Chapter Eighty-Seven
Lucky was sprawled on the floor in a straightjacket in the maximum-security psychiatric ward - pale, sweating, and shaking. His eyes stared blankly, not recognizing any shape, movement or sound.
"What's going on?" asked Barb. She walked over to Tony who was red faced and staring straight ahead in shock. "I thought he was on the minimum security floor."
"He's been on the streets for more than a week," he explained. "His condition deteriorated, he got into drugs again. We found him…and brought him back here, but he freaked out on the way over. It was bad." Tony hung his head and began crying.
"What should we do with him?" asked an orderly.
Barb immediately went into her head nurse mode. "If he's on drugs, they'll need to do a tox screen. I'll draw some blood on him now while he's out of it. He needs to be put into full restraints, and one of you must stay with him at all times. He has seizures, and we need to ensure that he's safe. If he has one, you'll have to roll his head to the side afterwards to prevent choking. I'll call Dr. Perkins and have him meet us here. Let's go."
The orderlies picked up a motionless, compliant Lucky and walked back with him to a room. They gently laid him on the bed and turned him over, untying the straightjacket and removing it from his arms. They moved him onto his back and set out his arms away from his sides. Barb drew lots of blood since it would likely be their only opportunity while Lucky was dissociated. His behavior would be unpredictable and likely violent when he returned to full consciousness if his previous behavior was any indicator.
Barb tossed a gown on the bed. "Put him in this," she instructed. "And place him in restraints afterward. I'm going to call Jim and Dr. Collins."
Barb walked back to Tony and placed her hand on his back. "Can I call your wife to come down here?" she asked kindly. "You're very upset, understandably. Perhaps she can help." Tony nodded and gave her Bobbie's phone number.
~*~*~*~
Jim knew there was bad news waiting for him when he entered the locked ward and saw Tony crying with his face in his hands. Barb met him at the door and walked him back to Lucky's room. "It's Lucky Spencer," she said. "Apparently he ran from the hospital a week or so ago and has been on the streets doing drugs. He has two needle marks on his arms, and his uncle mentioned heroin. He was in a near stupor when they found him, but he began reacting rather violently as they brought him back here. I watched him fight off four orderlies before he dissociated. I managed to draw plenty of blood from him, and they're doing a tox screen right now."
Jim's face fell when he saw Lucky. Lucky was in full restraints, his arms, legs, and neck secured to the bed. He was pale, sweating, trembling and breathing erratically with blank eyes. "How long has he been like this?" asked Jim. "For about 20 minutes," replied Barb. Jim leaned in and began listening to Lucky's heart and lungs with a stethoscope. "How long has he been on drugs?"
Barb said, "His uncle thinks for at least five days. He hasn't had anything to eat or drink for two days, nor has he taken his regular medications for four days," she added.
"I can tell," stated Jim seriously. "He's dehydrated. We need to start him on an IV immediately." Jim glanced back to Barb. "How would you describe his behavior when they brought him in?"
Barb shook his head. "I've seen him when he was psychotic, and that's the closest I could describe it. He seemed to have a lot more strength than he should, and he was totally enraged, unaware of his surroundings, out of it."
"Sounds like PCP to me," said Jim as he took Lucky's blood pressure. "Make sure they test for that on the tox screen. Unfortunately I think we're dealing with more than one drug here. There's no way he can be sedated or given medication until we know for sure what's in his bloodstream."
When Jim touched Lucky's face to turn his head and look in his eyes, the boy flinched harshly, and his eyes blinked rapidly as they tried to refocus. His eyes widened as he saw Jim, and he tried to lunge for him, but was brought up short by the restraints. He tried his best to pull off the restraints, but got nowhere. His face turned red with his efforts, and his damp bangs fell into his eyes as he began raging. "Aaaaaaaaaaaahhhh!!" he shrieked nonsensically as loud as his voice would carry.
"Lucky," said Jim calmly. "It's Dr. Perkins. You remember me, don't you?" Jim tried to touch Lucky's cheek, but the boy's eyes raged in terror and anger, and he jerked his head away as well as he could. The sound of Lucky's voice turned from rage to more of a keening, grief stricken tone, always loud, but the sound made everyone in the room feel sad and helpless.
Kevin Collins appeared in the doorway with a very concerned look on his face. "I heard him even before I opened the door to the ward," he said. "What's going on?"
"He dissociated when they brought him in, and he just snapped out of it," explained Jim. "Barb was able to draw blood while he was out, and they're running a tox screen right now. He's on heroin almost for sure, and probably PCP, too."
Kevin frowned and rubbed his forehead as he walked closer to the bed and pulled up a chair next to Lucky. "Lucky," he said very quietly and calmly. "It's Kevin. Can you hear me?" Lucky ignored the man beside him as if he weren't there and continued to alternately shriek and keen with grief. The tears poured out of his eyes, and his face was red and swollen with his efforts.
Kevin reached out his hand and placed it on Lucky's shoulder to gauge his reaction. Lucky jerked harshly and began making enraged, growling noises with his now hoarse voice. His legs futilely tried to kick, and his hands flexed in the wrist restraints as if he wanted to tear out the eyes of whoever touched him. Kevin motioned to Jim and Barb. "Let's leave him alone, so he doesn't feel the need to continually react." The orderly walked with them, but remained by the open door, out of Lucky's range of sight.
"Kevin, I'm concerned about his physical health. He's severely dehydrated," stated Jim tensely. "He needs to be started on an IV immediately." Kevin turned to Barb. "When will the tox screen be available?"
"They're doing a rush order for us," said Barb. "Within half an hour."
"Let's hold off on an IV until we obtain the results," instructed Kevin. "That way if we need to add any medication, we can do it all at once so he's not further traumatized. He seems to be calming with us out of his presence," he said. "Keep his room darkened and avoid any noise in the hallway. Jim? What's his medical situation in terms of a possible overdose? Can we keep him up here?"
Jim rubbed his nose and sighed. "In my opinion, he's not in danger of an overdose. What we have here is probable synergism or a mixture of drugs that are giving him various symptoms. His vitals are strong, but he's close to exhaustion due to the lack of food and fluids and his physical exertion. It's probably best that we keep him up here since the ER is not equipped for extreme psychiatric cases. We'll monitor him closely, and if he takes a turn for the worse, we'll transport him down to the ER. This way, if he's continually restrained, he's not a danger to himself or others."
~*~*~*~
"Tox screen's back," stated Barb with relief. Jim whistled, and Kevin looked disappointed. "What in the world has this kid been up to?" asked Jim as he shook his head. "Positive for heroin. Traces of amphetamines. Positive for PCP. No wonder he's out of control. Let's consult with the toxicologist, but he should be started on naloxone to counteract the heroin. The PCP should wear off within a few hours hopefully, and it looks like he took amphetamines maybe a day or two ago. I'd bet my money on the fact that he wasn't aware that he took PCP. It's not a popular drug anymore, and the dealers sometimes substitute it for other drugs. I bet Lucky thought he was taking an amphetamine instead."
Kevin scratched his head and gave a small smile to his colleague. "I forgot that you had that toxicology internship a few years back. Comes in handy, doesn't it?"
Jim nodded. "I think I've seen it all in terms of drug overdoses. The kid doesn't have blood levels that indicate a serious overdose on any of the substances, but it's obvious he's been taking heroin regularly for several days. He's not likely to have a serious withdrawal problem, but he'll be ill for the next 48 hours, that's for sure. The PCP is a worry because it's a fat-soluble drug and may have intermittent effects until it's completely out of his system. Because of the opiate, he can't have a sedative for at least 24 hours or his respiratory and circulatory systems might depress. It's going to be a long day and night."
"Okay," stated Kevin as he patted Jim on the back. "Thanks for your input, Jim. As always, I appreciate it. Let's get the necessary consults and start Lucky on the IV that he needs with the naloxone. He's to be continually monitored for 24 hours, but with minimal interaction to keep him as calm as possible without a sedative. Try to set up the IV, cardiac monitor and other equipment all at once so that he isn't repeatedly traumatized. Barb, can I pull you off of your other cases temporarily to supervise this one? I trust your judgment and experience."
Barb nodded. "Sure thing, Dr. Collins. I'll rearrange the schedules. He'll have the best care possible."
Kevin sighed and rubbed the back of his stiff neck. "I need to talk to his aunt and uncle."
~*~*~*~
He was floating, drifting through time and space. He couldn't feel anything - was he dead? His body seemed detached from the world and swirled in a rapid vortex going nowhere. Fear radiated from his entire being as he felt totally alone in the universe, disembodied, full of despair and without hope or meaning.
The light suddenly assaulted him, and he screamed loudly in confusion and terror. His mind was a jumbled mess of memories, distorted sensory impressions and untamed imagination that rained on him like dirt in his grave. He gasped and gulped for air as several people surrounded him, if that's what they were. He knew there was brief, invasive pain in various parts of his body, but he couldn't process or make sense of it. He whipped his head to the left as a hand did something to his arm, and he shouted, "Ooh …ahhhhh…NO! NO!" He breathed in, trying desperately to orient himself, but he felt like his body was rising above the bed, hanging in the cold air, threatening to fly out of the window. "Downdowndowndowndown!" he pleaded and cried, blinking through his tears. Every movement around him threatened him, and he gnashed his bared teeth, making guttural noises and frantically trying to hit, kick and bite.
The light departed, and he was left alone again, hanging above the bed as if in a hammock strung between two one hundred story buildings. He held his breath and waited for the fall.
~*~*~*~
When Kevin approached Tony and Bobbie, they were tense and silent, wrapped in each other's arms as they waited to hear about their nephew. Kevin spoke very calmly and quietly.
"Tony, Bobbie - we have the toxicology screen back. Lucky tested positive for heroin, amphetamines and PCP." Tony's face tightened, and Bobbie looked down at the floor.
"He's suffering a great deal of distress right now because we aren't able to give him a sedative until the heroin is neutralized in his system. He's on an IV now with naloxone, which will help remove the effects of the heroin from his blood. He hasn't technically overdosed on any of the drugs, but the PCP is causing him acute psychosis at this point. Normally, we would administer an anti-psychotic drug to lessen the effects, but with his history of seizures, it's contraindicated. I'm more concerned about him having a serious seizure than with experiencing the psychosis. We won't know how the PCP has affected his brain until it wears off - hopefully within four to six hours. I want to prepare you that he may have experienced organic brain damage, but it's not likely since he only used the drug once that we know of. Tony, it's good that you brought him in when you did. If he were on the streets with this drug reaction, it could easily have been fatal."
Kevin cleared his throat and looked concerned. "Another issue is that his psychosis may not entirely be the result of the drugs he took. Drug abuse can often bring forth underlying or existing mental illnesses, and Lucky has a history of psychosis. His behavior before he left the hospital concerns me. He wasn't eating or sleeping, and he refused to cooperate with his therapy."
"I can't take his screaming," Tony interjected with a tired voice as he rubbed his eyes. "He sounds so hopeless. Can't we do anything to help him? It's killing me." Bobbie rubbed Tony's arm to try to comfort him and gave him a hug, but her face was strained, too.
"Kevin, can I see my nephew?" asked Bobbie softly. "I know he won't recognize me, but I feel like I need to be with him, to know he's going to be okay."
Kevin looked hesitant, but then nodded. "Come with me. We'll look in on him." He turned to Tony. "Will you be okay?" he asked sincerely as his brown eyes sought Tony's face. Tony looked up briefly and nodded with a wave of his hand. "Go ahead," he said quietly.
Bobbie approached Lucky's room with slow steps and a heavy heart. The room was dark except for the weak glow from the cardiac monitor, which partially illuminated the bed. Bobbie listened closely. Lucky wasn't shrieking or crying out, but he seemed to be repeating a bizarre phrase or mixture of sounds over and over to himself. She walked part of the way into the room and then stopped. Lucky's head was turned away from her, and Bobbie's stomach clenched as she took a sharp intake of breath at the sight of her nephew. Lucky was as white as a sheet, and his eyes were sunken in his face, his cheeks thin and puffing. He was restless and still struggling against the restraints, although without the ferocity that he'd shown earlier. His fingers flexed and gripped at the blanket that covered his trembling body. Bobbie listened again, and she could make out the words "Not telling" repeated so quickly together that it sounded mostly like syllables rapidly rising and falling. Bobbie wondered if Lucky thought he was in Faison's compound again, being tortured. Lucky's head moved, and he began crying out hoarsely as if he were in pain. Bobbie stepped back into the hall and joined Kevin.
"He sounds like he's in pain, Kevin," she said worriedly.
Kevin sighed. "He's not in actual physical pain, but he might be recalling previous pain. I'm sorry. There's not much we can do for him but wait it out until the drugs are out of his system. Jim doesn't think that Lucky has been taking the heroin long enough to become physically addicted, so that's a good sign."
Bobbie leaned back against the wall. "What happens after the drugs wear off? What then, Kevin? Are we back to square one with the psychosis?"
"We might be," stated Kevin as he ran his hand over his creased brow. "Between the stress he was under before he left the hospital and the stress of being out on the streets, including the drug abuse, he may have regressed. We'll know more tomorrow."
~*~*~*~
7:30PM
"Tony," said Bobbie. "Let's go home for the evening. Lucky is exhausted and will probably sleep most of the night. We can come back and check on him in the morning. Maybe then we'll have some answers concerning his condition."
Tony looked up blearily and stifled a yawn. "You're right. I feel like a walking corpse." He laid down a coffee cup and stood to his feet, stretching. He wrapped his arm around Bobbie's shoulder and squeezed. "Where are the kids?" he asked.
"Felicia has them. She said they've had their dinner and are watching a movie on TV with Maxie and Georgie. They're fine. We can pick them up on our way home."
"Felicia has been a good friend through all of this," commented Tony. "We need to think of a way to thank her properly."
~*~*~*~
3:30AM
"Thanks for coming with me," one nurse whispered to another outside of Lucky's door. "I'm a afraid to take vitals if a patient is that violent, even with restraints."
The other nurse nodded. "No problem. Fortunately, he's exhausted himself and isn't moving much. Who's the physician on call? We need to inform someone about his respiration."
"Jim Perkins volunteered," stated the first nurse. "He's in room 758, asleep. Should I wake him to have him come and look at him?"
"Yes."
~*~*~*~
Jim Perkins walked slowly into Lucky's room with a large yawn. He rubbed his eyes, and then went over to his bed. He studied the readings on the cardiac monitor and oximeter, and then took a respiration reading. He frowned and looked closely at Lucky. The kid wasn't asleep, but his eyes were hooded, barely open, seemingly unaware of his surroundings, and his limbs were still. He wasn't thrashing about anymore or screaming, but every once in awhile he made a low, guttural noise.
Jim joined the nurses in the hall. "Let's place him on oxygen," he stated. "He's exhausted himself and isn't breathing in deeply or often enough. His saturation levels are down slightly. Be sure to notify me if he continues to have problems." Jim walked back to the sleeping room and fell onto the bed with a thud.
One nurse returned with the oxygen equipment and ran the tubing over Lucky's head and under his nose. He was obviously too tired to move or protest.
~*~*~*~
9:30AM
"He's still asleep?" Kevin asked Barb.
"The night nurse mentioned that he fell asleep at about 4:00AM," she said. "We didn't want to wake him."
"Okay, let him sleep for a few more hours, but I'll be back at 11:00. I need to talk to him to assess his condition and determine a treatment plan," Kevin said. "Remove his neck restraint so he's more comfortable."
~*~*~*~
11:15AM
Lucky's eyes were open, and he was rigid with fear. Barb had woken him up a few minutes
earlier, and he'd cried out and recoiled from her touch.
Kevin sat beside his bed to begin his psychological examination. "Do you know where you are?" he asked Lucky.
"The compound," Lucky answered in a very quiet, breathless voice.
"Can you tell me your name?" Kevin asked gently.
Lucky rigidly shook his head. "No. I can't," he replied fearfully, flinching as if he expected to be hit.
"Will you look at me and tell me my name?" asked Kevin.
Lucky screwed up his face and began crying. "Noooo. I can't," he cried. "I can't tell."
"What can't you tell?" probed Kevin.
"Noooo," Lucky pleaded, jerking frantically at his restraints. He looked down at them and began trembling and crying in earnest. He shook his head. "NO!" Lucky seemed to melt back into the bed, his arms and hands relaxing and extending, and a blank look overtaking his face. The tears on his cheeks looked out of place on his rigid facial muscles. Suddenly, Lucky began thrashing and trying to lift himself from the bed, his eyes staring at nothing, as he became lost in a flashback.
"I don't know. I can't tell you anything. DAD! I want my dad. You said, you said he c-c-could come to get me. You're a liar! A liar!" Lucky's head whipped abruptly to the side, making his bangs fly out from his face. His head jerked several times, and he moaned, "Uuuuhhhh." He smacked his lips together and ran his tongue over them tasting something.
"Lucky!" Kevin grabbed Lucky's hand and squeezed. "Lucky, come on." Lucky's eyes blinked, and he focused on Kevin's face. "Not coming," he said sadly with a deep sigh.
"Who's not coming?" asked Kevin.
"My dad," said Lucky as one
tear escaped from his eye, and he turned away. "No, I don't know. I can't think. I
don't know. What?" Lucky's brow creased in frustration and confusion, and he stayed
silent for several seconds. "Cindy's gone," he said finally as he shut his eyes.
"The mall."
.