The Patient

The body was found early Monday morning. Susan, the janitor, had started her shift cleaning the women’s bathroom on the third floor when it was discovered. She was cleaning the mirrors, then she noticed the foot.

The foot belonged to Michelle Wilkins, a 32-year-old woman who was admitted for a relapse in anorexia nervosa. As Susan opened the stall door, she planned to softly admonish Michelle, almost like a grandmother does with her grandchildren, and remind her of one of the most important rules: patients were not allowed to leave their rooms after 9:00 pm. It was when Michelle didn’t move, didn’t react at all, that Susan screamed.

Rebekah was working at the front desk as Susan came running down the steps, screaming about some emergency. She hesitated to believe Susan’s claims; she always had the tendency to be a little too lenient with the patients and had to frequently be reminded that they were there to recover, not to be coddled. It was when Susan started to cry that Rebekah sighed, got out of her chair, and slowly walked up the three flights of steps.

When Rebekah saw Michelle, and saw that she clearly wasn’t alive, she decided to call the police.

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As I walked through the doors of Mount Clare, forensic photographers were snapping pictures of every corner of the waiting room. An officer was questioning Rebekah at the front desk. Susan was seated in one of the teal couches, and she kept pulling tissues out of a box that another officer held out to her. Susan probably wasn’t giving any good information─if she was giving any at all─as the officer looked both extremely bored and like he was questioning his career choices.

The front desk was clearly the better option.

“Hi, I’m Dr. Swanson. Is there anything I can do to help?” Rebekah thanked me with her eyes. She’s never been someone who likes to talk, even making small talk with her can be painful.

The detective also looked relieved that he had finally seemed to find someone who was willing to give information. “Yes. I’m Detective Jones. Would you possibly be able to tell us anything about Ms. Wilkins?”

“She was actually one of my patients. Would we be able to talk in my office? My file on her is in there.”

“That would be perfect. Thank you,” I led him down the bright, white hallway.

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“Her file should still be on my desk.” My office was always cold in the morning, and the dark clouds that threatened rain made the bare office seem even more austere.

Detective Jones, who looked too young for his job, sat on the maroon couch reserved for patients as he flipped through Ms. Wilkins’ file. From my spot in the chair behind my desk, I felt as if I had a new patient. In a few years, this young man probably would need to see a psychiatrist in order to simply cope with the horrors of his work.

“So, Ms. Wilkins was here for a relapse in anorexia nervosa?” He put a small, black recorder on the wooden table next to the tissue box.

“Yes, she had been struggling with the disorder since she was a sophomore in high school. She was doing well for ten years, but then some stress in her family caused her to relapse into her old habits.” I checked to see if the notebook that I used during my sessions was in the top left desk drawer. It was.

The detective pulled out a notebook and pen as he asked, “What kind of issues?”

“Her and her mom got into a huge argument over her boyfriend. Apparently, Michelle was dating a man who was a serial cheater, and her mom wanted her to find someone better. When Brandon, the boyfriend, broke up with her, Michelle didn’t have her mom to turn to, so she turned to her eating disorder.” Detective Jones’ brows furrowed as he wrote down some notes.

“Do you know anything else about her family?” I shook my head.

“Aside from this issue with her mom, I only know that it has always been just her and her mom. She never really told me about any other family members or friends.”

“I know that this may breach confidentiality, but can you give me an idea of what her therapy sessions have been like?” The detective’s pen clicked twice. A nervous tic, perhaps?

“In the beginning, she was naturally very distraught. She was worried about missing work, insisting that there wasn’t anything wrong.”

I thought back to Michelle’s first appointment, to her screaming at me, telling me that she was fine, that she wasn’t sick. Then, to her wrapping her skeletal arms around her severely thin body as she cried. The fact that she only weighed 88 pounds didn’t mean anything to her. I just sat there for an hour as she ranted and raved about how healthy she was, but I held the doctor’s notes from her trip to the emergency room that said otherwise.

She had passed out at the law firm she worked at, and the secretary called 9-1-1. It wasn’t until our third appointment that she had finally calmed down and started talking. She slowly opened up and gained a few pounds throughout the two weeks that she was in my office, but she was always fearful of losing her job. I unfortunately couldn’t promise that her job would be waiting for her when she got out. The fact that they ignored the terrifying progression of her physical appearance suggested to me that there wouldn’t a job for her when she was well enough to be discharged.

At every session, she also constantly talked about going back to Brandon, that he would love her if she was skinnier. Every day, I had to remind her that she was wrong, that Brandon didn’t love her. Sometimes, this would provoke her, and she’d start yelling again. I started thinking about diagnosing her with a personality disorder.

“As her sessions continued, she started to open up more, but something just always seemed off.”

“What do you mean?” The detective had stopped reading her file and focused his attention onto me behind my desk.

“She just never seemed fully willing to recover. This isn’t too uncommon with people who suffer from an eating disorder, but she always seemed to hold herself at arm’s length. Every session was almost the same discussion over and over again. She constantly talked about how she could get Brandon back if she were skinnier. I never learned anything new about her that could help me help her. I tried so many different methods and techniques with her, but nothing seemed to work.”

“What was her final session like?”

“Oh…it was horrible. I had suggested that she consent to being tested for a personality disorder. I had a feeling that her struggles did not just stem from an eating disorder, but she would hear none of it.” I thought back to her begging me to help her, with tears streaming down her cheeks, but she just wouldn’t listen. She refused to follow my advice.

I sighed, “Unfortunately, I’m not surprised that this happened. She truly was not well, and she wasn’t getting better. I don’t want to sway your investigation in any way, but as her psychiatrist, I ultimately think that Michelle took her own life.”

“That certainly is a possibility, and based on what you’ve told me, it seems to be the most likely one.” The detective shut off his recorder and grabbed Michelle’s file. “You’ve been such a great help, Dr. Swanson. Thank you for helping me get a better understanding of Michelle’s mental state and her time here at Mount Clare. You wouldn’t mind if I brought this back to the station with me, would you?” he gestured to the manila envelope that contained Michelle’s information.

“Absolutely not. Please let me know if there is anything else I can help you with.” I stood up and walked him to the door.

“Will do, thank you again.”

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Even though the hospital was a crime scene, there were still patients that I needed to see. If anything, they would need my guidance now more than ever. Losing someone in such a tragic way would be distressing for anyone. It was naturally going to be even more upsetting for people who were in such delicate mental states. I’d have to keep an extra eye on my patients that were suicidal. I couldn’t risk any other clients following in Michelle’s footsteps.

My first session was not until 10:30 am, so I still had thirty minutes to spare before all hell broke loose. I pulled the desk drawer open, flipped through my notebook, and saw the star beside Michelle’s name. I tried to fight back a smile as I thought about last night.

I had told Michelle that I would help her, but she had to stop sneaking out of her room after lights out. I knew that she was purging throughout her time here, especially since she was monitored by different nurses during the daytime. I told her that this behavior was preventing her from recovering, and she seemed to understand.

The look of surprise on her face was almost comical. I had kept warning her in our sessions that something bad would happen if she didn’t get better. And it did.

She tried to explain that she wasn’t feeling well, but we both knew the truth. She had started purging again. She didn’t put up much of a struggle, and it didn’t take as long as I thought it would to strangle her. I guess her anorexia made it harder for her to fight back. Of course, she wasn’t that heavy, and it wasn’t hard to stuff her into the stall, although I didn’t see her foot. Her body, in the final stages of rigor mortis, must’ve shifted in the stall, causing her leg to move and her foot to touch the bathroom floor.

I looked down at the note that I made when she told me that she would sometimes try to choke herself with her shirt when she was in great distress. It was also a fairly easy way to kill someone.

With a woman like Michelle, it wouldn’t be so hard to imagine that she had taken her own life, especially when this information came from her psychiatrist.

I chuckled softly as I flipped through the pages, searching for my second star, for my next victim. Oh yes, Jane Hearne. The 20-year-old struggling with OCD. One of her compulsions was the age-old handwashing, like a Shakespearean tragic hero. Even though she told me that she had stopped giving into her compulsions, Susan had blabbed on and on about how she had repeatedly caught Jane in the bathroom, furiously scrubbing her hands.