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The rain kicked up just as Dr. Lenore Keats made it into her office. She shook off drops of water as she walked past the reception area. “Morning, Dr. Keats,” an attentive receptionist said. “Morning, Tricia.” “It's a real gully washer out there.” “Yeah,” the doctor replied. “You got in okay?” “I come in from the north side. The rain isn't hitting there.” “Is Everett in yet?” Usually Everett Hayden was in before her, but the rain had been heavier where he lived. “No. Dr. Hayden isn't here yet.” The receptionist looked at the young doctor; years of serving in professional offices had taught Tricia how to sense undue agitation. “Everything alright, Dr. Keats?” “Everything's fine. I'm just flustered from the traffic.” She looked outside at the billowing, gray clouds. “What a way to start the day.” * “You look happy,” Everett Hayden said sarcastically when he saw Lenore. “You on decaf again?” “I've had two cups of full strength this morning,” Lenore said. “Traffic was bad.” “Traffic's always bad. What else?” “Did you talk with Tricia? She seemed to think I was off my game earlier.” “You're working something over in the back of your mind,” he observed. He sat down, drinking a mouthful of coffee. “You crease your brow when you're thinking about something you're not talking about.” “It's a good thing I'm not married. I'd love to hear the advice you'd give my husband.” “Claire hates it when I give her advice – and she is unfortunate enough to be married to me,” Everett Hayden replied, his blue eyes sparkling. “I saw a woman at a bus stop on the way in,” Lenore said, feeling that a quick confession would end the speculation. “She was covered in sores. She was actively bleeding from violently scratching her own skin.” “Was she homeless?” “Yes,” Lenore replied. “We can't force people to seek treatment, and we can't force treatment on them,” he said. “I know the city is a little different from your circumstances back home. It will take time to adjust to seeing things that you want to fix, but can't, every day.” “She's probably schizophrenic. A little olanzapine might help.” “You can't just go around giving antipsychotics to people – even the psychotics.” Everett stood up, his medium stature enhanced by his confidence. “Choosing to be ill is personal right to some people. You just do what you can for those seeking to be better.” “I don't know why it bugged me so much.” “You're a doctor. You saw something broken and you wanted to fix it. Nothing wrong with that. In fact, if I remember your schedule today, you have quite a bit of fixing to do.” “You're probably right. The weather is crazy and my day is booked solid. I guess I was just agitated.” “We have drugs for that,” he smiled, leaving for his own patients. “I'll stick to the caffeine,” she replied. * Everett Hayden had one important appointment in the morning. Joseph Vanner arrived with his expected punctuality, bodyguard in tow. “Everett,” Joseph greeted. He was dressed for the office, having already put in hours of work before most of his employees arrived. He sat down in a well padded, leather chair. “Joseph,” Everett greeted. “How are we feeling?” “Fine, as a matter of fact.” Joseph Vanner motioned his bodyguard out of the room. “Ah, you trust me after all,” Everett said, noting the bodyguard's departure. “I'd say you were paranoid, but a man with your wealth should have a healthy concern about his security.” “Paranoid or not, there would still be some people after me,” Joseph replied. “Or so my lawyers tell me.” He paused, looking around. “I have a problem, Everett.” “What problem?” “I have things, living inside of me.” “Things, Joseph?” “Little worms. They crawl under my skin. I can see them sometimes, just beneath the surface.” Everett sat back, listening to his patient. “Do they itch?” “Occasionally.” Joseph Vanner's face became darkly serious. “I want you to do an experiment.” “I'm a clinician, not a research scientist. That's more along Lenore's lines.” “Of course. The new partner.” “She just joined my practice, “ Everett replied. “She has developed a small on-site laboratory in the backspace we weren't using. She's running some clinical samples for us, saving some money by keeping a few tests in house. But she has a research background.” “Then have her figure out what's inside of me,” Joseph said. “You don't have anything with you? Any specimen that you may have captured?” “No. And stop being condescending. This isn't imaginary. I've seen the tracks of the things. They move, Everett.” “Well, let me talk to Lenore.” “I'll be back this afternoon,” Joseph Vanner said, getting up. “But we're not done here.” “Yes, we are,” Vanner replied. “Have Lenore clear her schedule – no doubt you have her seeing a hundred patients an hour. I want to talk to her when I return.” “Joseph . . .” “Don't get too high and mighty on me, Everett. I'm the best thing that ever happened to you. I pulled your practice out of debt – I paid off some substantial financial obligations you had incurred. You owe me.” Joseph Vanner signaled his bodyguard and the two left, disappearing into the approaching rain. * “So Joseph Vanner wants to talk to me ?” Lenore said. She was eating her microwaved lunch quickly before having to see her next patient. “He insists. I'll take your patients while you talk to him.” “I don't feel comfortable talking to him.” “Even the richest man in town is made of flesh and blood. You're a doctor. You can't be intimidated by him.” “What's his problem?” She asked. “Originally he came in for depression,” Everett replied. “He reacted badly to his own success. His mind's way of coping with his achievements was to cripple him with overwhelming feelings of inadequacy and worthlessness.” “So why not just cut a check to charity?” “That would mask the symptom temporarily, but not address the underlying issues. He knew that. He's one of the smartest men on the planet .I put him on olanzapine.” “And now?” “I think he has developed a delusional parasitosis.” “He feels things crawling on his skin.” “Under his skin, actually.” “Olanzapine is a cure for delusional parasitosis.” “It is, which is one more reason I'm letting him speak to you.” Everett said. “I'm hoping that talking to you will shed light on what's going on with him.” “Any sign of amphetamine abuse, or cocaine – he mingles with some pretty heady celebrities . . . ” Everett laughed. “No, not Joseph. He's not like your woman from this morning on the park bench scratching herself to death courtesy of crystal meth or alcoholism. Joseph is both more complicated, and in some ways more fragile. He wouldn't be strong enough to make it as a homeless person.” “You're seeing some good in my old woman.” Lenore said. “I may get her in for treatment after all.” “Turning sinners into saints takes resources,” Everett said. “ That sort of strength Joseph has. He's given a lot of money to hospital buildings that don't have his name on them.” “So, what's your diagnosis?” “Have you ever heard of Morgellons?” “What, like on that news show? People think they have things growing inside of them? Didn't a bunch of people claim to have them, right after the show aired?” “Some of the people claimed to have things living in them, some claimed to have fibers growing inside them. Often they'll bring in little pieces of lint or debris, claiming it is evidence of their infection. Joseph didn't bring in anything he identified as evidence of his infection.” “No matchbox syndrome. Okay, send your man in. I've never seen a case of delusional parasitosis outside sitting right on my examination table.” Lenore replied. “It's always fascinated me.” “Why's that?” Everett Hayden asked, regarding his young partner with curiosity. “They say there's nothing worse than an itch you can't scratch; this is scratching you can't find an itch for. It may just be the only that is worse.” * Joseph Vanner arrived early, placing his bodyguard by the door. “I have half-an-hour,” he told her sharply. “You good enough for that challenge?” Lenore Keats, M.D. looked him over critically. “I get the job done when the job gets done.” “Quality over expediency?” “Accuracy over malpractice,” she replied bluntly. He smiled broadly. “I can see why Everett likes your work. You'll keep him out of hot water, this time. Then I won't need to bail him out.” “Why did you bail him out the first time?” Lenore asked, setting up a few medical tools. Her curiosity was part-genuine, part-bedside manner. She knew that a major malpractice lawsuit had nearly ruined Everett Hayden. He had told her that Joseph Vanner, an established patient from before the latter's accumulation of wealth, had salvaged what was left of Hayden's practice. “I'm in love with his wife.” “Claire?” “It's the best I could do to keep her from becoming a failed doctor's wife. Now she's happy again.” “Where do you feel the irritation?” Lenore asked. She wanted to find out where Joseph Vanner itched physically. “On the inside of my right calf,” he said. He lifted his pants leg up, revealing a red-orange patch of irritation. He had obviously scratched himself bloody. “I'll have to rule out ringworm, maybe a spider bite, in my differential diagnosis.” Joseph ran his fingertip over the rough erythema on his leg. The little purple blotches beneath the skin seemed to wriggle. Lenore watched the wound carefully, watching the unexpected movement in the wound with clinical skepticism. “Do you travel?” she asked. “All the time.” “Anyplace exotic?” “That depends on your definition of exotic.” She paused, looking him straight in the eye. “Don't BS me, Mr. Vanner. You know what I mean. Someplace tropical.” “No.” “Cleaned out any closets? Been in an attic? Own a cat? Sweat a lot?” “What are you trying to differentiate, my dear? My symptoms or my sexual orientation?” “I'm doing my job, Mr. Vanner. When did your symptoms first appear?” “About twenty-five years ago.” She stopped. “And you're just seeking treatment now?” “I'll tell you the history of my infection,” Joseph said. “I was in a business class. My professor was brilliant. He ran a Fortune 500 company by day, and taught the not so privileged like me at night. He had a peculiar ring-like pattern on his cheek. I watched it. Over time it moved.” Joseph Vanner paused, looking for the right word. “It migrated . One day it left his face. I saw it move beneath the skin of his forearm.” “And your point?” Lenore Keats was running her mind through contagious bacterial and fungal infections, trying to find a match. “I was struggling in that class. Feeling overwhelmed. One day, I touched him.” “What?” “On his forearm, placing my hand over his skin.” Joseph Vanner smiled. “I never had trouble with business again. And now I run a Fortune 500.” “You have trouble with your success?” “I have no trouble with success. I had trouble, with losing. Before I got my worm.” “You're brilliant , that's why you're a success. You're projecting something to make up for that – you really should talk to Dr. Hayden. This sort of thing is more his area of expertise.” “I don't want to help the husband of the woman I love,” Joseph Vanner said. “Claire I helped, indirectly. But the help was not for Everett's sake.” “What do you want me to do?” “Look at these, and tell me I'm delusional. Tell me that Everett's voodoo can help me.” Joseph Vanner said as he unbuttoned his shirt, carefully peeling it off. His skin was covered in little rings. They vibrated softly beneath his skin. Lenore gasped. “Is it a delusion, if you see them, too?” he asked her. “Those aren't fibers,” she said, peering closer. She pulled out a pre-packaged iodine swap. “Are you allergic to iodine?” “Now you're interested?” “I was expecting morgellons.” “Something in my mind, manifested by compulsive itching? No – these are very real.” “You've had them over twenty years?” she looked deeply into his dark eyes. “Not this many at once, dear doctor. I started out with one. But recently I felt a small eruption in the side of my neck. Then these appeared on my back. They move very methodically, down my arms, towards my hands.” “I'm going to extract one,” Lenore said. “It looks subdermal – I won't have to cut deeply.” “And then? Examine it, publish a paper?” “I've never seen anything like these. What other symptoms have you had?” Joseph Vanner put his hand on hers. “I thought you thought my symptoms were delusional?” She moved away and wiped the skin over one of the worm-like lesions with a rich blanket of deep orange iodine. “I'm going to administer a local anesthetic, and then I'm going to gently remove one. You may feel some pressure, and there will be a little blood, but you should be back at work in an hour.” “So I'll be what? A case study?” he asked. He winced slightly when the thin, stainless steel needle delivered the anesthetic. Lenore Keats pulled out a sharp scalpel. “Are you sure the area is numb?” he asked. “We'll find out,” she returned. She steadied him putting him in a position to best suit her spontaneous surgery. “There is one strange symptom,” he reported to her, feeling the pressure of his skin yield to the sharp blade. “Which is?” “Once I got the worm, I felt like protecting it. I never want to give it up. It's a symbiotic relationship – it gives you an enhancement, and you give it a home.” “You still attribute your success to the infection?” “You'll understand,” he replied. “My intelligence increased. My problem solving was enhanced. It made me a great success.” Joseph Vanner felt the organisms move, felt them burrow deeper into him, passing past skin and fatty tissues, and sequestering themselves in his deep anatomy. “Damn!” Lenore exclaimed. “The thing wriggled away. It moved pretty fast.” “You'll grow to appreciate them,” Joseph said. He felt her put a bandage over his skin. Reaching over, he picked up his shirt. “I'm glad you find them fascinating.” “Come in next week – we'll try again.” “I'll come in next month,” Joseph Vanner told her. “That's when my schedule permits.” “But you're infested . . . “ “I know how to deal with these critters,” Joseph replied, buttoning the last button. “Did I mention that about twenty of my business class went on to become very successful business people?” “I don't see how that matters.” “Some of us are empty chairs, Dr. Keats. We just need the right being to fill us. To help us conquer our fears and depressions. To enhance our possibilities for success.” “Medication cured your depression.” Lenore countered. Joseph Vanner summoned his bodyguard. “My depression had nothing to do with my business acumen. My depression was over the love of my life being married to a doctor who couldn't be bothered to count his sponges. But you – I have more faith in you. With your guidance this practice will be quite a success, I think. That will keep Claire happy, in a tangential way. That makes me happy. We all win.” He left, leaving Lenore behind him. The thunder roared as the next band of storms approached, and she thought of the old woman from the morning, with no sure shelter from the elements. Mentally unbalanced and homeless, where did the woman go ? Lenore wondered. What happened to the chair, full of nothing but delusions? * The storms did not abate. Lenore went home, avoiding giving a report to Everett Hayden. She was exhausted, but filled with odd excitement. The things that lived in Joseph Vanner fascinated her. She fell into a fitful sleep, her mind filled with images of Joseph Vanner, his morgellons, the old woman on the park bench, and the sounds of the storm. Lenore woke up at midnight. A profound itching radiated out of a small pinprick type hole on the back of her hand. She examined her skin carefully, observing the subtle track of a worm burrowing deeper into its new home. She did not gasp, which surprised her. She would have expected surprise, even more revulsion. But something connected within her, the worm waking her mind up the realization of possibilities she could not have comprehended before. She let her worm take her down into sleep, where it began to fill her dreams, just as its brethren had filled the minds of so many before her. She would call Joseph Vanner in the morning, to let him know he had been successful. She was happy to become one of those who knew. ___________________________________________________________________ |
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