Dark Men

Still bothers me to this day.

Police had picked up a middle aged woman making her way through a downtown area in a suspicious fashion; i.e. she was moving from one area of cover to another & constantly scanning the area for some threat. When she was taken into custody she was going on & on about "dark men" & kept telling the officers that they'd "signed her death warrant." They rightly assumed she had diminished capacity & brought her to the ED for evaluation.

Now, when she was examined it looked like she had put on a dozen shirts but when she was undressed & placed in a gown they found that she was only wearing one shirt...with a kevlar vest underneath. When questioned she said it was for protection from "the black men" & kept insisting that we couldn't detain her because they would find her. They worked her up. Head CT was negative, labs showed mild dehydration, tox screen was negative. The decision was made to admit her for a psych eval & transfer to an inpatient psych facility in the morning. We assumed paranoid schizophrenia.

Now, I received all this in report when I accepted the patient to my unit. I actually don't mind the really crazy patients because they're interesting & I was excited to interview her. She was considered high risk for elopement so we placed her in a 1:1 assignment. She arrived to the floor on a stretcher but had refused to lay down so when I first saw her she was sitting stock still, back straight, legs folded. Only her eyes moved, constantly scanning the environment. It struck me that she wasn't making note of her surroundings, didn't even look at me suspiciously as most PS patients do -- her eyes passed right over me without pause. She knew what she was looking for but it wasn't there...yet. I remember thinking, "Poor lady, so scared!"

She had a very slight build, looked mildly malnourished, her hair was long, dark & peppered with gray. Her hair had been pulled back into a bun at some point but most of the hair had fallen out & hung haphazardly around her face. Her nails were chipped & yellowed & she smelled like she hadn't showered in a week. TL;DR: She was unkempt. I introduced myself & helped her to her bed. My first priority was to get her something to calm her down, but was told in report that she only complied with laying down for the CT when they told her they would medicate her to make it easier; so I wasn't terribly surprised when I suggested we give her something to "take the edge off" & she refused citing "the dangers of sleep". She was restless & pacing at this point so I decided to decrease the stimulation by dimming the lights. This, unfortunately, only resulted in her emitting a screech, she lept towards me, knocked my hand away from the panel of switches & then frantically pushed them all to the on position. She spun around, head pivoting, eyes darting around searching for...something. She didn't find what she was looking for so she relaxed a small measure, shot me an accusing look & said, "YOU CAN'T SEE THE DARK MEN IN THE DARK!"

"Ok, anon, we can leave the lights on but I need you to take a seat. You can choose either the bed or the chair." She stormed to the chair, pulled it into the corner of the room furthest from the door & sat down. I attempted an intake interview but she continued to perseverate on the dark/black men & the need to keep moving & her certainty that they would find her. I wasn't getting anything useful out of her & probably wouldn't without medication so I took a seat on a stool between her & the door. I started charting, looking up from the computer every couple of minutes to check on her. She just sat there tensed her eyes never leaving the door.

A little after midnight she jumped out of the chair & backed herself into the wall. She was visibly trembling, eyes moving between me & the door. She was mouthing the words, "Don't. Move." She was as frightened as I've seen anyone. I pressed the assistance button thinking that we'd probably need to sedate her & made a placating gesture with my hand & told her, "It's all right, no one's here." I moved to turn around to look at the door & she started crying, shaking her head, whispering "No. No. No. No..." I turned around. Nothing there.

She screamed. It was this horrifying wail. I turned back to her, she collapsed on the floor & was trying to crabwalk her way backwards through the wall. She started this litany of "Don't let me die! Don't let me die! DON'T LET ME DIE!" Then she fainted. Or so I thought. & I was relieved, tbh. By this time other staff had arrived so we quickly lift her into the bed & I check for a pulse.

Fuck, no pulse. Call the code. No rhythm. Work on her for forty minutes, doc finally calls it. Everyone's flabbergasted & no one has any idea what happened. People start filing out, we're cleaning up the mess, extubate her, take off the pads. Then it gets really weird. There's this sound coming from the body, it's a kind of "eh, eh, eh, eh." None of us are alarmed, just releasing air. Her right hand twitches. Look at the monitor, still dead. I reach to take the electrodes off & her back arches her OFF THE BED. Tech looks at me, we're both freaked the fuck out. Look at the monitor, nothing. I start yelling, "HEY, HEY, HEY! GET OVER HERE!" People stream back into the room & congregate around the bed, monitor show nothing, we're all checking for a pulse but there isn't one.

The body relaxes back into the bed, the doc starts speculating, "Probably just a port-mortem..." Then she sits up. Everyone's frantic, people are jumping back from the bed, we're all looking at the monitor. No rhythm. Her head starts of pivot, taking us all in with dead eyes. We're all frozen, no one's breathing. Then it speaks. It was more of a croak, inhuman, but articulate & very loud.

"YOU BITCHES LET HER DIE!" She then went flaccid & collapsed back into the bed.

No one has an explanation for what happened.