Chapter 4 – Dr Josh
Dr Joshua Palmer, Consultant Psychiatrist, arrived early for his clinic, a long twill coat layered over his tan corduroy trousers and smart navy shirt. With a spring in his step, he entered the building. As he passed the front desk, the receptionist’s lingering eyes disturbed his momentum. He feared he’d overdressed or had splashed on a little too much cologne.
“Morning, Linda” he greeted, before rushing off along the vestibule to his office.
The footfalls from his polished shoes on the chessboard tiled floor echoed pleasantly through the empty waiting room. The site was a listed property. An old church, with pointed arches and ribbed vaulted ceilings, which became an orphanage in Victorian times after a fire. The team’s secretary swore the place was haunted and refused to work late nights alone. As a man of science, Joshua baulked at the idea, but witnessed some unusual phenomena himself. Occasionally, a melting wax smell emanated from nowhere in particular, and once, late at night, he heard a trill of piano notes ebbing along the gloomy passageways, as if a ghost was tinkling the ivories.
Today, he hoped to escape the Gothic surroundings for a walk to Brandon Hill with one of his patients, Dimitri Lebedinsky. He floated the idea of taking Dimitri for a walk in the community at the weekly multidisciplinary team meeting. His colleagues agreed Dimitri would benefit from some fresh air, but eyebrows were raised when he offered to take the patient himself. The team usually allocated these kinds of activities to support workers, but he explained he wanted to see how Dimitri coped in the community, and besides, nobody else had developed a therapeutic relationship with him.
He planned a coffee at Clifton Triangle and a gentle stroll down Park Street. Then they’d turn off into the park and ascend Cabot Tower. After conquering the steep hills and the tower’s spiral staircase, they’d take in the breath-taking panorama of the city. He imagined a proud smile on Dimitri’s face.
He eagerly awaited the phone call from reception to tell him Dimitri was here. Ten o’clock came and went, with no phone call. At ten past the hour, he rang the desk himself, barely able to disguise the disappointment in his voice when they told him Dimitri hadn’t arrived yet. The phone rang again at fifteen minutes past. Dimitri had called reception to apologise; he didn’t want to leave the house today.
Joshua flicked through the day’s schedule and discovered a fully booked clinic. He dialled Dimitri’s number and the young man answered. In vain, he tried to persuade him to take the walk. “Getting out is crucial for your recovery and you’ll love the views. I’ll be with you every step of the way.”
“I’m feeling low today,” Dimitri replied in a flat, downbeat voice. “I can’t. I’m sorry.”
They agreed to try again next week and Joshua hung up with a heavy sigh. He was hoping for a breakthrough. Dimitri had been under his care for almost six months. Last autumn, the police had called out-of-hours mental health services, after receiving complaints from residents of an inner city apartment block. A man was shouting, banging on the walls and throwing things out of the window.
Joshua had been on call. He spent most weekends alone—reading, listening to classical music and occasionally taking walks. When he arrived at the shabby apartment complex, a police officer took him to the source of the commotion on the top floor. A few shifty characters opened their doors as he passed by, an unpleasant stench of cannabis wafting into the corridor. Banging reverberated through the thin walls, followed by a blood-curdling noise, the kind of howl reserved for wild animals and the insane. He found the man’s general practitioner and a social worker camped outside the apartment, where they’d been trying to convince him to open up for several hours.
Joshua rapped the door with his knuckles.
“My name is Dr Joshua Palmer. I’d like to talk to you, Mr Lebedinsky.”
Silence. His mentor at college told him his calming voice was his best asset; if psychiatry doesn’t work out, he’d said, you could tame wild horses instead. “I’m here with a few colleagues. Please can you let us in?”
The bolt on the door clicked off. A voice murmured, “You… Only you.”
Joshua pushed open the door and entered the apartment. The others stayed back, ready to burst in at a moment’s notice. The apartment stank of rotting food and garbage bags littered the floor. Several crucifixes hung on the walls. Mr Lebedinsky sat crossed legged in the middle of the floor, shirtless and holding a bottle of bleach. Despite being unwashed, unshaved and deprived of food for weeks, Joshua observed a handsome young man beneath the grime, small but powerfully built. He’d scratched the sign of the cross into his chest with a razor blade and had poured salt over himself.
“Any closer, I drink,” he said in a Russian accent and shook the bottle of bleach.
“I’m here to help you, Mr Lebedinsky,” said Joshua.
A pair of blue eyes scanned him. “I want to trust,” he said, his voice fading to a whisper. “But what if you’re one of them?”
“Who’s them, Mr Lebedinsky?”
“The network of demons.”
That’s a new one. Usually, it’s Jesus, Satan, Mohammed or extra-terrestrials. “I know somewhere where you’ll be protected. We can talk some more there.”
The young man threw him a suspicious look. “You can?”
“Put the bleach down, Dimitri. Can I call you Dimitri?”
“Please put it down, Dimitri.”
The moment he dropped the bottle, the GP, police officer and social worker rushed into the apartment. They grabbed his arms and legs and removed him from the apartment. In the struggle, Joshua received a pummelling to the ribs for his treachery. The young man’s fists were powered like hydraulics. Finally, they dragged him from the apartment.
For his own safety, they placed Dimitri on a ward under section three of the Mental Health Act. Joshua prescribed a course of anti-psychotic medications. After an initial struggle, with violence against ward staff, Dimitri calmed. It was not long before he moved into a step-down unit. They discharged him three weeks later to staff-managed accommodation, and Joshua planned to follow him up in the community.
Over the next few months, Joshua kept a close eye on Dimitri’s progress, arranging weekly clinic appointments. Although far less agitated, the delusional ideation remained. He still believed demons, who controlled every government and transnational corporation, wanted to “annihilate his soul”.
For Joshua, most of the time, psychiatry involved reading a well-rehearsed script. But he felt moved by Dimitri’s plight. The young Russian was also easy on the eye—all the nurses said so.
Psychological therapy was challenging at first as Dimitri refused to reveal anything about his past or told blatant lies. In their first session, Dimitri claimed to be a descendent of Rasputin who helped build satellites for Khrushchev and became a lion tamer for the Moscow State Circus in the 1970s. When Joshua pointed out that he was in his early twenties, Dimitri shrugged and said he’d aged well.
Around Christmas, Dimitri finally opened up about his past. Born in Sochi, he was a promising gymnast. He’d even been considered for the national team. At first Joshua thought this was another of his tall stories, but Dimitri produced a photograph of himself, aged sixteen, doing a planche on rings, his deltoids and arms contracted.
“That’s fantastic,” said Joshua. “Would you like to train again?”
“I’m overweight,” said Dimitri.
Joshua scoffed. “There’s not an ounce of fat on you! Why did you stop?”
“I left that life behind when I fled home. I had a boyfriend back there. When my parents discovered this, they told me I must leave. They feared I would be killed if people found out.”
“How did that make you feel?”
“Terrible. I’m not normal.”
“There’s nothing wrong with being gay,” he told Dimitri. “I am.”
Even though he knew he shouldn’t talk about himself, the words slipped out. He cringed at Dimitri’s open-mouth. “I’d never guess.”
One day, I’ll tattoo the dreaded word to my forehead, maybe then I’ll understand myself better too. Since his late teens, medical school and then psychiatric practice consumed his energy. A steady routine of clinics, gym, paperwork, reading and sleep sublimated his desires. The thought of visiting the gay scene terrified him. He imagined a seedy underworld of glitter and black rubber. Pink fluorescent nightclubs haunted by flamboyant, androgynous monsters.
Dimitri must have sensed his unease. “I won’t tell, Dr Josh,” he said before giving him a sweet smile. Dr Josh! Is he flirting with me? He hated to admit it, but his heart was pounding. He cleared his throat and asked Dimitri if he was eating ok.
That night, desire infiltrated his dreams. He pictured Dimitri swinging on the pommel horse—strong, agile and graceful; his legs spinning like blades. Aroused, Joshua imagined the taut musculature of the young Russian’s bare chest and the pure white tone of his forbidden skin.
When he awoke, the sheets were damp with sweat. He took a shower and as the water trickled down, he hammered his fist against the glass door. He knew the rules, and agreed with the ethics, so why did it hurt so much to look but not touch?
The next day, he bought a gay porno magazine for some alternative stimulus. The old lady with milk bottle top glasses served him in the corner shop. The look she gave him when she noticed the magazine could curdle milk. Instead of feeling mortified, he gained a strange thrill from the embarrassment, imagining he’d somehow pleased the young Russian by capitulating to desire.
Back home, the oiled-up, muscled hunks failed to satiate. His mind drifted, and he fantasised about Dimitri’s features: his dark, curly hair and the distinctive contrast between his stern jawline and glassy blue eyes.
The phone rang shortly before eleven. Dimitri had changed his mind and arrived at the clinic. It’s too late, he thought. I’ve got another patient at eleven. Flicking through his diary, there were no gaps until next week. He told the receptionist he’d have a quick word with him.
He found Dimitri sitting in the waiting room opposite his eleven o’clock patient, Isla Sutcliffe. A strange girl, she’d snubbed the women’s magazines on the table for her own book, The Art of War. She peered up from the pages and scrutinised him.
“Sorry about this morning,” said Dimitri. “Leaving the house is hard for me sometimes, but you’re right, getting out more will help.”
“I’m glad you came,” said Joshua. “But unfortunately I have other patients to see now.” He hoped Isla would voluntarily offer to cancel her appointment, but she seemed to be enjoying the show too much to help him out. “We can try again next week, eleven o’clock Thursday morning?”
“Okay,” said Dimitri, rising to his feet. “Thank you, Dr Josh.”
As Dimitri left the building, Josh’s eyes lingered on his firm buttocks. Remembering where he was, he turned to see Isla grinning. He invited her upstairs for her appointment.
On the way up to his office, Isla teased him. “So who’s the hottie, Dr Josh?"
He scowled, but his cheeks burned.
“Don’t worry, I can keep a secret,” said Isla.
She’s read me like a book.
Once in the office, he offered her a seat, but she remained standing. She tended to pace around the room and sometimes she perched on the window ledge and gazed outside. At her initial assessment, she sauntered over to his desk, picked up the framed photograph of his mother and commented that she was pretty. Didn’t she have any sense of boundaries?
“So, Isla,” he said, opening his notebook. “How did you find the tablets?”
She gazed at him without blinking. “I flushed them down the toilet.”
“I thought you wanted to try medication?”
She stared at him impatiently before responding. “Not meds produced by Elixium.”
Josh turned back a few pages in his notebook, wondering why that was important.
“Don’t you remember? My sister died after taking their filth.”
“Oh yes, I’m sorry.” His pulse raced.
“It’s okay,” said Isla. “I can see you’re flustered today, and besides… I like you. You’re one of the few genuine doctors I’ve met.”
“Thanks. Well, I can specify a drug not manufactured by Elixium Pharmaceuticals. As I told you last time, I don’t think you have an underlying mental illness. You asked for tablets and I agree they might help you through this period of stress.”
“Good to know you don’t think I’m a complete whacko.”
“You have what we call reactive depression. The cutting,” said Josh, looking down at the scars peering through her long sleeve Nirvana t-shirt, “it’s a stress reaction. The tablets might help you deal with the immediate stress, but it’s your choice.”
“There’s no point now,” she said, staring at the floor.
“Why do you say that?”
She sighed. “I can’t tell you.” She wandered over to the window and peered through the blinds. Did she think she was being followed?
“You can trust me. Anything you say in here is between me and you.”
“I need more than your word. I need collateral. Tell me about that Cossack cutie from before…”
“I’m not sure what you mean.”
“Your last patient.”
“I can’t talk about other patients, Isla. It’s confidential.”
“You’ve got the hots for him, haven’t you!?”
He turned the page of his notebook, his hand trembling. I must be more careful with Dimitri. If this potty-mouthed teenager figured things out, my trained colleagues can’t be far behind.
“I can tell you’re exhausted,” she continued, fixing on him. “You’ve been thinking about him all morning. Turning him away broke your heart.”
Her words taunted, but her demeanour invited him to confess, to share his secret so she could use it against him. Classic manipulative behaviour. Women with borderline personality disorder operated this way, he’d seen it many times. Perhaps he ought to amend his diagnosis. “Let’s keep the focus on you, Isla. It’s your appointment.”
“I get it,” said Isla, smiling knowingly. “I met a boy the other night I really liked. I mean, he was geeky, had this thing he did with numbers, and he was super gullible. He would have robbed a bank for me if I’d asked.” She laughed. She reminded him of a cat toying with its prey. “But he’s really sweet. If only I wasn’t buried under a steaming mountain of shit, it might worked.”
“What’s stopping you?”
“This guy, Chad. He’s on my arse twenty-four seven. We’d literally have to run away.”
“He upset you last time. If he’s harassing you or is violent, you should inform the police.”
“If only it were so simple. He’s got something over me.”
“I can’t tell you.”
“Everything you say here is confidential. I want to help you.”
“Let’s just say I found a way of wreaking revenge for what happened to my sister. Only I might be in trouble. There’re consequences for putting your head above sand, and those consequences… I think they’re coming for me.”
Josh wrote the word paranoia in his notebook and underlined it. Maybe she does have an underlying diagnosis.