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DESPITE BEING a medical professional, James Ivers still felt uneasy descending the steps into the basement housing the county morgue. He had worked with cadavers in med school, but the idea of dead bodies stored in musty lockers in the bowels of the old building was unsettling. He walked along the dim corridor until he found himself in front of a door marked “CORONER.” He knocked.
“Come in.”
Ivers pushed the door open. Inside, he found a man sitting behind an ancient metal desk.
“Dr. Ivers, I’m Ron Orbin, County Coroner,” the man said, rising and extending an open hand. “Please call me Ron.”
“Glad to meet you, Dr. Orbin, though not under these circumstances. Call me Jim,” the young ophthalmologist responded, pumping the extended hand of the gray haired man. “You practice at the hospital, don’t you?”
“Well, a qualified yes, at the Outcare Clinic. In my spare time, I serve as Coroner. One of the perks is this luxurious office suite,” he said, laughing, sweeping his arm in a grand arc, “that the County provides in the basement along with the corpses. I especially enjoy the odor of mildew. Anyway, this is where I conduct my business. You’re with Advantage Eye Institute.”
“Yes, I’m down here three days a week and in Samsonville the other two. They call it an institute, but it’s really just a regular ophthalmology practice.”
“As I said, this is where I conduct my coroner business.” He gestured toward a well-worn straight back chair, “Please, have a seat. I’m preparing my investigator’s narrative on the findings in the death of Mr. Allen Mind. My understanding is that he visited you for an eye ailment in the days preceding his death. I want to gain some understanding as to the nature of his complaint and the medical treatment you provided.”
“Yeah, the guy who was seeing monsters. I figured that’s why you asked me here today. I’ll be happy to do whatever I can. This sure is an unfortunate situation. You know, I’ve never had a patient claim he was seeing monsters, then die. Kinda creepy. I didn’t administer any treatment as such. All I did was examine him and issue a diagnosis. There was no treatment called for. He was in bad shape the last time I spoke with him, going on about monsters and all, but I didn’t think he’d end up dead. Have you determined the cause? I hope there’s no issue with my diagnosis.”
“First things first,” Orbin responded. He returned to his seat behind the scuffed, grey-green metal desk. “I asked you here so I can fill in some of Mr. Mind’s death history before I submit my final report. Let me assure you, this isn’t about anything you did. I was really hoping you could help me understand what was going on with Mr. Mind in the days before his death — physically, mentally and perhaps spiritually. It may help me with my final report.”
Ivers wrinkled his brow. “Sure, whatever I can do. I don’t know if I understand what you want, but I’ll give it a try.”
“You did say he was seeing monsters, didn’t you?”
“Well, that’s what he was babbling about. You think that had any bearing on his death? Do you think he committed suicide?”
“I don’t know what I think, but perhaps you can provide some information or insight that may help. That’s all I can ask.” Orbin pulled open a drawer and retrieved a file folder. The two sat in silence for a moment as he thumbed through the contents. Suddenly the pipes which ran along the ceiling of the cramped office rattled violently, startling Ivers. “Don’t worry, it’s not the dead trying to get out.” Orbin laughed. “Someone just flushed upstairs. Scared the crap out of me the first time I was in here by myself. The hospital records show that Mr. Mind came to the ER on the Friday a week before last. Says here, he complained that he was having trouble with the vision in his left eye. A blind spot that had suddenly appeared. I’m just paraphrasing, you know. The report goes on to state the ER physician, a Dr. Newton, performed an examination and issued a preliminary diagnosis of vitreous hemorrhage, recommending a visit to an ophthalmologist within 36 hours. Advantage Eye Institute provides the on-call for eye related needs for the hospital, doesn’t it?”
“Yes,” Ivers responded, “In fact, Dr. Newton called that day to discuss his diagnosis.”
“What happened?”
“I told him without examining Mr. Mind myself, I couldn’t confirm or dispute the diagnosis. My recommendation was for the patient to see his eye doctor within the next day or so.”
“Was that the extent of the conversation?”
“That was it for the first call, but Dr. Newton called back to relate that Mr. Mind did not have an eye doctor or even a personal physician in the area and asked if Mr. Mind could visit the Institute. I told him to have Mind come by after lunch, and we’d work him in. That was it, as far as talking with Dr. Newton.”
Orbin picked up a pen and began writing on the paper in front of him. “Did Dr. Newton mention anything about Mr. Mind seeing monsters?”
“No.”
“I assume Mr. Mind kept his appointment.”
“Yes he did.” Ivers leaned forward, waiting for Orbin to finish.
“Go on, I’m listening.”
“OK. As I said, Mind came in that afternoon. He appeared to be a normal middle-aged man in general good health. Never had an inkling during his first visit of what was to follow. Anyway, I conducted a complete examination. I determined it to be central serous retinopathy. I told Mind it didn’t require treatment and should resolve itself within two to three months. He seemed comfortable with the diagnosis and we established a follow-up visit in three months.”
Orbin put his pen down. “I’ve heard of that, but never had any real experience with it. I believe it’s caused by a buildup of fluid behind the retina, like a blister. Results in a blind spot?”
“Yeah. Fortunately, if you have two eyes, which most of us do, the unaffected eye will compensate, so you can have near normal vision. That’s what I told Mind.”
“And he bought it?”
“I thought he did.”
“Did he say anything about monsters?”
“Not during this visit.”
Orbin thumbed through the folder. He drew out a sheet of paper and studied it. “On the Wednesday following his visit with you, Mr. Mind was admitted to the hospital. You were called to the hospital to treat Mr. Mind. The report goes on to say . . .”
“That’s correct,” Ivers interrupted, “but I had seen Mind again in my office before that day.”
“Which day?”
“Wednesday, when he went to the hospital.”
“I was unaware of that. Tell me what happened,” Orbin said, leaning forward.
“Well, that was on Monday. After lunch, the receptionist came back to the examination area to tell me that Mind was up front, very agitated, demanding to see me right away. I asked her to tell him I would get to him as soon as I could, but to explain I would have to see scheduled patients first. She came right back and said he was very upset and begging to be seen right away.”
“What happened?”
“I went out to the waiting area and Mind was obviously upset. I decided to park him in an exam room in hopes that he would calm down.”
“Did he?”
“Once he got in the room, he quieted down, but he was so upset, I decided to hear him out right then. That’s when things got squirrelly.”
“Squirrelly?”
“I don’t know what else to call it. He said his blind spot had changed color. Said the blur had turned from grey to dull red. Said that spot had been a dead space as far as seeing anything, but now, he could see two eyes within it. He was definitely upset, pleading with me to do something. He said those eyes belonged to a monster. Looking back, I don’t think I recognized just how disturbed he was.”
“That was the first time he talked of a monster?”
“As far as I know.”
Orbin looked up from his notes. “Did you examine him?”
Ivers drew in a breath. “Of course I did. I couldn’t see any change. I told him over time, it was possible small portions of the blind spot might regenerate explaining both the color and the dots of light. I said it could look like eyes. That’s when he got angry. Said I didn’t understand. He said the spot was getting bigger and that the monster was looking at him. He said it was trying to get into his brain. It was obvious he was in a bad place, but I had no idea how it was going to end up. I tried to reassure him, and after a while, I thought I had him convinced there wasn’t anything in his eye and in time he would see some improvement. He left and I didn’t see him again until Wednesday.”
Orbin raised an eyebrow. “I see. It’s hard to know.”
“Know what?”
“I once had a patient . . .” Orbin paused, placing his paperwork down, “who came in after returning from her dream Amazon rainforest vacation. Apparently she and her husband did everything – kayaking in tributaries, jungle trekking and the like. It wasn’t long after they returned that she began to experience abdominal cramps, bloating, fatigue, headaches and the like. An otherwise health woman in her mid to late 40’s, she was convinced she had contracted some exotic parasite and insisted I treat her for that. In fact, she got quite belligerent. As it turned out, she was pregnant. But, it wasn’t until the test came back positive that she would give up on the belief she had some parasite eating away at her.
“If you practice long enough, it’s inevitable you will encounter those patients who can’t or won’t accept what you tell them because they have absolute belief in their own self-diagnosis. They can be terribly difficult to work with. The mind controls everything in the body. A stressed-out patient can sometimes create symptoms to fit their self-diagnosis. I wouldn’t be too hard on myself if I were you. Besides, I don’t know if there was anything else you could have done for Mr. Mind.”
“What do you mean?”
“Oh I don’t know,” Orbin mused. “Anything to add about Monday?”
“No, other than I never had the faintest notion about what happened on Wednesday,” Ivers added, shaking his head.
“Speaking of Wednesday, let’s move on.”
“Sure.”
“The report from the hospital states that Mind came to the ER about 10:00 AM presenting a severe wound to his left eye. After a preliminary examination, you were called.”
“Well, they called the Institute and as I was the physician on site, I responded. I don’t think they asked for me by name.”
“Go on.”
“My receptionist took the call. She said they had a patient in the ER with an eye wound and needed someone to come right away. I headed right over, no idea what I was in for. When I arrived, they took me right in and there was Mind. You could have knocked me over with a feather. He was the last person I expected to see. He had a catastrophic wound to his left eye. He was unusually calm for an individual who had experienced such trauma. There was significant damage to the cornea, sclera, and orbital muscles – really all the structures of the eye. I asked him how this had happened.
“What he said still chills me to the bone. He told me the spot in his eye had grown. As it grew, he could see the monster. He said the thing had ragged teeth and was gnawing at the edges of the spot, ripping away his sight. At some point the spot got big enough for the creature to push its head through. Mind said all he could see at that point were its teeth gnashing, straining to reach him. Mind said he knew the thing was hungry, hungry for flesh. It was then, Mind said, he had used a steak knife to gouge his eye out. Ghastly, absolutely ghastly.”
“What then?”
“He was taken up to surgery where what remained of his eye was removed. Fortunately, Mind had not damaged the tissue behind the eye and the result was a normal enucleation with no complications. Prognosis was for a normal recovery. Post op, he was taken to the psychiatric ward for evaluation.”
“Yes, that is consistent with the report from the hospital. When did you next see Mr. Mind?”
“I stopped by the next morning, before I headed to Samsonville.”
“And what was Mind’s condition at that time?”
“Pretty much what you would expect 18 to 20 hours post op. I checked his chart. Apparently he became agitated during the night, and was sedated to allow him to rest.”
“Did he say anything?”
“He said something about the spot. At first I thought he was talking about his left eye, but as he went on, it became clear he was referring to his right eye.”
“His right eye? Did you examine him?”
“I took a look with a direct ophthalmoscope, but it’s not really the right instrument. I couldn’t make a determination. It needed to be done it in the office, but that was out of the question. Given the circumstances, I thought it was probably just a delusion.” Ivers paused and slumped back in his chair. “I didn’t think much more of it until Friday morning when I stopped by the hospital to check on him. That’s when I found out he had died. I felt bad about that. They were pretty close-lipped about it, so I really didn’t find out much more other than it happened sometime in the early morning. Sad, sad business. I checked the newspaper, but it had even less information. I was hoping you could fill me in.”
Orbin removed his eyeglasses and set the folder aside. “According to the report from the hospital, he started ranting Thursday afternoon. Same sort of stuff he told you. Went on about a hole in his eye, some monster trying to get in. Begged and pleaded for them to take out his other eye. He must have gone wild — so violent they had to restrain him. From the chart records, they pumped the sedatives into him.”
“They didn’t overdose him did they?”
“No, no, they administered a significant amount, but not enough to kill him. I interviewed all the staff and they were all in agreement: Mind continued to struggle in a semi-conscious state for the rest of the day and into the night. By all accounts he wailed and thrashed incessantly. Even with the sedation they had administered, he had to be kept in restraints. Never stopped ranting. He went on and on about monsters eating him alive and the only way to stop it was to cut out his eye. They said he cursed, he prayed, threatened to kill them all if they didn’t do it. I can’t imagine the extent of his suffering. The duty nurse reported he suddenly grew quiet about 3:00 am. According to her statement, she went to check on him immediately. Data confirms the monitors were recording vital signs up to that point. She said by the time she got to his room, he was dead.”
“I didn’t know the man, but I’m sorry he died like that,” Ivers said. “Seems like a horrible way to go. He must have had a massive heart attack or stroke to go that quickly. The stress he was under must have been too much for him.”
Orbin sat back in his chair and folded his arms. “That’s what I thought at first. I examined the surgical wound. Looked normal, no hemorrhage, or other abnormality detected. I checked the meds, nothing there to indicate a problem. There was nothing left to do but perform an autopsy. I can tell you he didn’t die of a heart attack or stroke.”
“What then.”
“I don’t know what to tell you, much less what to put in my report.”
“I don’t understand.”
“Neither do I. You see, his skull was empty, his brain gone, scooped out like a Halloween pumpkin.”
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Great intro and scene setting. Excellent dialogue to move things along. Mmn, not sure about the ending though. Did I miss something?