Episode 26 — Chapter 30
What could I possibly do?
As she continued to reflect on the dilemma, an idea took form in her mind. It seemed reckless and risky, but once it took root, it seemed to her that it might actually work. She had to do some shopping first and then she would make one final visit to the hospital. Everything had to go perfectly. She couldn’t afford to run into Dr. Cantril again, or she’d likely be banned from the hospital altogether.
Dr. Cantril sat at his desk. He was done with patients for the day, but he had plenty of paperwork to keep himself busy for several more hours. His desk phone interrupted his concentration.
“It’s Mr. Hodges from legal.”
“Thank you, Stella.”
“Mr. Hodges. I hope you have good news for me.”
“Sure do. I saw the judge today, ex parte. He signed the temporary commitment order. I thought you’d like to know.”
“Fantastic. Could you email me a copy so that I can arrange for the patient’s transfer tomorrow?”
“You’ll have it in less than sixty seconds.”
Dr. Cantril hung up the phone, feeling better than he had in years. He was amazed at his good fortune in locating such an incredibly fascinating and rare disorder, and at Layton Regional of all places! It had also been an incredible stroke of luck that the patient had insisted on having his face reconstructed in the likeness of the great Ty Cobb—no family members would be able to recognize him or claim him with a changed appearance. Without family to intervene, he would have complete freedom in selecting modalities and interventions; it couldn’t have been a more perfect situation. The order had come just in time, since Mr. Cobb had made it abundantly clear how desperate he was to leave.
Dr. Cantril pushed his other files to the side. Tonight, he would spend his time evaluating and outlining a course of treatment for Mr. Cobb. The case would undoubtedly garner much attention in psychiatric circles and beyond. He congratulated himself on having the foresight to record Mr. Cobb’s sessions, though he regretted not having done so with the first one. The filmed sessions would be priceless in dealing with the press and his peers in the future.
The real question would be the choice and sequence of modalities to use on Mr. Cobb. The case would need to be done by the book, as it would undoubtedly come under intense scrutiny in the psychiatric community. The first thing that Dr. Cantril had to instill within the patient was trust. He had been unapologetically blunt in challenging Mr. Cobb’s time displacement delusion, but it had been necessary to satisfy the third prong of the MacArthur-Maudsley assessment. However, if Mr. Cobb believed that the therapist considered him insane or demented, it was likely that Mr. Cobb would become uncooperative and refuse to engage in further dialogue. His approach would now change. He would work on gaining Mr. Cobb’s confidence in future sessions and the delusion would serve the functional purpose of helping Mr. Cobb cope with depression and a damaged ego.
Dr. Cantril decided that the first modality would be psychotherapy in order to gradually chip away at some of Mr. Cobb’s delusional thoughts by gradation. If that didn’t yield positive results, then he would prescribe anti-psychotic medication. It was premature to dwell on more intrusive interventions—they would be considered further down the road.
Savannah arrived at the hospital twenty minutes after 5 p.m. carrying a large shopping bag. Of utmost priority was to avoid another encounter with Dr. Cantril. While in the lobby, she placed a call to Dr. Cantril’s office. The call was transferred to an after-hours dispatcher who had no idea whether the doctor was still physically in the hospital or not. Savannah couldn’t be sure, but she hoped that Dr. Cantril had gone home for the day. Still, her resolve began to melt away as she considered all the ways her plan could fail.
I’ve been watching too many movies lately; everyone always has an ulterior and sinister motive. I’m sure Mr. Cobb is in good hands. But the more she repeated that mantra, the less convinced she was of its truth.
Savannah exited the fourth floor elevator, walked tentatively down the hall and turned left. The door to Room 4-117 was closed. She wondered if the patient had already been transferred.
Anxiously, Savannah turned the knob and the door opened. For the first time, she observed Mr. Cobb standing up; he was facing the window. She discreetly placed the shopping bag in the corner of the room. The patient was testing his newly-uncasted leg.
“Good afternoon, Mr. Cobb. It’s good to see you out of bed.”
The patient turned around and gave a polite nod.
“I hope I’m not bothering you,” Savannah flashed a friendly smile.
“No, ma’am. I can use some company.”
“You must be pleased to finally be free of the leg cast.”
Mr. Cobb nodded. “Leg’s a bit weak. They had me hobblin’ up and down the hall earlier today. Someone came in a little bit ago and showed me some things to do for my leg, to help bring back some strength. I reckon I’ll be out of here in a day or two.”
Seeing the patient again, in flesh and blood, Savannah’s brilliant plan now seemed utter lunacy.
“I was reading about you on the internet…”
“Internment? What’s that you say?” Mr. Cobb interrupted.
“No, it’s not internment,” Savannah laughed. “It’s called in-ter-net. I couldn’t begin to tell you how it works, only that you can find answers to just about any question if you have a device to access it. That phone I showed you yesterday; I can access the internet with that. Here, if I type in your name and ask for photos of you, you can see for yourself what comes up.”
The patient looked at the device and saw the screen filled with photographs of Ty Cobb along with a plaque in his honor.
Focusing on one of the photographs, Mr. Cobb spoke under his breath, “My God. That looks like me, but older.”
Savannah slid her finger on the screen and an endless stream of Cobb photos appeared.
“This is utterly fantastic. How did you do that?”
“It’s simple. Everyone carries a phone around today.”
The patient looked disoriented. “If they have such amazing inventions as this, maybe someone’s figured a way for me to get back home.”
“I wouldn’t be too optimistic about that. I’m pretty sure we’d have heard about it if time travel had been discovered.”
Mr. Cobb slumped down on his bed. “I wake up every morning, believing I’m back… back home. But then, before I open my eyes, I hear the sounds… the sounds tell me I’m far, far away.”
Dr. Cantril had filled ten pages with notes regarding therapy and medication. He hesitated a second before going to the next page. He had to be careful what he wrote and finally listed: “Possible Interventions.” He then wrote: “Consider only if therapy and medication fail.” If they did indeed fail, as he assumed and hoped they would, it would pave the way for the more intrusive, albeit controversial, realm of modalities. For this, he would need to collaborate with other specialists, getting them to endorse the treatment. He couldn’t afford to be perceived as venturing off the reservation without support. He wrote down “Electroconvulsive therapy or insulin shock therapy,” then paused and added a large question mark to the right, to make it clear that it was something to be carefully pondered; it had been tried on delusional patients, with varying degrees of success, but its use had greatly diminished in recent years amid concerns that it often caused more harm than good. Nevertheless, those options had to be considered.
He then wrote “Psychosurgery;” which was another highly controversial alternative. Next to that, he wrote “Bilateral cingulotomy,” and added another large question mark. One of Dr. Cantril’s close friends was a neurosurgeon, who had previously discussed with him disabling areas of the brain to treat behavioral disorders. The techniques targeted pathways between the inner edge of the cerebral cortex and the frontal cortex, where thought processes are seated. Since Mr. Cobb obviously had lesions on the frontal lobe, a lobotomy would likely be the modality with the greatest chance of success, by selectively destroying connective nerve fibers and brain tissue. Of course, the treatment also bore the significant risk of causing permanent brain damage; but if he could actually achieve a cure of the grandiosity delusion by removing frontal lesions, with the patient resuming his prior identity, that would be a medical breakthrough of monumental proportions and his name would be held in high esteem across the psychiatric community.
Dr. Cantril felt shivers down his spine as he contemplated his future fame and acclaim. He took a deep breath, closed his eyes and imagined standing before an audience of his peers in a large auditorium completing his presentation to ear-shattering applause. On top of the world! The scandal of Georgia Regional Hospital would be buried forever.
Dr. Cantril opened his eyes and returned to the task at hand. He would need to carefully document the progression of therapy leading to the more intrusive modalities and make sure to outline the assessment of risks in pursing each intervention. He didn’t feel comfortable having the page titled “Possible Interventions” appear so early in the case; some might think he had already pre-ordained those options before other modalities were pursued. He tore the page out. He ripped it into small pieces, wondering if someone was already going through his trash. He finally opted to spread the tiny scraps of paper into five or six waste baskets on his floor, making it more difficult for someone to piece it together. He couldn’t afford a single misstep on this case.