Institute of Mental Illness – 8 AM
Excited and a bit nervous, for it was her first day on the new job, Dr.Sangeeta. Newly qualified as a psychiatrist and recently appointed as the junior most psychiatrist on the staff, ran up the steps to her second floor department eager to make a best first impression, to show everyone there that she too fitted in. After catching her breath from the unusual exercise and after making the mandatory good’ morning wishing (ass-kissing) rounds of all the senior specialists in the department; she joined up with the fag end of the crowd hurrying along the corridors as part of the chief doctor’s morning ward rounds. And as the collective wise heads discussed about the improvements (or lack of) in the condition of the patients in their custody now, she unconsciously moved forward to the front of the crowd attracted by the discussion on the most interesting case currently being treated in the ward, the serial killer who had been assigned by the courts for evaluation to the psychiatric ward.
“And here” said the chief, “is our most famous patient Kritika. Three months ago she was a young promising software engineer, now she is the most famous serial killer of the city” he paused before he turned to look straight at Sangeeta who had all unconsciously pushed her way right up to the forefront of the crowd thus attracting his malign attention and sneering at her, said “well, doctor, are you up to the challenge of treating this one?”. Caught unaware by this sudden challenge thrown her way, Sangeeta was nonplussed for a minute, before her natural confidence asserted itself and drawing herself up to her full height subconsciously, she assented “of course, sir”. The chief not expecting this show of confidence in someone on her first day of duty, looked taken aback for an instant and then he said loudly for everyone to hear “well, we are expecting great things from you, doctor, after all you are the only foreign qualified psychiatrist in this hospital”, with a derisive emphasis on “foreign”.
As everyone around her twittered and gave her pitying looks, Sangeeta inwardly cringed, for she had known this would come up someday, but didn’t expect so soon. Her foreign degree was going to be a drag here in India, the reason why she had tried her uttermost not to come back home once she had finished her studies in London. But fate had played its cruel hand, the government had changed the regulations and the new visa guidelines meant she had to return back to her country of origin and apply for a fresh work visa to go back. And so she had returned unwillingly and had then learned that she would have to spend a further six months or more here till she got a new work visa to go back to her job in London. All in all she was destined to be here for another six months or so and meanwhile, getting a little experience certificate wouldn’t hurt and hence she had joined up this hospital temporarily, fully expecting these barbs to come her way. Well, there was nothing else to do, but grin and bear it for the next six months and after that, bye, bye India. Forever.
Institute of Mental Illness -11AM
Sangeeta shook her head of all her heavy thoughts of lost opportunities and time wasting and approached the nursing counter, where two hefty male nurses and a still heftier female matron sat gossiping over yesterday’s television serials. “I want that girl Kritika’s case reports” she said with a jerk towards the padded room behind where the patient was kept locked in and went on to say “but first I want to see and talk to her, before reading the notes on her” The nursing matron got up and signaling to one of the male attenders to follow behind, walked up to the indicated door with a bunch of keys. She unlocked the triple locks and motioned for the male nurse to enter inside first. He opened the door, took a peek in and then indicated that everything was well and they should enter. Only then did Sangeeta and the nurse go in. the patient was lying down docilely on her bed and staring morosely at the ceiling. “heavy sedation?’ asked Sangeeta to the nurse in a aside, “yes” assented the nurse “but she still doesn’t sleep but keeps carrying on a conversation all night, talking loudly to herself” the nurse’s voice dripped with boredom.
For those who have never seen the inside of a psychiatric ward, the rooms are the very definition of a padded cell- the walls, the floor, the back of the door and every little inch is covered by a foam and coir based soft padding to prevent the patients from banging their heads on a hard surface to commit suicide. The single bed bolted to the wall in a corner of the room is usually provided with restraints (full body papoose boards) and manacles (for the hands and feet), but these are rarely used for long time patients, as once past the initial struggles to escape, most patients learn not to disturb the doctors and nurses from carrying on their duty. This docility is achieved by a combination of drugs (Sedatives) and punishments, but mainly because by then the patients are gone too far inside their own heads to ever respond to any outside stimuli. For them the doctor or the nurse standing beside them is a vague shadow intruding on whatever life they are living inside their head, an unwelcome disturbance so to say and better to be got rid off as soon as possible to escape back into their own world without disturbance from this world.
But this patient was different. It might be because she was too new here. Or it might be for some other reason, that she was resisting the total oblivion and apathy to be expected of a psychiatric ward patient. She was staring straight at them and there was intelligence in her eyes, a look of recognition at people staring at her, a look of shame at having become a spectacle to be stared at like an animal in a zoo. This gave Sangeeta hope. Whatever made this girl do all the things she was accused of, she still wasn’t totally lost in her mind. There was an inner strength in her eyes, the way she looked at them which showed that she still was trying to hold on to the little dregs of dignity she still possessed as an intelligent human being. Sangeeta decided on the spot, to help her along that path to dignity by treating her not as a patient but as a human being.
She stood beside her bed and signaled the attender to uncuff the girl’s manacles. He hesitated a bit but with an eye signal from the matron he complied and then the nurse moved forward to make the patient sit up, reclined on the back board of the bed. The girl looked thin, wan and half starved, unlike the photos of her splashed all over the newspapers a few weeks ago. How to, where to start wondered Sangeeta. This wasn’t an obscure patient, this was possibly the most famous patient in the city right now, the most famous criminal in fact, accused of stabbing three different men to death on journeys in the suburban railways. She had mounted a defense of insanity in the court and hence had been sent here. Was she really insane or was it all just a pretense to escape the law? If so, why had she done it? What reason could she really have to stab three Innocent men in the neck? Would that be the place to start wondered Sangeeta staring at the girl intently. Will she tell me the truth if I asked her? Maybe alone? So she turned round and signalled to the nurse and the attender to leave the room. They both looked at Sangeeta as if she were one more psychiatric case who had wandered into the ward. “Doctor” the nurse began “she is a violent type, it’s not safe” she said indicating the frail looking young girl on the bed. Sangeeta turned and looked the nurse squarely in the eye. “Matron, that’s why you and the attender are going to wait just outside the door ready to rush in if I call for help” she said with a conviction she didn’t actually possess. The nurse and the attender looked at each other, shrugged and left the room lightly pulling the door closed behind them.
Sangeeta turned around to the girl and decided to start off the questioning with some easy ones. Better to ask her first if she had eaten anything, she looks so hungry. So Sangeeta asked “did you” before she was abruptly interrupted by the till now silent girl who said “Kill them? Is that what you want to know doc? Yes, I did. I killed them. But not me alone. He made me do it” she said with a significant glance back behind Sangeetas shoulder. Now it’s a strange thing, Sangeeta had spent years training as a psychiatrist and knew the ways the minds of those patients worked, but this was still very creepy and she half turned to check if anyone was really standing behind her as the girl spoke. Reassured by the empty room she turned back to the girl and said “actually I was about to ask you if you had anything to eat this morning, but since you mention someone else to be involved in your case, I might be able to help you if tell me fully about him” she paused for effect and went on “after all you are an educated, intelligent girl, you must know how bad this must look, you are accused of murdering three random strangers on the local train over a period of a few days. You were actually caught trying to stab another one. You face either a life sentence in prison or being locked up lifelong here in this room. If there is anything you could say to help me, help you, it might go well for you”
The girl looked sad, and spoke in a hoarse whisper “I knew it, I knew you won’t believe me, why would you? No one believes me; even my own parents didn’t believe me, when I told them he made me do it. But it’s the truth, god promise. There is this voice always, always screaming at me, night and day, day and night, saying things to me, asking me to do things for him, giving me no rest, no rest, for even one minute, always forcing me to do what it wants. And I did it merely to sleep. To sleep. He promised he would be silent if I did it. But only for a few days, he was back whispering again and again, asking me to do it again, if I wanted to silence him again” she almost screamed at the end and then exhausted by this lengthy outburst fell silent for a few minutes.
Sangeeta who had listened intently to all this outpouring, could only wonder what had bought on this hallucination, this patient had suffered a full blown psychotic episode and had wandered around the city like a normal person, with no one doubting for an instant what she was going through. It’s at times like this that Sangeeta felt the futility of our modern lifestyle when someone right beside you could have a complete breakdown and people would never notice, so intent were they on winning the rat race that the first time they would learn about their friends or neighbors or colleagues problems would be from the morning papers screaming “so-and-so committed suicide” then they would gossip for a few days about what pushed them over the brink and get back to their lives. Well, one can’t change society, but at least this girl could be helped thought Sangeeta as she turned towards the girl and asked “this voice? Is it always a male voice?” the girl looked stricken as she said “yes, yes, always, there is only one single voice, the voice of ” but without completing, she clamped up suddenly.
Sangeeta looked at her intently, “what?” she asked gently “you were about to say something before you stopped” the girl looked at her fearfully “he wants me to stop speaking to you. Not to tell you anything. Or he will punish me when you are gone.” Sangeeta smiled gently at that and said “that’s ok, you can either tell me now, or tell me later, years later when people have decided you are mad and have locked you up forever and then even if you tell, even if you scream it the top of your voice, no one will ever believe you” she looked straight at the girl’s eyes and said “this is your last chance to help yourself. I will listen to whatever you say with an open mind. I will believe you. I want to believe you. Convince me. Give me a chance. Don’t listen to that voice. Tell me the entire thing for your own good” and she stood back and waited for the girl to make the right decision.
The girl looked lost in her own head for a few minutes but then her eyes cleared and focused again on Sangeeta and she said “doc, I used to travel to my company by the electric train daily. One day while returning in the night, I heard someone talk to me, but when I turned around, no one was there in the compartment except me. Besides it was a ladies only compartment I was traveling in and this voice was a male voice, so I was frightened and got down at the next station and took an auto home. But the voice kept accompanying me all the way home, even in that auto. Very much frightened I rushed home, locked the door and had fever for three days but still that voice wouldnt stop. Since that day, till right now, I keep hearing this voice talking loudly to me all the time, as if someone is sitting there right beside me, talking to me,telling me to do things, things it wants to be done and just to shut it up for a few minutes, for a few moments of blessed silence, I do its bidding”
Sangeeta probed her directly then “do you know who it is? does the voice tell you who or what it is?” the girl looked suddenly fearful “yes in the beginning I asked him and he said” she swallowed and paused as if unsure of choosing the right words to speak before gathering her courage to say “he said I am the devil” and hurried on, words tumbling out in a rush now “and at first I did believe that he really was the devil, Saitan you know. But now I know he is just a ghost, someone who must have died on the same train tracks earlier and was haunting the train, from the way he talks about people and things and all. Also, he knows a lot of things about a lot of people. Those men who died on the train?” Sangeeta interrupted her to ask “the ones you stabbed?” the girl flinched as if Sangeeta had just slapped her “yes” she moaned “yes, those three dead men, those men were bad men the devil said, one of them had raped a young flower-seller girl, a mute girl in that very same compartment and one of them, a school master, had threatened a school girl who couldn’t not pay her fees at his school to satisfy his sexual urges and the other one was, well, all of them were very bad people and got what they had coming to them” she finished emphatically.
Sangeeta ,stood there silently absorbing all this and thinking so this is how she justified it to herself and got over the guilt, by denial, interesting and then she told the girl with an encouraging smile “I have to go now, Krittika, to see other patients, but I will be back to check on you again very soon, so don’t worry, ok? But, just tell me one thing, one last thing, did you often suffer from headaches?” the girl smiled at her then and her smile lit up the room as she said wonderingly “wow, you are a great doctor, you know, you are the first one to ask me that question and believe me, for the past three months, I have seen almost three hundred doctors” Sangeeta waited expectantly for the girl to answer her “and?” she prompted her. The girl said “yes, yes, I used to, way back then, you know, before all this, I had severe splitting headaches and ear-aches and I used to consult an ENT doctor and first he said it was sinus and then he said it was vertigo or something, but he never really found out the reason why? But he gave me one tablet called flunar something which used to cure me completely” she babbled. “Thats interesting”, said Sangeeta in a careful don’t get your hopes up voice, “but I really have to run along now, will catch up with you later, bye” she said as she stepped out of the room and signaled to the attender to lock up behind her.
Institute of Mental Illness -5PM
It wasn’t till later that evening that Sangeeta could get around to reading the notes of her morning patient. As she opened up Kritikas file, she sipped a strong coffee to keep her alert after the very fatiguing first day she had had, but true to her training she read every single word on it and learnt for the first time that the girl had been in a car accident a few months ago and subsequently had switched over to trains from the company provided cab. But more importantly whoever had seen her first, when they were admitting her had written the notes very thoroughly including the fact that during the accident she had also been given anti-convulsant medicine called chlorpromazine for brain injury. All the links were falling in place, thought Sangeeta with an inward grin, as she turned to the front of the patients’ record to check the parent/guardians details and dialed the girl’s father to ask him two very specific questions.
When she entered the girls room a few minutes later she was bursting with quite satisfaction, it’s not every day that you pick up a challenge and win it with complete satisfaction. She found the girl back to staring blankly at the ceiling again “hello” said Sangeeta pleasantly and waited for the girl to turn around and watched her come back to the now and here “I am leaving now for the nigh just thought I would tell you one or two things I learnt about you before I went off tonight” The girl looked straight at her, licking her lips “yes doctor”. “i talked to your father sometime this evening” said Sangeeta “and he told me that you had epileptic fits since childhood and were talking a medicine for it till your teenage years, is that true?” The girl shrugged “yes, but it was a long time ago, what does it matter now?” Sangeeta shook her head “humph no, it matters very much, when you stopped taking that drug, your migraines came on, for which you took another medicine without telling your doctor about the previous one and finally during the accident you were given another brain affecting medicine because neither you, nor did your parents, tell the doctors of the two previous medicines you were taking. All three of them powerful brain altering drugs. And see where it has got you?”
The girl got up or at least tried to get up, with a jerk “you mean?” “yes” said Sangeeta emphatically in her best doctors voice “i mean exactly that, all this voice talking in your head is all bullshit, you took three powerful medicines which can affect the brain and together they have given you powerful hallucinations that made you imagine another person in the room, when all the time it was just one part of your brain talking to another. I don’t know where you read those stories about the men raping and all, but in your state of heightened mental excitement, you imagined those poor men to be something that they were not and goaded by your scrambled brain, you stabbed them unknowingly. There was/is no voice. No ghost. Leave alone the devil. This is a scientific world and people still believe that kind of trash? All the ghosts, all the devils are inside our own brains. No need to look for them elsewhere. There is nothing in this world called a ghost, ok?” and breathless by now, she paused to catch her breath.
The girl looked ashamed and hopeless all at the same time, as he asked guiltily to Sangeeta “so what happens to me now doctor? Do I get punished for what I didn’t know I was doing?” Sangeeta grinned at her easily “no. you get cured now my dear. Finding out what’s wrong is the difficult part, curing is easy. I have already written up the notes on your problems and my findings and sent them to my chief. First thing tomorrow we will explain to the court that you are not responsible for what happened, so you will not be punished by the law in the future also. After that we will start your cure, it’s just routine medicine, the treatment to give you to heal your wounded brain. I promise you that after tonight, you won’t hear that voice again. And in three weeks you will be completely cured and out of here, happy?” she asked as the girl started sobbing and then bent her head to catch the words as the girl mumbled something like”he also says the same, tonight is the last” Sangeeta laughed loudly now and said “for once I agree with your devil. Bid him goodbye forever. From tomorrow you are normal” and leaving behind her someone who had regained hope in life, Sangeeta left the room.
Chapter 4 .
Dr.Sangeeta’s house – 6AM
The alarm clock trilled its sound and Sangeeta with not a little hatred reached out a lazy hand to silence it. When a voice, a very gruff manly voice, an educated voice, spoke very close to her ears “wake up my dear, wake up, we have lots of work to do today, places to go people to kill, come on, come on, wake up clocks ticking and bad men are waiting” Sangeeta screamed at the top of her voice “Nooooo….” (to be continued…..)