When Your Patient Is a Murderer
It was impossible to reconcile the woman on the gurney with what she had done.
She was 31 years old. She had straight brown hair, wide brown eyes, and a faintly quizzical expression. She was overweight, and unwashed. She lay on the gurney, looking up at the ceiling.
Her ankle was shattered. My job was to watch her for a few hours to make sure her foot didn't turn blue.
"Can you feel your toes?" I asked. I didn't introduce myself.
Her toes emerged from an immaculate new white splint, and I touched them, with a gloved hand, pressing them, letting go, watching as they pinked up again. She looked at me, and said nothing.
Just outside her room, staring at her through the glass, in silence, were the police.
True monstrosity has an undeniable radiance. It's rare, and it fascinates us.
She'd leapt from a second story balcony, trying to escape, and broken her ankle. The police had brought her in. Her ankle was splinted. I knew what she'd done before I walked into the room, because the story had spread throughout the ER.
So it was impossible not to study her as she lay there. I didn't know all the details then. I learned them later, from the papers.
At times, heroin and alcohol have the sense of peace within them, but methamphetamine is pitiless, harsh and dry and bright. You can tell at a glance.
I saw the meth in her immediately. But she was alert anyway, and calm, and she knew where she was, and why, and so I understood: She had not been out of her mind.
The police are difficult to shock. They are used to brutality and violence, used to the worst of people.
But they were shocked. They were shocked very deeply. I could see it in their silence, and in their distance, as they stood outside her room, and their radios crackled.
It's a strange thing to watch news grow—to walk into a story that hardly anyone knows, and then to see it ripple out across the world. First local news, then national news, then international news—FOX, CNN, The Guardian, the BBC, all the way to Australia.
Inevitably, if you work in emergency rooms or places like them, you run across people who have committed terrible acts. Often those acts have a pathetic, witless spontaneity to them. Everyone's drunk, everyone's angry, someone has a gun. Their darkness is unexceptional, even if the consequences are not. Most of the people who do such things are not so different from the rest of us: There is plenty of common ground between the guilty and the innocent.
But the darkness within her felt like something else entirely. She'd crossed a kind of event horizon, into a place of no return.
Even then, I thought—this story is a vortex, like looking over a cliff.
For a few days, after getting out of prison, my patient had been living with her male cousin and his new girlfriend. The girlfriend was a single mother with two young children. They'd met online three weeks before. They had no shared past.
The mother left her children alone with her boyfriend when she worked.
The eldest child, a 10-year-old girl, was raped by the man every day for those three weeks. During this time, she kept going to school, and revealed nothing. And when my patient moved in, she helped her cousin rape the girl almost immediately.
If the confessions are true, the mother not only knew about this abuse, she watched it and enjoyed it. And if the confessions are true, the mother had sought out at least three other men online to do this to her daughter as well. After they raped the girl, the mother had sex with them.
The day after the girl's tenth birthday, shortly after she got home from school, my patient and her cousin injected her with methamphetamine, then raped, strangled, and stabbed her together as the mother watched. The neighbors heard nothing.
Twenty minutes after her daughter's murder, the mother had sex with her boyfriend. Then all three adults cleaned up and made dinner together, as if nothing had happened.
Sometime after dinner, they dismembered the girl's body in the bathroom, and set it on fire.
But hours later that night, they began fighting among themselves, and it was this disturbance that caused neighbors to call police.
Through it all, there was another child in the house. A little boy, younger than his sister, who had not been harmed.
As the days passed, the story kept getting worse, and I couldn't help but follow it. Soon each of the adults accused the other, and contradicted themselves, and changed their accounts, and lied, and lied again, and it felt more and more like a hall of mirrors, increasingly nightmarish, where even the confessions were suspect.
Then the vigils began, and the teddy bears and flowers appeared on the street in front of the apartment, and there were pictures in the paper of people hugging each other and holding up candles, and there was a funeral that was attended by thousands of strangers, and there were interviews with family members, and the girl's smiling picture was everywhere, and it was all front page news.
Each day the child became steadily more angelic, and steadily more abstract, less real, less the ordinary girl that she was, as if extolling her virtue might somehow reduce the power of the crime.
"Can I have a bedpan?" she asked me, later, uncomfortable on the gurney.
I looked at the nurse. I didn't reply, but I left the room, and the nurse got her a bedpan. The police nodded, so the nurse stepped out too, and closed the curtain, and let her urinate on her back on the gurney, in private, like an ordinary person.
I've thought a lot about that night in the months since the murder. I remember how closely I looked at her, and how impossible it was to reconcile the woman on the gurney with what she had done. I remember thinking there was nothing to take from her, nothing that was possible to understand within her. I remember thinking there was no lesson to be found there at all.
I looked at her toes a final time. But I didn't speak to her again.
Now I think I was mistaken. I think there was a lesson to learn, but it took me a while to see it.
The lesson was in the conduct of the police. They walked in to that apartment on a routine call. They found a scene that defied imagination. They had no warning, no time to prepare themselves, and could do nothing but react.
And then the woman ran, leaping from the balcony, because she was guilty, just like the others.
They knew what she'd done, and they knew it quickly. But they put up the yellow tape nonetheless, and went back into the apartment with their cameras, and took the photographs, and looked straight into it, gathering the evidence, piece by piece. And they brought her to the ER for medical care.
They were so careful, as they watched her through the glass. It struck me even then, when I was looking the wrong way. I was looking at her, but I should have paid more attention to them. They were so quiet, and so controlled, as if to say, We'll follow the rules exactly here, because it is rules, and protocol, and the assertion of law, that offer the best hope of resistance. Thinking back, their behavior seemed unconscious, reflexive, as if they were clinging to order, and reassuring themselves with it.
Her monstrosity mattered, of course. But I'd like to think it did not matter more than the response to her monstrosity. Darkness resisted is no less dark, but surely discipline in that resistance redeems us.
"You can take her," I said, finally.
So they uncuffed her from the gurney, stood her up on one leg, sat her down in a wheelchair, and cuffed her again. They were quick, efficient, and neither kind nor unkind.
Then they simply wheeled her down the hall and out the door, into the darkness, where the detectives were waiting.
Frank Huyler is an emergency physician living in Santa Fe, New Mexico. He is the author of The Blood of Strangers.
Sign up for our newsletter to get the best of Tonic delivered to your inbox.