Absence of Mind Read online

  I grimace when I see that it’s Dr. Green on the schedule. Dr. Green is a thin, dark man with short, black hair and condescending nostrils. He’s not regularly assigned to us, but when we’re short on staff, we get him. His knowledge of brain disorders is twenty years out of date, and he regularly makes decisions the entire nursing staff thinks are bad.

  Davis messages me again.

  << Are there germs in here? Diseases? Anything contagious? I don’t want to touch anything. >>

  < No. This is the neuro ward, so people don’t generally come in here with anything contagious. >

  He goes back to staring intently around the room, looking for hazards and occasionally wiping away tears. Despite the sedation, he seems ready to spring into action if he faces any new threats.

  I’m trapped. I don’t think I can leave him here alone. But luckily, after a moment, Dr. Green steps into the room.

  < Ah, Dr. Green, here you are. >

  << Here I am, indeed. >>

  There’s always a sneer in his voice.

  Meanwhile, Davis has dived behind the bed again.

  I give Dr. Green a quick update, including a sped-up video of the last few minutes, and then talk the patient back up off the floor so that Dr. Green can talk to him.

  Dr. Green puts Davis through the standard evaluation questionnaires and screening tools. As I listen to the responses, I realize that something strange is going on here. The patient claims to have had no prior symptoms. No voices in his head and no visual or tactile or olfactory sensations. No prior violence. No unusual stress, no anxiety, no depression, and no notable mood swings. Minimal alcohol use and no drug use. No pain, illnesses, medications, surgeries, or disabilities. No family history of brain disorders. He said he was watching a scary movie late last night and then became terrified and has been trying to protect himself from all the threats in the world ever since.

  Most notably, he’s afraid of everything, but he’s not expressing any delusions. He’s not convinced that we’re out to get him, he’s just terrified that we might be. It’s basically the most intense anxiety I’ve ever seen, and that’s on high doses of Callex and Altipar.

  < You guys, are you noticing that these new patients have none of the usual onset factors? >

  | Bourey: We aren’t total simpletons, you know. |

  | Rhonda: Bourey, be nice. Yes, Phoebe, we’re noticing it. |

  < And is #717 the only one who’s barely responding to Callex and Altipar? >

  | Bourey: Nope. |

  | Allan: No. |

  | Abhay: Not at all. |

  I frown, wondering what in the world is going on.

  Meanwhile, Dr. Green posts an update.

  << Paul Davis. Dx paranoid schizophrenia. Rx Ifothal, 450 mg twice daily, Movatase 5 mg twice daily. Continue hospitalization. >>

  Whoa. Wow. This is probably the worst call I’ve ever seen him make.

  < Doctor. Hold up. >

  I gather my thoughts and then message him again.

  < Ifothal has been superceded by better drugs for five years. And if this is paranoid schizophrenia, it’s wildly atypical. There are no delusions and no hallucinations. >

  Dr. Green turns and looks directly at me.

  << Questioning me again, Phoebe? >>

  < Ifothal has high risk of neuroleptic malignant syndrome, especially when given when not needed. That’s why it’s not a go-to drug anymore. >

  << Phoebe, would you like to be reminded that you are a nurse and I am the doctor? >>

  < Doctor, neuroleptic malignant syndrome? Coma? Seizure? This ringing a bell? >

  << So observe the patient for any issues, Nurse. >>

  And with that, the doctor sweeps out of the room.

  Even though Navi communications don’t require proximity, I follow him out of the room, staring at his back as he goes down the hallway.

  < That’s an irresponsible diagnosis and prescription, and I refuse to administer it. >

  He turns and faces me again.

  << Honor it or I’ll write you up. >>

  My fists clench, and I feel adrenaline shoot through my veins.

  < I will report this to the charge nurse. >

  He steps closer to me, his beady little eyes searching mine. He speaks out loud, but almost in a whisper, mindful of the other people passing by in the hallway. “And I will write you up, Nurse. So do as I tell you. I am the doctor here. You are the one who changes bedpans.”

  And then he walks away.

  I grind my teeth, feeling my mouth twist in anger. Without another word, I go back to Davis, make sure he’s reasonably stable, and administer the required medication. It’s a good thing he doesn’t want to talk, since I’m struggling to push down my seething rage and probably can’t manage anything multisyllabic. I also request the live stream from the security camera in Davis’s room and pin it to my display so I can keep an eye on him.

  Most doctors, in my experience, are not like Dr. Green. Well, they all respond equally badly to being challenged, and many of them are dismissive toward nurses, so in that regard, they’re all the same. But few of them would go for the jugular like he just did.

  And I can’t do anything about it. Sure, my Navi recorded the whole exchange, but nothing—not even video evidence—will convince hospital administration to ignore a doctor’s write-up. It’s not how things work in hospitals, at least not in the hospitals I’ve worked in.

  Mostly, I’m upset because I wasn’t able to convince the doctor to prescribe something else. I see myself as my patients’ best advocate most of the time, and this time, I’ve failed. If Davis starts going into seizures or a coma, it’s going to be partly my fault, because I couldn’t be tactful and persuasive when he needed me to be.

  As my rage settles down, though, and I rush through the remainder of my round in a futile attempt to make up lost time, it dawns on me that I’ve been an idiot. I glance at the clock in my Navi display and see that Davis and I only have to make it four more hours without a negative reaction. Then I’ll be able to recommend to the night-shift doctor that he reevaluate and re-prescribe. And if it’s the regular doctor—Dr. Pienaar—I’m confident that he’ll make a better call.

  I mentally kick myself. I may have been right, but I didn’t have to burn that bridge.

  As I continue to hurry from patient to patient, I realize that my heart rate is racing more than it should, even given the recent drama. It feels like palpitations. I pause outside a patient’s door to self-evaluate.

  Overly irritable… chest tightness… heart palpitations… lots of stress… two large cups of coffee in less than an hour.

  Hmmm.

  Okay, I hate to admit it to myself, but I’m not doing myself any favors with the coffee. I think it may be time for me to quit.

  At almost ten o’clock, I get permission to go home, but only by agreeing to come back at eight in the morning on what was supposed to be a day off. We don’t have enough staff for this many patients.

  I’m relieved that Davis made it through and that Dr. Pienaar wrinkled his forehead, cursed Dr. Green in two different South African languages, and prescribed something different and much safer. But I’m still haunted by Davis’s case, along with all the other new cases that don’t fit the usual profile.

  It’s not that psychosis doesn’t happen right out of the blue. It does. But it’s rare for it to happen to someone who doesn’t have any stressors in his life or any family history or any personal history, and yet be strong enough to provoke physical violence, and then fail to respond to the meds the way it should. And with dozens of cases all at once, we’ve got a weird situation on our hands.

  I sigh and try to stop thinking about it. I can easily spend all my time either at work or thinking about work, which is a bad habit.

  I toy with the idea of showing up to Jamie’s party late—my Navi reminded me about the party a few hours ago—but I’m just too tired. I already sent him an apology for not going, so I leave it at that. I’m about to tell m
y Navi to surprise me with a short film based on my past preferences when Mila springs to my mind. Those ice-blue eyes. Such a strange person. I wonder what makes her the way she is.

  I go ahead and call her again. I don’t know why I call her, other than that maybe I’m a glutton for punishment. Or, I suppose, because I am curious about her.

  She surprises me by answering. Her voice is dry and cool, like autumn leaves. “Hello?”

  I speak subvocally. “Hi. Hello. This is Phoebe, the woman who ran into your car, and you rescued my dog? Sorry.” I wince, not even sure why I tacked the apology onto the end of that.

  “Yes?”

  “Um. I was calling because I said I was going to buy you dinner as a thank-you.”

  “Yes, I remember.” She doesn’t say this in an encouraging tone of voice. In fact, she sounds like she’s being sentenced to prison.

  “Um, okay.” I’m suddenly hot all over, and I wipe my forehead. This is definitely rating high on my list of awkward conversations. “So, is there a good time and place for you? For this dinner?”

  There’s a pause, and then she says, “Why don’t we go out and get some pie and coffee right now, and then you can be done with the thank-you?”

  Wow. I sit there stunned, at a loss for words.

  I ping my Collective.

  < I guess you all are right. This Nonnie is weird. And rude. >

  I hear a sigh on the other end of the line, a strange artifact of calls with physical telephones. Apparently, she’s noticed my silence. “I apologize if that was rude,” she says. There’s another pause. “But pie and coffee tonight would be good with me if you’re up for it. There’s Cat’s Diner off I-20.”

  I’m reconsidering the whole thing, frankly, but I forge ahead. “Actually, I just got off work, and I have to be up early in the morning. So tomorrow night is better for me. I get off work at eight, so how’s nine o’clock?”

  “Yes, thank you much, and I will meet you there then.” She hangs up without waiting for a reply.

  I feel like I’ve had my self-esteem trampled by a herd of elephants. Extinct elephants, I remind myself. As the warm wash of embarrassment passes, I get back to my Collective, who’ve been replying with eager questions.

  < She didn’t do anything particularly weird. We set up coffee plans. She’s just… not friendly. I guess. >

  << Dominick: I can’t wait to hear about this coffee thing. You’re brave. >>

  << George: I don’t see why you’re bothering. >>

  Yeah, me, neither. For a few minutes, I wonder if I should even show up tomorrow night. Mila doesn’t seem like she’s looking forward to it. In fact, I would probably be doing her a favor by standing her up.

  It suddenly occurs to me what might be going on. Mila could have Asperger’s Syndrome. Usually, people’s Navis help diagnose them early, and the apps we have now are excellent at providing real-time feedback to help them develop their social skills, but Mila has probably never had a Navi. And if she doesn’t interact with people much, maybe no one would’ve ever realized.

  Well, I know I can’t diagnose anyone, certainly not after two brief conversations. But now, I want to know more about her, and I’m almost prepared to feel for her, rather than be offended by her, if she does have an untreated neuro disorder.

  << It’s time to wake up, Phoebe. >>

  << It’s time to wake up, Phoebe. >>

  << It’s time to wake up, Phoebe. >>

  I groan and bury my head under my pillow. Naturally, that doesn’t work.

  << It’s time to wake up, Phoebe. >>

  < Shut up, Navi. >

  << You have thirty-five minutes remaining to leave for work. Your commute is longer, because you are taking the rail to work today. You must shower now. >>

  < Snooze. Snooze snooze snooze. >

  << You have been written up twice already for insubordination. You cannot afford to be late. You will be fired. >>

  The reminder is like being dunked in cold water. I told my Navi word-for-word what to tell me to get me up, and I chose well. It always works like a charm, and I hate it every time.

  So I drag myself out of bed, exhausted and angry, as I do most mornings, and trudge into the kitchen with the intention of downing a cup of coffee. But this time, when I get there, the coffeepot is dormant and cold.

  < Coffeepot, WTF? >

  My Navi replies.

  << I have overridden the coffeepot’s instructions. Last night, you decided to give up coffee. >>

  < No way. >

  I’m practically reeling, yet I do now remember something about this from yesterday… something about heart palpitations… but I don’t care right now. That was yesterday’s problem.

  < Navi, make me some freaking coffee! >

  << Last night, you decided to give up coffee. >>

  Argh.

  There’s got to be some manual way of making coffee. Some buttons or something. I look for buttons on the pot, but I don’t find anything. There’s a power button, but it doesn’t make the coffee start brewing.

  << You have twenty-five minutes remaining to leave for work. Your commute is longer because you are taking the rail to work today. You must shower now. >>

  < Son of a bitch. >

  << You have now donated $10 to Citizens Against Science. Every time you curse, you donate $10 to a charity you hate. >>

  Oh, oh—oh—I can’t think of a protest that doesn’t involve cursing.

  < I cursed to you! That shouldn’t count! >

  << Instructions unclear. Please try again. >>

  I lean on the kitchen counter and grind my teeth. Today is off to a stellar start.

  << You have twenty-two minutes remaining to leave for work. Your commute is longer because you are taking the rail to work today. You must shower now. >>

  I groan and stagger off to the shower, making plans for how I’m going to get a coffee on my way to work… or at the break room at work… or something… but I know that it’s futile. My Navi is always watching me through my own eyes, always there to keep me on track—unless, of course, I disable the instructions I’d set up. But, as I recall, I always bury my self-help programming under three or four layers of security so I’ll find it too difficult to change later.

  I’m too smart for my own good sometimes.

  So, Past-Phoebe thought it was a great idea to give up coffee, did she? Well, Present-Phoebe would like to kill Past-Phoebe.

  Instead, I take a big dose of ibuprofen on my way out the door, to combat the caffeine-withdrawal headache I’m bound to have in a couple of hours otherwise.

  < Navi, please remind me WTF I was thinking when I decided to give up coffee. >

  It recites the information I dimly remember assembling and giving to it yesterday.

  << Coffee interferes with insulin production, potentially contributing to Type II diabetes. Coffee elicits excess cortisol, worsening stress. Withdrawal symptoms from coffee are quite unpleasant and start within a few hours. Coffee lowers serotonin synthesis, possibly contributing to depression. Coffee unbalances electrolytes. >>

  < All right, all right. That’s enough. Shut up. >

  As the light rail takes me to work, I review the notifications that stacked up in my panels while I was fighting with my Navi. I staunchly ignore the messages about fast-food places offering breakfast along the way.

  The first thing I do when I get to my ward is go into the break room to get coffee like I always do, because I’ve already forgotten. But as I approach, my Navi flashes an emergency message.

  !!! Warning! Action not consistent with personal goals. !!!

  | You have decided to give up coffee. |

  I mentally kick myself, because I can’t imagine how I managed to forget that so quickly, and then I stare forlornly at the full pot of hot brew right there in front of me.

  I don’t remember what I told my Navi to do to me if I try to drink the coffee, but I think it was extreme. I think I told it to go to full Red Mode if necessary.

/>   I decide to test the boundaries a bit.

  I edge a few steps closer, eying the coffee.

  !!! Warning! Action not consistent with personal goals. !!!

  | Activating Personal Persuader app. |

  Uh-oh. The Personal Persuader app is good.

  I don’t answer. I take a coffee mug from the cabinet and step cautiously toward the coffeepot.

  | You don’t want to drink coffee anymore.|

  | Coffee is bad for you. |

  | You only need to wait thirty-three more hours to beat this addiction. |

  | In thirty-three hours, you will have much more energy than normal. |

  | You will also sleep better. |

  I falter.

  | Will you please drink a big glass of water instead? |

  | You will feel much better, I promise. |

  < I don’t believe you. >