THE MAN WITH A MICROPHONE IN HIS EAR, Part 3, by Art Smukler, author & psychiatrist

The Man with a Microphone in his Ear takes you inside the mind of a very inexperienced, psychiatric resident. On his 2nd day of residency, he is assigned to treat a violent, psychotic man. Overcoming his own fear was just the first step…

When we passed the nursing station Lena stuck her head out. She made eye contact, gave me a wry smile and went back inside. Jerome and I walked to the end of the hall, turned around, and walked back.

“Doc, the voices aren’t coming from the duct, they’re coming from my ear,” Jerome said, as we passed the day room.
“From your ear? Like from inside your head? A voice inside your head?”
“I can’t say anymore about it.”
“Why?”
Jerome shook his head.
“Did you ever play football in high school Mr. Cotton?” I asked after a few minutes. “You look like a football player.”
“Defensive guard,” he said, and looked down at the floor. Then he looked up. “Two years at North Philly.”
“Are you involved in any sports now?”
Jerome looked back down at the floor and didn’t answer. He wasn’t acting threatening, but more like he had enough talk for the day. I could relate to that. After three or four slow walks up and down the hallway with Jerome maintaining his silence, I sat down next to him in the dayroom.
“Would you rather stay here or go back to your room?” I asked.
For a moment, he just stared at the TV in silence. Then he said, “Here. I’ll stay here.”
“Will you be okay?”
He nodded.

With some misgivings, I left him sitting in the dayroom where he blankly stared at a daytime soap, with a guy kissing a very pretty woman.
Back in the nursing station, Lena gave me a big smile, and then turned back to her chart writing. I figured that was about as much affirmation as I was going to get.

For the next week, Jerome was cooperative on the unit and let the nurses give him his injections of Thorazine without any complaints. Everyday, the two of us walked up and down the hallway. He told me how he wanted to go home and how worried he was that he would be fired if he didn’t get back to work. I reassured him that they weren’t allowed to fire someone who was in a hospital, that there were laws to protect people who got sick. Everyday, I asked about the voices. Everyday, he just ignored the question. No-matter what I said to draw him out, he just avoided the entire topic.

I discussed Jerome’s progress with Dr. Newman, and he said for me to be patient; that establishing a good therapeutic relationship was essential and took time. When I inquired how long that might take, he shrugged his shoulders.

One morning as Jerome and I walked down the now familiar hallway, I asked him if he’d like a cup of coffee. He nodded and said he liked cream and two tablespoons of sugar. I got the coffee from the nursing station, and we walked over to the dayroom and sat on a sofa in the corner, away from the other patients.

“You look a little better,” I said. “Not as upset and angry.” The perpetual scowl and hardness in his eyes were gone. He had a softer look.
Jerome nodded and took a sip of coffee. A slight smile creased his lips.
“Are the voices still there? You know, coming from your ear?”
He nodded. “They come from a microphone.”
“Inside your ear?”
He nodded.
“Someone’s transmitting through it?”
“I don’t know, but whoever it is keeps saying I shouldn’t go back to the cafeteria. That’s where I work, in the cafeteria at North Philly High. But if I don’t go back, I’ll be fired.”
“What exactly does the voice say?”
“Don’t go back. If you go back, they’re goin’ to fuck you. I don’t use bad language, but the voice does. Sometimes it gets real foul.”
“Who will fuck you?”
“I don’t know, Doc.”
“How about we go back in your room and I’ll examine your ear. Both ears. In fact, I’ll do a complete physical exam.”
“You think you’ll see it?”
“If I do, you’ll be the first to know.”
“You know, Doc, you’re okay. That other doctor…me and him just didn’t hit it off.”
I went to the nursing station, got a stethoscope, blood pressure cuff, an otoscope, and a rubber percussion hammer. Back in Jerome’s room, I did a careful physical exam, looked with the otoscope in both his ears, tested Jerome’s reflexes, and did a complete neurological exam.
“Mister Cotton,” I said when I was finished. “You’re in excellent physical health. There’s no evidence of a microphone planted anywhere in your body.”
Jerome nodded and took a deep breath. “Doc, you seem like a smart doctor, but they outsmarted you.”
“How?”
“The microphone is real small and you just couldn’t see it.”
“This otoscope is powerful.” I turned on the light and handed it to him. “If it was in there, I’d have seen it.”
Jerome just shook his head and handed the otoscope back to me.
“Look, I’m going to get x-rays of the mastoid bones and ear canals and an audiometry test,” I said. “The audiometry test is to make sure your hearing’s okay. If the microphone’s there, it’ll show up on the x-rays.”
Jerome just nodded. “Do you have to keep giving me those shots? They hurt.”
“How can I be sure you’ll take the pills. Last time when Doctor Gerber gave you pills, you didn’t take them. Then all the trouble started and you became violent.”
“I give you my word.”
“You’ll swallow them when the nurse gives them to you? No funny-business holding them in your cheek?”
Jerome nodded.

I walked to the nursing station and sat down to do the morning charting. Lena sat down beside me. “I saw you and Jerome takin’ your morning constitutional,” she said, an enigmatic smile playing across her face.

“Looks like he’s doin’ better.”
“I think so too,” I said, filling her in on my decision to switch over to oral Thorazine.
She nodded and smoothed a stray hair from the side of her face. “Can I ask you a question?”
“Of course.”
“Last week when you removed the restraints, weren’t you scared of him?”
I thought for a moment and laughed. “When I first met you, you were kind of intimidating. Maybe a little scary–”
Lena broke out in laughter. “I knew you could handle him,” she said, laughing even louder.
“You got me assigned to Jerome?”
She nodded, a wide grin plastered across her face. “If you could handle me, you could handle Jerome.”
For a moment we locked eyes, and in that moment we became friends. “You’re something else,” I said laughing.
“Right back at ya,” she said, and laughed again.
“Lena, one more question. Why were you so formal or strange or whatever, when we first met?”
“Hmm… Good question. No-matter how many years I’ve been doing this, I’m also vulnerable to the new resident first day jitters. If we have a good group of residents, life goes pretty well up here. The wrong group can create havoc. When I get nervous, I don’t say much, and I get a little controlling.”
“A little?”
“You can imagine what my husband has to put up with.”
We both laughed.

* * *
A week later, the x-rays and the audiometry test were back. I had been treating Jerome for two and a half weeks and with enthusiasm presented the negative results. I held up the x-rays to the light pointing out how clear the auditory canals were. With my pen, I traced the canals showing how there was absolutely no sign of a microphone. Jerome just shook his head and sighed.

“What? Why are you sighing?”
“Doc, they was just a little too smart for you again. Nothin’ against you, but they are very smart.”
“Too smart for me?”
“When the doctors weren’t lookin’ they took the darn microphone out of my ear and just put it right back in when the tests was finished.” He smiled. “That’s what I mean by smart.”
“Mister Cotton, that’s not possible. There is no microphone. The voices you hear are feelings that are coming from your own mind. That’s why you were brought to a psychiatric hospital, to this hospital. It’s my job to deal with microphones and voices.” I didn’t add that this was my first three weeks on the job and my only experience with microphones was related to the big chrome ones that performers used.
“Doc, you’re a smart man. I don’t mean you no disrespect, but”, he shrugged his shoulders, “the microphone’s back in there and sayin’ the same things like I told you about.”
I took a deep breath. “What things?”
“I told you before. That I should watch out because they’re going’ to hurt me. They use a lot of bad language.”
“Who’s going to hurt you?”
“If I knew I’d take care of the problem myself.”
“Why do they want to hurt you?”
“I been in the school district a long time and they’re afraid of what I know.”
“What do you know?”
Jerome looked at me and shook his head. “Doc, I just can’t say.”

And so it went. No-matter what direction I took, Jerome’s island of lunacy never faltered. Every morning we walked and talked. We talked about the Phillies and how Jerome’s dream was for the Phillies to win the World Series and to take his family to the ballpark. As the days went by, I looked forward to our discussions. We sipped coffee in the dayroom, talked about sports, hippies, and the war in Viet Nam, but I got absolutely nowhere whenever I brought up the microphone.

The following week, I met with Jerome and Victoria. She was a warm, pleasant woman, almost as tall as Jerome, with dark skin and with a flare for bright colored clothes, a kind of Jamaican look. She never missed her scheduled visits, and according to the nursing report was always the first visitor to arrive and the last to leave. She held Jerome’s hand and reiterated what a good man he was and how up until a few months ago he was perfectly healthy. She thought that Jerome was doing much better and thanked me profusely. She also brought up the subject of Clyde, and how their son wanted to visit his father. Jerome shook his head and looked down at the floor. “I can’t have him seein’ me in a place like this,” he said. “I just can’t.”

I looked around the dingy consultation room, noticed Ted, the patient with the Parkinson’s-like shuffle, walking past the partially open door, and sighed. If I had a son, I wouldn’t want him visiting me under these conditions. Victoria and I looked at each other, a look that implied that she was thinking the same thing. “What about a day pass this weekend?” I said. “Maybe four or five hours on Sunday afternoon?” The smile that spread across Jerome’s solemn face brought tears to my eyes.
Sunday afternoon, Victoria picked up Jerome at 12 noon and they returned at exactly 5PM.

Check back for the last episode..

Art Smukler MD is also the author of Chasing Backwards, a psychological murder mystery and Skin Dance, a mystery. They are available as paperbacks and eBooks.

About artsmuklermd

I'm an author and a board certified psychiatrist. My blog takes you INSIDE THE MIND OF A PSYCHIATRIST. SKIN DANCE, a mystery, takes you inside the mind of a 41-year-old LA psychiatrist who must use all his psychological skills to thwart a murderous stalker. CHASING BACKWARDS, a psychological murder mystery, takes you inside the mind of a first year medical student who is running for his life. THE MAN WITH A MICROPHONE IN HIS EAR, takes you inside the mind of a 1st year psychiatric resident who is assigned to treat a violent, paranoid man.
This entry was posted in Psychiatry, Self Examination, The Man with a Microphone in his Ear, Writing and tagged , , . Bookmark the permalink.

One Response to THE MAN WITH A MICROPHONE IN HIS EAR, Part 3, by Art Smukler, author & psychiatrist

  1. Elise Warner says:

    Fascinated by this chapter, Jerome and your work with him.

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