Case 4: Falling Down

[Triage Note: 53 old male, feels there is a needle in back of throat. +++ anxious, speaking well, no drool]

It’s exactly ten days before Christmas. Merv McMillan is standing at a sink in an examination room, waiting to see the doctor. He clears his throat, then sticks two fingers beyond his tonsils and gags. The sound is so forceful, it makes my eyes water. He retches. He coughs. He clears his throat again, then peers out of the room, calling into the hall. “I can’t fucking breathe! I’m choking! I need a doctor! Why won’t anyone help me?”

A security guard steps forward. “Please sir. Step back into the room.”


Merv was picked on as a child. From grade school, right until graduation, he remembers being called “Merv the Perv.” The “idiots,” he says, “thought it was funny. They never stopped.” Merv just stayed afloat through high school, and was able to graduate, by the skin of his teeth, at nineteen. After years at odd jobs, he began studying Mechanics at a local college. He struggled with studying and test-taking, but was able to achieve a passing grade his first year. He enjoyed the practical aspects of the course and foresaw excellent prospects at the completion of the three year program. During the summer, however, his first and only girlfriend decided to move back to her hometown, 150 miles away. He was given an ultimatum: “Move with me or it’s over.”

Merv followed his girlfriend, and two years later, they were married. He was worked as a janitor, constantly regretting his decision to leave college. “It was the biggest mistake of my life.”  Three years into marriage, their son Michael was born, and one year after that, his wife left.  That winter, left alone with a young son, Merv moved home to be with his parents, Romanian immigrants who’d come to Canada in the 1960s. His mother, Irene, took care of Michael during the day, while Merv worked as a handy-man, alongside his father. His father was often verbally abusive, admonishing him for “messing-up jobs,” and repeatedly berating him for the failure of his marriage.

The following spring, his mother noticed a lump on her leg. “It was the first time I’d ever seen her slow down,” he said. “I’d catch her sitting on her bed, rubbing mustard and paste all over it.” After weeks of limping through her chores, she finally agreed to visit a doctor. The lump was cancer. It was in her lungs and her spine. She died that August. “I’ll never get over it,” Merv says, suddenly sobbing. “She was the only person who ever really loved me.” The death was hard on Merv’s father. He became more abusive, telling his son, he wasn’t “able to do anything right.” When night came, his father would drink heavily, often becoming physically abusive. “He never touched Michael, thank God. Just me.” And in the early hours of the morning, his father would become remorseful -waking Merv, crying, apologizing – or even calling friends at “two or three in the morning.”

“Do you think he was mentally ill?”

“If he was,” Merv says. “He was never treated for it.”

“Have you ever been treated for mental illness?”

Merv is appalled by the question. “Of course not. I’m not crazy.”

“Do you know the date today?”

“Not off hand,” Merv says.

“Do you know where you are?”


“Do you know why you’re here?”

He shakes his head slowly. “No.”

Merv and Michael moved out. When Michael became a teenager, he reconnected with his mother – Merv’s ex – moving in with her for months at a time. “He comes and goes now,” Merv says. “I can’t stop him. He’s twenty-one.” The winter he turned forty-seven, Merv met Amanda at a local pub. Fifteen years his junior, Amanda was like no one he’d ever met. “Every night was a different party. Drinks, sex, the best time I’ve ever had with anyone.” They moved in together, working during the day, and drinking almost every night. In April, Amanda found out she was pregnant. Merv stopped drinking and tried to convince Amanda to do the same. She called him crazy. Mentally ill. She moved in with one of her “drinking buddies.”

Merv went back to the local pub. He’d routinely drink “two hundred dollars in one sitting – ten to fifteen beers, and several shots of liquor.” One night, he confronted Amanda and her new lover, demanding to see his newborn daughter. An hour later, he had a broken nose, two black eyes, and a restraining order. The following week, he was charged with DUI.

One Monday morning in December, he arrived to work intoxicated. He slipped and injured his wrist. He was ordered into AA, as well as physiotherapy and acupuncture for his wrist.


“Please sir, step back into the room.”

Merv spits on the floor. He spits at the security guard. He holds his breath, then spews out words, gasping: “I can’t breathe. I can’t breathe. There’s a needle in my throat!”

A nurse approaches. “Where? Where do you feel the needle?”

Merv approaches as the security guard calls for backup. He puts his hands around his neck. “Right here, all the way around. Right where she put it.”

“Who put what?”

“As if you don’t know,” he said, lunging toward the nurse. “You’re in on it too.”

“Call a doctor, stat!” The nurse calls out. “We’ll need sedation.”

Merv is tackled to the ground. There is a loud thud as his face hits the floor, his arms twisted behind his back. A doctor arrives. “What’s the story?”

His cheek mashed against the ground, blood and spit foam from his lips has he tries to talk. “The lady with the acupuncture needles. She put them right through my brain and into my neck and throat. They’re all stuck in there. A hundred of them. She’s trying to kill me. Amanda hired her to kill me.”

The doctor is already walking away. “Haldol and Ativan. Ten and two I.M.” He jots a note on a chart.  “And physical restraints.”

In half an hour, Merv would be asleep, his arms and legs strapped to a stretcher. Two days later, he’d wake up and tell a medical student his life’s story. And two days after that, he’d be back at work.

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