EMTs came.
‘October 17th’. I think to myself. I remember this attack. This did happen exactly the way Mary described. I open up my computer to check the incident logs for the past year. The attack happened on October 19th. Two days after Mary’s session with Dr. Jacobsen.
Again, the doctor went on to explain to Mary how important it was that she tell staff when patients confide in her that they plan to cause harm to themselves or others. This time Mary was even more agitated as she explained to him that no one told her anything. That she hardly spoke to any of the other patients. She insisted she knew nothing of the attack until she saw it out the window… 2 days before it happened.
There are more of these… quite a few more. Notes of sessions where Mary recounts to the doctor the things she saw out the window that day… and those things coming to fruition within a matter of days. Fortunately, the rest have been relatively mundane compared to the two incidents I just described.
I go back through the notes from previous years. This has been a pattern ever since she has been here. Dr. Jacobsen, I suppose in an effort to keep his own sanity; as we are often warned of the danger of being pulled into the delusions of our own patients, maintains his belief that Mary’s imagination is so strong that when patients tell her things, she believes she is “seeing” those things out the window.
I see now why he decided to leave however. His last note reads as follows:
“April 28th: Mary asked me in a confused tone of voice what I am doing back so soon. When questioned further she said she saw me out the window, bags packed, with a box full of items from my office, saying my goodbyes as I walked to my car. She said she assumed I was going on vacation for a while since I was taking so much with me. I had only told the senior staff I was leaving. I had not even begun to pack my things. There is no way she could have known”
Not long after I finished reading this there is a knock on my door. A nurse escorts Mary into my office. She is exhibiting clear signs of distress. I introduce myself as Dr. Greyson, and explain that I will be working with her until Dr. Jacobsen returns, though I am not so sure he will be returning.
“I can’t do this all over again,” Mary said in an exasperated tone.
“Dr. Jacobsen was finally beginning to understand, to see that I am not delusional. It took almost an entire year to convince him of the truth. You people call me delusional, yet when presented with clear evidence of a reality you simply don’t want to accept you fabricate reasons to explain it away and cannot be convinced otherwise… is that not delusion?” She asked me.
Clear, concise and too the point even in a state of frustration, to a new doctor she didn’t know. This was not typical for someone diagnosed with paranoid schizophrenia.
“I am tired,” she said. “I am tired of trying to explain myself, I am tired of being locked in this place because of something I cannot control, but mostly I am tired of warning you of things that you can prevent from happening and nothing being done about it, while I am forced to helplessly watch the events unfold exactly as I said they would.”
“Mary, I understand it is difficult feeling like you have to start all over with a new doctor, but I have read your file, I understand what has been going on with you and I just want to help.” I explained to her.
“Ohhh I know you do, but you can’t.” She said flatly. It just figures that he would leave now. Right when he was finally starting to believe me. What I saw out the window today…..” she trailed off, I saw her begin to shake. She was fighting back tears as her eyes widened.
“Dr. Greyson, I know you won’t believe me. But you and I are the only two people who can prevent what is going to happen here. I won’t be able to live with myself, to live with the guilt. I am begging you, just for a moment to put aside everything you believe to be true, as I am told to do every damn day. Put aside your delusional belief that you understand everything about how this universe works, that you understand everything about physics and the nature of reality itself, because how can you? Put it aside and heed my words.” She said this to me in a desperate tone, but not the desperate tone of someone experiencing psychosis. Rather one of someone who seemed clear headed in every other way, and was genuinely terrified.
“Okay Mary, I’m listening.” I told her.
“You need to destroy the rose bush in the courtyard, NOW.” She said forcefully. “Get up, get a shovel and rip its every last root from the ground.” She said this in such a stern voice, I didn’t know what to make of it.
“Why Mary? Why the rose bush?” I asked.
“It wasn’t there yesterday. I look out that window every day, so I notice things no one else pays attention to and that rose bush was not there yesterday. Rose bushes don’t appear overnight, do they? There is something wrong with it!” She was shouting now, pleading with me.
An orderly walked in having heard her from the hallway.
“Come on Ms. Mary, why don’t we go for a little walk.” She said.
“No, no…. Please Dr. Greyson, please listen to me…. Get rid of it. Burn it!! Please!” She begged and pleaded as a few more orderlies stepped in to walk her to the nurse’s station. I assume to give her a dose of anti-anxiety medication.
I sat there for a while. Thinking about what she said. Thinking about Dr. Jacobsen. Looking out the window, I saw it. A single large rose bush in the courtyard. One I had never noticed before. For a moment I felt a chill run down my spine. For a moment I considered digging it up, at least it would make Mary feel better. And for a moment, I almost felt as if the rose bush appeared sinister in some way.
‘Pull it together before you end up like Jacobsen’ I thought to myself. Obviously, the roses just started to bloom, it’s spring time. It was just a dead looking set of branches before. Of course, neither myself nor Mary would have noticed it before. I laughed at myself for being so ridiculous.
I left my office to go grab some lunch from the cafeteria. I saw Mary sitting in a chair looking out her window as always. I stopped and knelt beside her.
“Hi Mary” I said in a soft tone. “I don’t want you to feel like I wasn’t listening to you. I know how terrifying this all must feel, but it isn’t real. Our minds play tricks on all of us sometimes, yours is just working overtime. The roses didn’t just appear, they just bloomed quickly as Spring approached. Do you understand?”
She laughed a defeated laugh and said nothing.
I ate my lunch, unable to get Mary out of my head. There did seem to be an odd number of coincidences surrounding her. Sure, she could have been told by the patients what their plans were, but all the small mundane things she seemed to “see” out the window before they happened? And as far as I could tell, she did not seem to interact much with any of the other patients at all. Not to mention knowing Dr. Jacobsen was going to leave before he told any of his patients.
‘He must have told her and just forgot’ I thought to myself. ‘Obviously her persistence regarding these delusions, despite the medication was getting in his head.’
Suddenly, I heard screaming. I jumped up from the table and ran out into the hallway.
“Nooooo nooooo get away from it, get away—“
It was Mary’s voice. The pleading turned into a terrified high pitched squeal as she jumped from her chair and covered her eyes in horror.
“Dr. Greyson! She called to me, “LOOK! Look out the window!”
I saw one of the patients walking away from the rose bush as Mary began sobbing hysterically. One of the orderly’s brought a syringe for her, but I told him to wait and that I would see her in my office.
“Mary, I need you to calm down and talk to
me or they’re going to sedate you, do you understand?”
She nodded. Her pupils were dilated, her hands were trembling, she was tapping both feet frantically. She covered her face with her hands as her head slumped forward. A completely different Mary than the one I had just spoken with an hour earlier.
“I told you there was something wrong with that fucking rose bush!” She shrieked at me.
“Okay, okay, just tell me what you saw Mary, I’m listening.” I said, trying to sound as soothing as I could.
“I saw him, the patient, I don’t know his name… I saw him sniffing the roses…. And something … something reached out from one of the roses and shot into his nose, his mouth, his eyes….. something like vines, or like tendrils or something? I don’t know how to explain it, but I fucking saw it okay!?” She cried.
I can see why she was terrified. I felt so sorry for her; empathizing with how terrifying it must really be to see things like this, to never be able to trust your own eyes or your own mind.
“It’s going to be okay Mary— she cut me off in hysterics, screaming at me to get rid of it. That was the only way it would be okay, she told me.
Fuck it…. I know I shouldn’t give in to someone’s delusion, but this poor woman…If all she needs to feel safe is for someone to dig up a rose bush; my job is to help people. It’s the least I can do right?
After my shift I went to find the groundskeeper and asked him for a shovel. Obviously confused, I explained the situation to him.
Curiously, he told me he does all the landscaping work, and he never planted that rose bush. He had also been wondering where it came from, but had simply brushed it off as us “sane” folks tend to do so easily when something doesn’t make sense in our paradigm of reality.
“I’ll do it, my clothes are already covered in dirt,” he said with a hearty laugh as he eyed my white button down shirt.
I thanked him and watched him begin to dig the rose bush out of the ground from its roots as I pulled out of the parking lot. I could see Mary in the window, watching him intently.
The next day as I made my way to the courtyard, I saw the rose bush was still there. I could see the portion of dirt that had been overturned but it looked like the groundskeeper had stopped abruptly.
I went to the shed to speak with him. I asked him why he stopped.
“Oh, well.. I just… I guess I forgot.” He said.
I grabbed the shovel and went out to do it myself. The groundskeeper chased after me and tackled me into the dirt.
“What the hell man!! What are you doing!?” I shouted at him.
“Leave it alone!” He screamed at me, as some of the staff began walking towards us trying to make sense of what was going on.
I explained everything to them, the reaction I got was not what I was expecting. I was escorted to the office of the head psychiatrist Dr. Brenner and given a firm talking to.
“Dr. Greyson, your behavior today was highly inappropriate,” he droned.
“Mine!? The groundskeeper literally tackled me, look at my clothes!” I exclaimed.
“Yes, well I do hope you have something to change into, we can’t have you treating patients looking like such a mess.
You have been trained doctor, you have been trained and warned about the dangers of feeding into the delusions of these patients. You may have thought you were helping poor Mary, but all you’ve done is fuel the fire of her delusion. We have had to sedate her and move her to a high security ward thanks to this incident.” He told me.
“What, why!? She is scared of a rose bush; she is no threat to anyone!” I told him.
“She attacked a patient today, Dr. Greyson. She claimed the rose bush did something to him, she believes it is somehow controlling his mind and that if we cut him open, we would see.” I was told.
I said nothing. Seeing from the point of view of all my training I now realized how mistaken I had been. Thinking no harm could come from simply removing the thing she feared, when I should have been helping her face it.
I apologized to the doctor and explained my understanding of the error I had made. He let me off with a warning and I went back to my office, feeling utterly defeated. The guilt hit me hard. Poor Mary, now stuck in isolation with no windows, her illness gripping her tighter than it had in the entire year she was being treated by Dr. Jacobsen. I felt awful.
A few hours later as I was making my way to lunch, I stopped at Mary’s window and looked out at the courtyard. What I saw shook me to my core.
There must have been 40 patients outside, they usually only allow about 10 out at a time in shifts so that staff can keep a close eye on them.
All 40 of them, plus the staff in charge of watching over them, were on their knees … digging in the dirt with trowels they shouldn’t have been allowed to have. I watched in disgust as one of the patients spat something into their freshly dug hole, covered it with dirt, watered it, and moved on to begin digging a new hole.
I ran to the head psychiatrist’s office and frantically explained what I had seen.
“Ahhh yes, we are implementing a new program. Inspired by your attempt to destroy the groundskeepers hard work, we thought it would be nice for the patients to feel a sense of purpose by helping out with the landscaping and plant some new rose bushes.” He said with an awkwardly forced smile.
“But… but —“ he cut me off, told me he was busy and asked if he should be concerned for my mental well being as well. He told me to take the day off and go home.
I did as instructed. I had no desire to be there. I was growing increasingly panicked. I was beginning to understand how poor Mary must have felt.
‘See how easy it is?” I thought to myself. ‘How easy it is to become paranoid, to lose your own mind over a silly idea?’ I could feel my own sanity walking a tightrope and it terrified me. I was the doctor. They were the patients. I had always seen such a strong distinction between the two. I now realized that the line between sane and insane can be much thinner than I had previously believed. I tried to recall my training as I laid awake all night convincing myself that I was creating patterns out of simple coincidences, just like a paranoid patient would do.
But when I pulled up to work the next day, I knew. Hundreds of rose bushes littered the courtyard. Full grown, and in full bloom, where yesterday were just small holes in the ground.
As I made my way to Dr. Brenner’s office everyone I passed seemed different somehow. The halls were eerily silent other than the light footfalls of those I passed. No patients complaining or yelling or even speaking. The staff walked by me like I wasn’t even there. They all seemed to be in some sort of trance, walking back and forth in silence.
I burst through the office door and began shouting before I could even think to compose myself.
“Dr. Brenner, what the hell is going on?? Do you not see the hundreds of fully grown rose bushes? Those were nothing more than dirt mounds when I left here yesterday, they couldn’t possibly have fully grown over night. You have to see that something is wrong here!” I continued to shout at the man, he showed no expression whatsoever.
“Dr. Greyson, I already explained to you our new program. So the patients planted a few rose bushes, and that’s got you this upset? The groundskeeper must have brought some in ready to be planted. Do you not see how ridiculous you sound?” He said calmly.
“No, no I saw it, I saw a patient dig a fresh hole and then he spat in it and covered it back up like he was planting a seed!” I exclaimed. “And this morning, everyone is so calm, none of the nurses said hi to me…”
“So you saw a mental patient spit….. a busy nurse didn’t pay you enough attention and forgot to say hello, and a few rose bushes being planted as part of a new program; one I had already told you about, has gotten you so upset you felt the need to barge into my office screaming?” His tone was still completely calm, though now more condescending.
“Well, ummm.. yes, but—“. What could I say? Every word that left my mouth sounded more and more insane. I knew how I would have interpreted it just a few days ago if it had been one of my patients saying this to me.
“You’re right, never mind. I haven’t been sleeping well, I think the stress of the job is getting to me. I won’t bother you again.” I left his office and hurriedly made my way to my own.
I am writing this now because I know they’ll be coming for me. They’re going to lock me up right along side my former patients. But there is something happening. Mary was right.
BEWARE THE ROSE BUSHES.
They are trying to open the door. I barricaded myself in but it won’t hold for long. None of the windows open in this place. Now all I can do is stare out the window watching the patients continue to dig holes. I can hear the nurse outside my door preparing a heavy dose of Ativan for me. Something is happening. I don’t know what. I don’t know how fast or how far this will spread but whatever you do… if you see a rose bush, you don’t remember seeing before… RUN.
DO NOT stop to smell the roses.