Chapter 1

It was only after I had removed my hand from his neck that I noticed the red smudges my fingers had left on his skin, streaks of dull crimson marking the site where I had been unable to detect his pulse. Startled, I looked at my hand, to see that I had blood on my fingers.

Feeling lightheaded, I rose unsteadily from my knee. My attention was drawn once more to the skillet which lay face down on the floor, in the same posture as the dead man. On impulse, I leaned toward it, but then fought the urge to put it back on the stove. It was the same twelve inch cast iron skillet that I used and cleaned most mornings and which would already be amply marked with my fingerprints; I didn’t need to add bloody ones. As I looked down at the man with the bashed-in head, the man who had been my wife’s lover, I knew that, as his life had ended, mine had become embroiled in chaos.

Monday, June 3

Perhaps prophetically, the sequence of events that brought me to that moment began some weeks before, in the Coldwater County Detention Center, as the new county lockup had been branded.

From the isolation cell, where they’d stashed me, I remember being surprised, and generally annoyed, to discover that the new county jail was just as pervasively and maddeningly noisy as the old county jail had been. Although separated from the general population, it was stiIl engulfed by a stunningly discordant volume of human noise. The talking, laughing, jeering, cursing, yelling, and crying simply boomed off of the ubiquitous hard, glossy, damage-resistant surfaces, easily penetrating the steel door that closed off the isolation cell. I even had a hard time understanding the detention officer who’d spoken to me from that doorway only a few minutes before, and he’d been scarcely six feet away.

I could barely hear myself think, and yet they expected to have an official interview conducted there. I decided to demand another arrangement. Besides, I wanted someone else as a witness for what I expected to happen.

Just then, a serious-looking man in a sheriff’s department uniform pulled the door open. He had a three-stripe chevron on his shoulder, and a skinny young man at his side. The kid’s greasy brown hair hung down to the shoulders of a faded black T-shirt, a barely discernible “666” in washed-out red characters printed across its front. In turn, the shirt hung loosely over torn, black-gone-gray jeans. Worn black high-top canvas sneakers completed the ensemble. The k id’s hands, presumably in cuffs, were behind his back as the officer, who had hold of his prisoner’s arm, brought him into the cell.

I stood up from the concrete slab bunk. “We can’t talk in here,” I said, in a slow, distinct, and loud voice. “The echoes make it impossible.”

“Well, what do you want to do?” the jailer asked. “You know the interrogation rooms have no furniture yet, and there’re big empty holes where the one-way glass is supposed to go.”

Looking across the open space behind him, toward a familiar door, I queried, “How about the nurse’s office? Is Mike in?”

The officer looked over his shoulder, then turned back. “I think so. Let’s go see.”

I retrieved my black faux-leather portfolio from the bunk. The officer, Jerome Sanforth, known as Jerry, grabbed the kid by the upper arm and walked him across the jail receiving area to the nurse’s office on the opposite side. He knocked on the door. A few seconds later, the door opened a few inches and we could see Mike, a faint scowl on his face, seated at his desk next to the door, reaching across and holding the door open. His expression softened when he saw us.

Mike McGovern, the detention center’s registered nurse, was a tall, blonde, broad-shouldered, former college football tackle. He’d been hired only a month ago, to bring the new jail into compliance with state regulations.

I said, “Mike, can I use your office for a mental health interview? You don’t have to leave. I’d actually prefer if you’d sit in.”

He pushed the door the rest of the way open and made a sweeping gesture to indicate the office was mine to appropriate. “As you wish,” he said.

With a grin and a dismissive shake of my head, I said, “Thanks, Farm Boy.” Another impromptu meeting of the Coldwater County Chapter, Fans of The Princess Bride.

I stepped past Mike’s desk and turned toward the officer. “Thanks, Jerry, I’ve got ‘im. You can take the cuffs off.”

Sergeant Sanforth released the cuffs, looked at me, and quipped, loudly, “Just yell if you need anything.”

“Funny, Jerry. Don’t quit your day job.” Sanforth was the Sheriff’s detention center supervisor.

Then I addressed the young man. “Mister Caldwell, would you please take a seat?

I pushed the door shut behind me and the decibel level dropped to that of a revving top-fuel dragster.

Kendal Randal, age nineteen, had been brought to the jail, or rather, Detention Center, late the previous night. He’d been taken into custody by the city police in the town that served as the administrative seat of Coldwater County, Leaufroide.

With sincere apologies to any French-speakers, the town’s Americanized name was pronounced luh-FROYD. As the story goes, late in the eighteenth century, a French fur trapper had decided to give up the voyageur lifestyle and he set up a trading post at the head of canoe navigation in the nearby river. He had written “l’eau froide” on the map of another French trapper to indicate the river’s name as it translated into French. The British name for the river was the Coldwater, l’eau froide means “the cold water” in French. It was at that spot where the French phrase had been written, that the town later grew from its beginnings as a trading post, gaining its name from the French phrase written on that early map.

Mike asked, “You want to use the desk?”

“Nah, won’t need it. I don’t think we’ll be long.”

Mike’s office was about twelve by fifteen feet. It doubled as a medical exam room, and had an exam table with an overhead light, and several locked steel cabinets. The functional difference between the clinic room and the rest of the jail, however, were the sound-absorbing acoustic panels on the ceiling and the upper two feet of the walls, the same type of damage-resistant acoustic panels that were on back order for the rest of the new Detention Center. In one corner of Mike’s office there was also an old, flimsy, metal and plastic folding chair. Kendal Caldwell sat in the folding chair, so I pulled a wheeled exam stool over and sat in front of him, practically knee to knee.

“Mister Caldwell, I’m Gary Mazur from the county mental health program.” I offered my hand to the grungy teenager and he took it with a loose grip. “This is Mike McGovern. He’s a registered nurse and supervises health services here in the jail. I’ve asked him to sit in so he can become familiar with some of the mental health problems he may encounter. Is it okay with you if he observes?”

Caldwell looked over at Mike, who smiled at him. “Sure, I guess,” he said with a disinterested shrug.

“Thank you.

“The reason I’m here, Mister Caldwell, is to assess your mental state after last night’s incident. Are you up to answering a few questions?”

“Are you a shrink, you know, a psychiatrist?”

“I am not a psychiatrist. I’m a psychiatric social worker. I have a master’s degree in clinical social work and I have a state certification for purposes of diagnosing mental and emotional problems for the state courts. So, can I ask you a few questions?”

“Sure, I guess so. Are you gonna get me out a’ here?”

A mental status exam is generally a detailed and protracted observation and question-and-answer session that elicits information about the subject’s state of mind and emotions, including such specifics as mental alertness and reasoning ability, the soundness of one’s reality testing, the awareness of one’s circumstances, and it draws out indications of mental and emotional problems, including symptoms of various defined psychological disorders. Actually, I was planning to shortcut almost all of the standard assessment.

“Perhaps we can get you out of here, Mister Caldwell. That’s what I’m here to determine. Are you still feeling suicidal?”

The Leaufroide City Police had picked Caldwell up the night before, after he’d walked out onto the interstate overpass and threatened to jump from there onto State Route 47, all of twenty-feet below. By the time our crisis worker had arrived on scene, the ambulance, fire truck, and police cars were leaving and Caldwell was already on his way to the jail, charged with disturbing the peace, disorderly conduct, and criminal mischief.

We didn’t have a psychiatric inpatient facility in the county, so, when emotionally disturbed people came to the attention of local law enforcement, they tended to be brought to the community hospital’s emergency room or to the county jail, but mostly the jail, as they frequently violated minor laws, such as with Mr. Caldwell, which is why folks would call the cops, rather than EMS, in the first place. Then the cops or the jail staff would call us at the county mental health crisis service.

Normally, I would have come over first thing that morning, but I had my reasons for waiting until after lunch. I’d called Jerry Sanforth earlier to explain the delay.

The kid said, “Uh, suicidal? No, uh, no, not now.” Then he looked at me and hastened to add, “But sometimes the voices tell me to do things.”

“The voices? What do you mean by ‘the voices’?”

“I hear voices in my head. They tell me to do stuff.”

“These voices are in your head? It’s not like someone else talking to you, like I’m talking to you right now? Maybe somebody nearby that you just can’t see? Or maybe whispering in your ear but remaining hidden?”

“No, no, no. They’re in my head. There’s no one talking or whispering to me.”

“You said the voices tell you to do things. What sort of things?”

“Uh, like, jump off that bridge last night.”

“What else do the voices say?”

“What?”

“Do the voices say anything else to you, besides telling you to jump off the bridge? Do they say anything else?”

He looked at me speculatively, then, hesitating, said, “Uh, yeah. Sometimes.”

“What else do they say?”

“What else?” He paused. “Uh, they just, uh, they scream at me.” The last words were said almost like a question.

“Anything specific?”

“Uh, no, just screaming, I, uh, can’t tell what they’re saying.”

“But it doesn’t seem like someone is screaming next to you? The screaming’s in you head?”

“Yeah, yeah, like, just all the time, in my head.”

“Are you hearing the voices right now, while we’re talking?”

He paused for a couple seconds, looking uncertain, then said, “No, uh, not while you’re talking to me.”

“I see. Have you ever had any mental health treatment or been admitted to a hospital for psychiatric care?”

“Like from a shrink? In the nuthouse? No, never.”

“Well, how long have you had these voices in your head?”

“Not very long. Maybe a couple, uh, weeks.”

“A couple weeks? I think you’re lucky, Mister Caldwell. We caught this early. I think the best thing for you would be to get on some medications to help you with these voices. What would you think of doing that?”

“Yeah. That sounds like a good idea to me. I think I need quetiapine. I mean, I mean, I’ve heard that’s good,” he waffled.

“Good enough, Mister Caldwell. Let’s see what we can do. Mike, can I borrow that clipboard?” I pointed to the clipboard on the corner of his desk.

Mike turned back to his desk and reached for the clipboard. What Mike had yet to realize was that I was going to be a real hard ass about this situation. I needed him to understand, as the recently-hired Detention Center’s nurse, and only a few months after his RN certification, how he might be manipulated by the men and women under arrest or serving sentences. Mike pulled some papers off the clipboard and handed it to me.

I reached into my portfolio, which I’d kept on my lap, pulled out a single sheet form, and secured it under the clip. I retrieved a pen from the portfolio and offered it and the clipboard to Caldwell. He took the clipboard and looked at the form.

“Mister Caldwell, if you’ll just sign this admission application, we can get you on your way.” I held the pen toward him, again.

“Uh, what is this?”

I leaned forward and pointed to a line of bold text at the top of the form. “This is a voluntary admission request to the state hospital, over in Plattsburg.”

“State hospital? I don’t wanna go to a state hospital.” He handed the clipboard back to me.

“Mister Caldwell, you said you wanted some medicine to help deal with the voices. We don’t have the resources here in Leaufroide to monitor you, you know, to prevent you from, well, killing yourself. We don’t even have an inpatient psychiatric unit. With the voices telling you to jump off bridges, I think it will be several weeks, possibly several months, before the doctors can find the right medications and dosages to deal with your symptoms. That’s what they do at the state hospital, and they’re pretty good at it.”

“Don’t you have a psychiatrist here?”

“Sure we do. We’ve a psychiatrist and a psychiatric nurse practitioner on staff, but they can’t monitor you twenty-four-seven, either.”

“I could stay with friends.”

“I didn’t know you had friends in town. Can I call them for you?”

“Uh, she doesn’t have a phone.”

“Where does she live? I can go over there and talk to her.”

“I’m not sure of the address. But I know she’ll let me stay. I can walk over there.”

“Oh, no, Mister Caldwell. I can’t let you go about unsupervised, not with the voices in your head telling you to kill yourself.”

“Maybe the doctor could just give me some meds, y’know, some quetiapine. I think I’d be alright, then.”

“That might take care of the voices temporarily, but how would you live? Do you have a job or some source of income?”

“Maybe I can get SSI. I mean, that’s what it’s for, ain’t it? Mindy -- I mean, my friend gets SSI.” SSI was Supplemental Security Income, a benefit paid to disabled people who had not worked long enough to qualify for Social Security Disability (SSDi).

“Are you speaking of Mindy Peterson?”

“Uh, well, yes. She’s my girlfriend.”

“That’s nice. How long have you known her?”

“We, uh, we just hooked up last week.”

I raised my eyebrows and drew my lips into a thin I wouldn’t be so sure expression. “Ah, Mister Caldwell, I’m afraid I have some bad news for you. I talked with Miz Peterson’s mental health caseworker this morning and she said that Miz Peterson didn’t want you coming back. She said you spent all her SSI money and her Nutrition Assistance allowance and that you hit her. I don’t think you have that place to stay, anymore.”

“Oh. Uh, I could stay with Barney Austin.”

I shook my head, feigning regret. “As it turns out, Mister Austin has the same caseworker, and she tells me that you spent all of Barney’s SSI money on marijuana and that you punched him, too. He’s not very happy with you. Nor is his caseworker.”

Mike leaned forward in his chair and looked decidedly more interested in the conversation.

For the size of the Coldwater County Detention Center, a Registered Nurse met the state requirements for healthcare management. However, it was also required that the RN work under the professional review of a medical doctor, though that MD did not have to be on site. As it happened, the only MD who worked for the county happened to be the psychiatrist who I supervised in Community Mental Health. So, as a cost-saving strategy for the county, Mike was attached to the County Mental Health team for clinical and administrative supervision.

Community Mental Health (CMH) was one of five service teams within the Coldwater County Health and Human Services (CCHHS) Center, often just referred to as the Health Center or just the Center. The other departments were Public Health (PH), Substance Abuse Rehabilitation (SAR), Developmental Disabilities Habilitation (DDH), and Administrative Services (AdS).

To provide Mike with regular doses of both professional and moral support, I included him in our weekly CMH team meetings. As a result, he was familiar with most of our Community Maintenance Project clientele, folks like Mindy Peterson and Barney Austin, adults with serious and chronic mental illnesses who, with properly supervised medications and some expert assistance with the problems of independent living, were able to remain in Leaufroide, in their own homes or apartments, rather than be confined to an institution. It was also a cost savings to the state to hsve proplw live in the community rather than as an inpatient at a state hospital.

“So, can I get SSI?” Caldwell wanted to know.

“Possibly. But SSI is for disabled people who don’t qualify for Social Security Disability benefits because they don’t have enough credits in the Social Security system. I’d estimate that you’re too young to have worked enough quarters to qualify for Social Security Disability, so SSI would be the correct program. But, first of all, do you think you’re disabled?”

“Sure, I’ve got those voices. Uh, yeah, and the, uh, the suicide thing.”

“Then maybe so. But you’ll need some doctors to say you’re disabled, to support your application for SSI. That’s why I think the state hospital would be your best bet.”

“No. No state hospital.”

“Then I’m not sure how we can help you.”

“Can’t you get me some emergency SSI?”

“We can help people apply, but we don’t have any control over who gets approved. Tell you what I can do, though. Since you’re shy about admitting yourself to the state hospital, I can have the sheriff take you over there on an involuntary police hold.”

“I said no state hospital.” He sounded a bit angry.

“I understand it’s not your preference. But I have some responsibility here to protect you from harming yourself, so I have the authority to sign an order for a police hold.”

“Yeah, maybe, but that’s only for three days, anyway.”

“Ah, you’re familiar with the Vinley Act. Good. Then you know that there’s a hearing at the end of the three days to determine if you should be admitted for up to six months. I might add that, of all the people I’ve felt it necessary to send over to the state hospital in the past three years, not one of them has been released at that three-day hearing. They were all found to be in need of further involuntary commitment for up to six months.

“See, we don’t like to send people to the state hospital if we can figure out some way to help them right here in Leaufroide. Unfortunately, suicidal people are one thing we can’t take care of here. When we actually send someone over to the state hospital, it’s because they really need to be there for a while.”

“You can’t do that to me.”

“Actually, I don’t want to do that to you. What I’d like to do is help you return to Kingston. In fact, I have a bus ticket here, non-refundable, for the three-fifteen bus this afternoon.” I pulled the ticket print-out from my portfolio and held it up in front of him.

“I don’t want to go back to Kingston.”

“You’d rather stay out here in the boondocks than in the big city?” Leaufroide’s population was only about fifteen thousand, with maybe another ten thousand in the rest of the county.

“Yeah. I don’t like Kingston.” Kingston, about two hundred and fifty miles west, had a population of around two hundred ninety-five thousand. It was the state capital and the state’s largest city.

“Okay then. Let me borrow that clipboard back, please, and I’ll fill out this form” -- I pulled yet another printed sheet from the portfolio -- “for an involuntary admission that will get you to the state hospital.”

“I said, no state hospital! The hell’s ‘a matter with you?” Caldwell half stood, then dropped back into the chair.

“Mister Caldwell, what choice do I have? We can’t monitor you here in Leaufroide. It would mean my job if I knowingly allowed a suicidal person to wander around on the street, without money, without family or friends. That’s simply not feasible. No, sir, that’s why the state has provisions for an involuntary hospital hold.”

“But you could help me here,” he whined. “Maybe I could stay in the jail until you get the emergency SSI and the meds.”

“That won’t work, Mister Caldwell. The county prosecutor has dropped the charges against you and the Vinley Act won’t permit us to keep mental health holds in a jail. You’re going to have to leave today. So, Kingston or Plattsburg?”

“But you have to help me if I’m hearing voices. You have to get me SSI. Yeah, and quetiapine.”

“Not really, Mister Caldwell. Let me lay my cards on the table.” I leaned closer, though I still had to talk in a normal tone because of the jail’s background clamor. “I don’t believe that you’re hearing voices. And from the police report, it’s pretty clear you had no real intent to jump from that bridge.”

“Then you can just let me go.”

“So you can beat up and steal from the vulnerable people who actually need our help?” I sat upright, again, shaking my head. “Ain’t gonna happen. Here’s your choice: bus ride to Kingston or sheriff’s ride to Plattsburg.”

“Nope, neither. If I’m not mentally ill, then you can’t put me in the hospital. And if there are no charges, you have to let me go.”

“On the contrary, Mister Caldwell. With your suicidal behavior and your claims of hallucinations, I’d pretty much have to put you in the state hospital, no matter what I believe. And, once you’re there, I’ll make sure you stay for the whole six months. Remember, I haven’t lost in a court hearing yet. I’m very good at presenting my case for the six-month hold. That’s why I’ve got this job.” That wasn’t really the reason I had that job. The real reason is because neither my boss, nor his boss­--the Vinley Act designated Mental Health Assessor -- wanted it.

Caldwell sat there for fifteen seconds, just looking at me. Eventually, he said, “You’re an asshole.”

I nodded in reluctant acknowledgment. “You’re not alone in that opinion.”

“Give me the damn bus ticket.”

“I’ll hand it to you as you get on the bus. Let’s get your release paperwork started.” I checked my watch. “We should have time to stop at McDonald’s, get you some food to carry with you. My treat. C’mon, let’s go see Sergeant Sanforth.”

I walked him to the jail office and left him there to get processed out. Then I went back to talk with Mike while I waited.

He started in on me right away.

“What the hell, Vizzini? Is that even legal?”

“What, buying a guy a bus ticket to Kingston?”

“Hell, you’re running him out of town.”

“More ‘n that. When I drive him to the bus station, I’m going to tell him if I ever see him here again, I’ll order a police hold the very next minute. That little shithead is out here because he can’t get any of the agencies in Kingston to get him on SSI or on his favorite chemicals. So he hitches out here, rapes, beats, and steals from our vulnerable clients, folks who’d never be able to stand up to cross examination if they ever did file a complaint with the police, of whom they’re terrified anyway, and then he tries to con us into getting him on the dole and on his favorite drugs. That fucker is lucky I’m not kicking him back to Kingston.”