It's weird, but after a few nightmares and now these fucking awake things, I didn't trust sleep. I felt dead tired and I hurt, but I didn't want to close my eyes and let the demons mess with me. Lack of sleep wasn't going to help my stress management, but I didn't know what else to do. Except drink more. I told my clients drinking didn't help, that it actually added more stress to the body, so when the effects faded off you got left with a body and a mind in worse shape than when it started. I still drank despite that knowledge. I got a good idea why the alcoholics I've been counseling for years ignored a lot of what I had to say. Ironically, all the times I've gone out on bogus disability leave had come back to haunt me. The fact is, I couldn't afford to take any sick time off. There was some quirk in the disability law that allowed employers to fire employees if they've reached a certain amount of days away from the job for whatever reason. Over the years I've cooked up fake diagnoses, so I could train or spar. Fibromyalgia, irritable bowel syndrome, post traumatic stress and some others all did the trick. The key was to get a doc to write you a condition really hard to prove with objective symptoms. I knew it was bullshit, and I'm sure Claudia knew it was bullshit, but there was really nothing she could do. Now, I could use some genuine disability time and I didn't have any, so I had to show up at the clinic. Disability law was something I didn't quite understand. I knew Claudia did so I knew I had to get to work.
"Duffy, what the hell are you doing here? You should be home and in bed," Trina said when I walked through the door.
"Good morning to you too."
"I'm serious. You're in no condition to be here."
"I got to, other wise the Michelin woman will have cause."
"No way."
"Yeah, she's let me know I've run out of disabilities."
"Oh my God. Be careful."
"Yeah."
She looked at me in that way that told me she was assessing me. She also had a way of looking at me that set off a little bit of a spark. I headed toward the cubicle when she called for me.
"Duff, I heard about Rene." She bit her lip and scrunched her forehead. "I don't know what to say except that I'm sorry."
"I'm not sure what to say either." I felt my chest tighten a, and just wanted to get to my desk. "Thanks though, Trina." She stood and looking at me while I walked away. On my desk sat a package from the Veteran's Administration. There was also a note from Claudia to come see her as soon as I got in. I'm sure she just wanted to give me a hug and express her concern for my well being. Whatever it was, it was going to have to wait because I was dying to read about my buddy Karl and his military experience.
I wanted to know the Karl back story and maybe get a better handle on the helmet, rubber gloves, and his hate for the New World Order. The package came with a form letter about confidentiality and the general phone number to call for veteran medical records.
The first page of the file contained a discharge summary, which is kind of an executive summary of everything in the chart. It's kind of like Cliff Notes for the lazy counselor. This is how it read:
DISCHARGE SUMMARY
VETERAN'S ADMINISTRATION HOSPITAL
ALBANY, NEW YORK
Karl Greene
Date of Evaluation: 1/8/08
Case No.: 1667-9289-11A
Date of Report: 1/10/08
Unit 7
Admission Date: 1/2/08
PURPOSE OF EVALUATION
This is the first psychiatric admission for this 28 year old, single, white male, who was referred through the office of Veteran Affairs following what was described by his commanding officer as 'Behavior consistent with PTSD'. Greene, a sergeant in the US Army Special Forces division was admitted to the VA following a brief stabilization admission in Germany.
Sergeant Greene was receiving psychiatric services at this hospital until 1/7/08 when he assaulted a mental health worker, breaking the worker's nose, and causing facial bruises and lacerations. Greene refused to attend group therapy and objected when the mental health worker grabbed his elbow to escort him. Staff report that Greene claimed the mental health therapy aid was part of conspiratorial activities against him. Greene rendered the mental health worker unconscious with a martial arts style blow. It should be noted Greene did express remorse at assaulting the mental health worker and did seek out assistance in reviving the unconscious worker.
BACKGROUND INFORMATION
Sergeant Greene had been an active duty sergeant in Special Forces for the last four years. He enlisted during the Iraq conflict, verbalizing he wanted to be part of the nation's war against terror. Greene was cleared of any mental history and did not show any symptomatology consistent with mental illness at the time of enlistment until a series of trauma related events occurring within battle.
The event that appears to have precipitated his current admission involved a raid on a suspected insurgent headquarters within the city of Baghdad. On December 25, 2007, Greene and 3 members of his team entered the house believed to hold the insurgent leaders. Sergeant Greene was the first soldier through the door. He immediately took on fire from two of the insurgents. Greene was not wounded and was able to neutralize his attackers with gunfire.
As Greene and the three members of his team proceeded through the house, they were surprised by another Iraqi who emerged from a closet. Two of Greene's team members were shot, one fatally, before Greene fired upon the assailant. As Greene continued to fire on the Iraqi, he heard the shrieking of several children. When Greene stopped firing and looked into the closet where the Iraqi had emerged he found two young children, a brother and a sister, ages 5 and, 3 dead from his gunfire.
Sergeant Greene had been cleared of any wrong doing in this situation, but the next morning following this incident he was found wandering outside the camp with his firearm. His fellow soldiers were concerned about his behavior and were concerned he might be suicidal. His commanding officer requested psychological services and he was immediately sent to Germany for observation.
Tom Schreck
Out Cold: Round Three of the Duffy Dombrowski Mysteries
MENTAL STATUS EXAM
Sergeant Greene presents as an angry, distrustful individual who did not appear willing to open up, though he wanted to be compliant within the rules of the military. He reported he wasn't sleeping well but "…that he never really did…" When asked if the circumstances that got him referred to psychiatric help bothered him he responded "…wouldn't you be bothered by something like that?"
Initially, Greene appeared oriented to time and place, but while in psychiatric care his stability deteriorated. It may be the case that this is related to his post traumatic condition and as time went by the events of the incident exacerbated Greene's condition as he repeatedly found it difficult to rationalize the events in regard to battle circumstances.
Several medications were tried in an effort to stabilize Greene, but they did not appear to be effective. It may even be the case that his state worsened after medication, though it is impossible to discern if that is a cause and effect related to the medication or just the natural progression of his deteriorating state.
Tom Schreck
Out Cold: Round Three of the Duffy Dombrowski Mysteries
SUMMARY AND RECOMMENDATIONS
Sergeant Greene came to the military with no history of mental illness. At the time of this summary he shows symptoms consistent with Post Traumatic Stress Syndrome. It is quite possible he also has developed schizophrenia with paranoia and some of his behavior suggests substance abuse. It is recommended that Sergeant Greene receive ongoing care for mental illness and substance abuse and that he remain on a regimen of medication to control his reaction to stress.
Theodore Martin, MD
Staff Psychiatrist
Simply put, at least as best as I could understand it, Karl lost it after he accidentally killed a couple of Iraqi kids. If you were going to lose it over something, that would certainly do it. That made some sense, but it didn't really explain the Redskins gear, the rubber gloves, and his theory on the massive plot to fatten all of us with partially hydrogenated oil. On second thought, maybe living with killing a couple of innocent kids did explain that.
I flipped through the rest of the chart, which consisted of his medical history, a section on military mumbo jumbo and the day-to-day case notes. I skipped to the case notes to see if Karl was confronting everyone at the VA who used non-dairy creamer.
Karl was in the funny farm unit for over four weeks so there should be at least a page a day of notes. Hopefully the VA counselors were a little more diligent of their paper work than yours truly and I'd be able to tell what Karl's stay was like. I flipped through the daily progress notes and noticed something wasn't right. The section was too small. The first few days were documented thoroughly then one note went on to a second page and stopped abruptly. Then a brand new page started with two weeks of abbreviated notes. It looked like someone ripped out the original documentation and replaced them with new notes. They did a shitty job because it would've been pretty obvious to anyone who had ever written in a chart. It was even obvious to a counselor who hated paperwork. I was about to get a second opinion from Monique when a shadow blocked the ceiling fluorescent light hanging over me.
"Duffy I left you a note to come see me as soon as you got in," Claudia said.
"I was just coming in."
I followed Claudia to her office.
I'd been down this road before and it wasn't a good road to go down. Getting in trouble at work was something I had gotten used to. Watching The Michelin Woman gloat as she read me her riot act wasn't.
"This is a warning of pending termination," Claudia said glaring at me.
"C'mon Claudia the charts have been worse," I said.
"Oh, I know. That's why this isn't a termination…yet." She half smiled. "It has come to my attention that you have violated a client's confidentiality."
I couldn't imagine how she heard about Karl. The Michelin Woman was a nosy bastard and she would've had her ways, but I decided to keep my mouth shut.
"I received a call from Paula Bentley, the ex partner of your client, Mr. Spain. She says you came to her place of work to advocate that she allow her ex to have visitation with their daughter."
"And I didn't go to her place of employment. I went to pick up that computer and I bumped into her."
"It doesn't matter. It is grossly inappropriate."
"Even so, that's the first time I've ever been caught-I mean-ever done something like that. I've never been warned. You can't fire me for that."
"No, but if you're charts aren't up to date I can combine these two offenses and have just cause to fire you."
"That's a bullshit technicality and you know it." She smiled and closed her eyes.
"Please watch your language in my office." Under my breath I muttered "Fat fuckin' bitch."
"Did you say something?"
"No."
From there, she outlined her plans to can me. She would further investigate my breach of confidentiality and then review my charts. If she was able to confirm that in both cases I was negligent and inappropriate I'd be out on my ass. I've been close to getting canned before, but on those occasions there were always way outs. I wasn't so sure this time.
Tom Schreck
Out Cold: Round Three of the Duffy Dombrowski Mysteries