Outlaw’s Mind – Part 3

Okay, here it is, the third part of Outlaw’s Mind, for anyone who is interested in reading more.

It was shortly after that incident that Timothy had finally allowed the school counselor to talk him into seeking some form of medical help for his problem.  That counselor, a pleasant but serious woman in her forties known to him only as Mrs. Gibson, had recognized—after quite a few sessions with the troubled young man—that he was not a case of the youthful signs that predicted a future of sociopathy, or antisocial personality disorder.  She had quickly discerned that he was more troubled by his rage than those around him were, that he wanted to behave well, that he wanted to accomplish a good life.  But his rage, as he had awkwardly explained to her, seemed to have a life of its own.  He even sometimes woke up from dreams feeling furious, not able to recall what had triggered it, but unable to dismiss it.  He was, when younger, a somewhat artistically expressive youth; he drew pictures and occasionally even made clay sculptures, amateurish on both counts, but nevertheless pleasing to him.  When he woke up in the night consumed by unreasonable anger, his only recourse was often to destroy these minor works of his own art, damaging himself so that he wouldn’t damage anyone else.

Mrs. Gibson had recognized that this anger might well be fundamentally biological, that it might literally have a life of its own within him.  This idea had thrilled Timothy, as it matched his own experience of the anger he’d inherited, with accrued compound interest, from his father.  Thus, after his disturbing epiphany with Allison, he went to see Mrs. Gibson again.  She spoke to him of a type of tumor—not cancerous, but dangerous—that she’d heard of, called a “pheochromocytoma”.  He had asked her to write the word out for him, so he could do research of his own.  With real pride in her eyes, she had done so, and had then referred him to an endocrinologist she knew through her family, calling the doctor’s office that day while Timothy was in the office.

Timothy’s mother had been leery of this at first.  She feared the expenses entailed in serious medical workup, let alone in treatment, but thanks to Mrs. Gibson’s connection and recommendations—and, it seemed, the doctor’s fascination with the possibility of treating such a young man with such a rare condition—the endocrinologist had assured Mrs. Outlaw that he would accept whatever payment her insurance company offered, meager though it was.

A further hurdle of getting a referral from a primary physician, something required by the insurance company to Timothy’s tremendous irritation, had been eased by the neurologist getting him a quick appointment with a general internist of his acquaintance, who quickly evaluated Timothy, found him grossly healthy, and wrote a clear and convincing referral to the endocrinologist, as though he had been caring for Timothy for years.

When Timothy first met Dr. Barrett, the doctor sat him down, checked him over, checked his blood pressure and pulse rate, looked at the EKG that the primary doctor had done, and then sat down to go over what Mrs. Gibson had told him about Timothy’s past.  Timothy had granted her permission, in writing, to do so.

Dr. Barrett had explained to Timothy that a pheochromocytoma was a type of tumor of neuroendocrine origin, that secreted large amounts of “catecholamines” such as epinephrine and norepinephrine, the former also known as adrenalin, often in bizarre, pulsatile fashion.  He told Timothy that often people afflicted with these tumors had baseline high blood pressure and frequent headaches, neither of which Timothy had, but that they were by no means universal, and in any case, Timothy was very young and otherwise healthy.  He might tolerate physical processes now that would later produce much more glaring symptoms and signs if left untreated.

Timothy had felt that his personal symptoms and signs were more than catastrophic enough.

Dr. Barrett had seemed utterly confident that they would find the evidence of one of these “benign” tumors, given Timothy’s history, and he’d seemed almost insultingly happy about it.  Timothy forgave him this, though, because one thing the doctor had made clear to Timothy was that most of the time, correcting a pheochromocytoma was simple:  the tumor was surgically removed.

Timothy had fantasized longingly about being admitted to the hospital, prepped, fearlessly interacting with the staff, eager to have an operation, and he fantasized about awakening afterward to a smiling, handsome, soap-opera surgeon who told him the tumor had been removed and he was cured.

Alas, this was not to be.

Timothy had joyfully submitted to blood tests and had even been happy to spend a good portion of one weekend at home so that he could do a twenty-four-hour urine collection.  This, the endocrinologist explained, was to measure catecholamine breakdown products.  As the doctor had explained—and as Timothy confirmed in his own research, using the then-early internet as well as the public library—at any given moment, the various adrenalin-related chemicals in the blood of a person with a “pheo” might be well within normal range, and so the blood test, while necessary, was far from sensitive.

Unfortunately, when Timothy had gone back to Dr. Barrett, the man had been disappointed to report that the levels were normal.  He had obviously been able to see how crestfallen Timothy was, because he had hastily assured him that, especially in such a young person, the frequency and amount of the secretions were not likely to be as obvious as they were in a typical patient.

Dr. Barrett commissioned a second, then a third, twenty-four-hour urine collection.  The Outlaws’ insurance plan had refused at first to cover either of them, had been cajoled and pressured finally into covering the second, but had stubbornly insisted that the third was not medically necessary nor indicated.  Dr. Barrett had, with some sorrow and obvious sympathy, covered the price of this one out of his own pocket.  He had met with Timothy for a final time, trying to reassure him with the knowledge that at least he knew that his endocrine system was normal, based on all the tests they had done.

This had not reassured Timothy.  A problem that could not be detected could not be removed.

In the weeks following this failure, Timothy’s temper was, if anything, worse than before.  He got in several fights at school, avoiding major trouble mainly because he’d been held back by groups of other students as soon as he’d shown that he was going to continue attacking even once it was clear that he had the upper hand.  This had, on each occasion, been carried out by older boys, and even they had seemed afraid to try to restrain Timothy singly.  He was not physically imposing, a slim, average-height fourteen-year-old, but when his rage gripped him…

One of his friends from the time, a boy named Earl Walla, had told him after one occasion, “Tim, when you get pissed off, it’s freaking scary.  I mean, I don’t even have to see your face.  It’s like I can feel it coming off you, like you’re possessed or something.”

“That’s stupid,” Timothy had told him, feeling a chill go down his back, nevertheless.

Timothy had lost that friendship not long after.  Earl, though a nice enough boy, was of course subject to the usual teenage frailties of wanting to seem cool and jaded to other boys, and to girls.  One day, when PE class was outdoors, and the boys were doing laps and sprints around the track, Earl had made a point of saying, within easy hearing of a group of other boys that he had apparently deemed cool, “Hey, I saw this rerun on TV the other day, and I realized what you’re missing.”

Timothy, utterly puzzled, and breathing rapidly from a recent wind sprint, just said, “What?”

“It was that stupid old show, Lassie.  I realized, what you need is a collie dog, like that one,” Earl had said.

His hands on his knees, holding himself slightly bent over as he caught his breath, Timothy had asked, “Why would I need a dog?”

“Not just a dog, a Lassie dog.  The kid who owns Lassie was named Timmy, just like you.”

Timothy had closed his eyes, irritated.  “I don’t like being called Timmy,” he said.

“Why not?” Earl had asked.  “That kid’s famous, or he was anyway.  He’s probably rich, too, if they’re still showing that show on reruns.”

“I don’t like it,” Timothy had said.  “I’m not ‘Timmy’.”

If Earl had heard the early warning signs in his friend’s voice, he had not paid attention to it, perhaps because one of the nearby boys had chuckled appreciatively when he’d first suggested the Lassie association, with its diminutive version of Timothy’s name.

“Okay, okay,” he said, in a mock-placating tone, obviously still poking fun at his friend in what should have been a typical, traditional, and harmless bit of male bonding camaraderie.  “Well, how ‘bout this.  There was this old singer in the sixties called Tiny Tim.  He sang this song called ‘Tiptoe Through the Tulips’.  What do you think about Tiny Tim?”

A few of the other boys had laughed a bit more loudly, one of them mumbling “Tiny Tim” in appreciation.

Timothy, however, had not been amused.  He had looked up from under his brow at his grinning friend, feeling his head begin to pound, the fatigue of the run quickly dropping away.  “Don’t call me that,” he had growled.

Earl had not heeded the danger, or he been distracted from it by the response to his comments from the other boys.  If Timothy’s anger was indeed a palpable force on prior occasions, Earl was oblivious to it that day.  At least for the moment.

“Come on!” he’d said, laughing at his own ideas.  “It could be one of those retro things, something that’s cool now because it’s so dorky.  You could go on tour.”  Then, glancing back at the other boys to confirm their approval, he broke into a silly little dance on the balls of his feet, his arms cocked at the elbows, his index fingers making rings with his thumbs and his pinkies extended, and he sang in a high falsetto that was quite a good impression of the original singer, Tiny Tim, “Tiptoe…through the tulips…by the ocean…”

That was as far as he got.

Earl was probably lucky that Timothy—for no particular reason—targeted his stomach rather than his chin or face, because Timothy exploded upward, striking Earl with the force of his entire body behind the blow.  It struck Earl in the belly, just below his ribs, and it lifted him off the ground a few inches.  If Timothy had landed an uppercut with that force, he might have broken Earl’s jaw…or his neck.

Timothy considered none of this at the time.  Even before Earl had begun to fall over, his breath knocked out of him by the blow, Timothy’s left hand had followed up with a blow to his friend’s exposed side.  This was later found to have caused minor rib fractures in the floating ribs.

Earl was unable to yell in pain, his wind still knocked out of him, but he had fallen to the ground, bent in half.

With no particular thought behind the decision, Timothy had chosen to continue punching rather than to kick his friend’s now-horizontal form, and this might well have saved the boy from far worse injury than he ended up receiving.  He swung downward with his right hand, striking Earl in the rear of his right shoulder.  It sounded like a drum thanks to the resonance of Earl’s lungs.

The boys who had laughed at Earl’s comments had jumped to their feet, but they said nothing, simply stared in shock at Timothy laying into Earl.

Earl had balled up automatically as he had fallen, and Timothy continued to pummel at his back, one blow near the spine, another more on the side, one or two falling frighteningly close to Earl’s neck.

Finally regaining his breath, but clearly not able actively to resist, Earl had yelled, “Stop!  Stop!  I’m sorry, Timothy, I’m sorry!  Please, stop!”

Timothy heard tears in his friend’s voice.  Earl was bawling like a grade-schooler, bunched up like a fetus, and begging Timothy for mercy before the eyes of the boys he’d clearly been trying to impress.  Timothy recognized this, knew that he was overreacting, knew that the nearby boys were right to be gaping at him in undisguised shock and impotent horror.  And he wanted to keep beating on his friend.  He wanted to beat him bloody.  He wanted to beat him to death.

It was the spectacle of Earl’s utterly conquered tears that had prevented this, more than the sound of the gym teacher yelling in fear and anger as he rushed toward them.  Timothy, his rage still mostly in control of his actions, stood up, did not wait for the teacher to get close, did not obey any commands but those of his own ire.  He screamed aloud, a guttural, primal sound of ancient fury, and he took several strides toward the school.

There was a door nearby—it was not the one they had used to exit the school, but was a single door, perhaps there for teachers’ access or for emergency purposes.  It was metal, but with a pane of what was presumably safety glass in it.

Timothy, hating the world, hating Earl, hating himself, swung at the glass.  Whatever it was made of wasn’t quite strong enough, for it spiderwebbed in response to his blow.  This time, bones broke in Timothy’s hand, but he didn’t feel them any more than he’d felt the brick wall.  He swung again, and this time his fist went through the safety glass.  Though not ordinary window material such as would have been in a house, the broken edges were still sharp, and Timothy suffered several lacerations in his forearm both as he put his hand through the pane and as he pulled it out to try to strike again.  One of these cuts must have been over a decent-sized blood vessel, since it immediately started to bleed copiously.

Timothy was no more forestalled by this than he had been by pain in his hand.  Indeed, a tiny but serious part of him thought, “That’s good.  Maybe I’ll bleed to death.  I deserve it.”

Then the gym teacher, who was also the school’s wrestling coach—Timothy could never remember his name in later years—had seized him from behind, put him in a full nelson long enough to calm him down, and had tried at the same time to put direct pressure on Timothy’s wound, clearly unfazed by the direct contact with a student’s blood even in that era of HIV and Hepatitis.  Even as he had held Timothy in place, despite howls and shrieks and a flailing of legs, the gym teacher had yelled for someone to call 911.

Timothy had been brought to the emergency room, calmed significantly by shock and—just possibly—by a modest amount of blood loss.  The coach/gym teacher had controlled his bleeding well enough until the EMTs had arrived, then they had put a compressive dressing on it and sped him along to the hospital.  There it was discovered that, despite the amount of bleeding, no truly major blood vessels had been damaged, so Timothy would not require surgery.  He did need stitches, though…twenty-eight of them, spread over four different cuts, a few other minor ones simply requiring ordinary bandages.

These were likely to heal faster than the bones of his right fist.  X-rays—done in the ER, after his mother had finally arrived from work, having given approval for the stitches over the phone, and the urgency being strong enough for the ER docs to go ahead—revealed that he had simple fractures in two his metacarpals and in the first phalanx of his pinky.  Timothy, who learned the meaning of the bone names later, wondered whether the pinky fracture had happened at that earlier time when he’d smashed his fist against the brick wall.

He asked the ER doctor whether it could have been an older fracture, and she told him she doubted it.  There was no sign of any healing having taken place in it—no callus formation, as she called it—so it seemed to have happened at the same time as the others.  In retrospect, this would have become obvious to Timothy, for the pain, and its duration, of the recovery from this new injury was far worse than had been that following his hammer blow to a much harder surface.

Thankfully, none of the fractures was displaced, so treatment would be supportive, and no cast was recommended, though a brace of sorts was made, which could be taken off to bathe, but which the ER doctor recommended Timothy leave on at most other times.

As things were preparing to wrap up for Timothy’s discharge from the ER, the doctor had asked his mother if she wanted a prescription for some pain medicine for Timothy, but his mother had fervently shaken her head, and had acted somewhat insulted.  Timothy would come to curse that decision, but he also found himself glad of the pain his injury caused him.  As before, he felt that he deserved it.  This self-spite, however, did nothing to reduce his tendency to rage; it anything it worsened it.

While they were being given discharge papers, Timothy’s mother looking quite weary as she tried to focus on the necessary information, a voice had called from the side, “Timothy Outlaw, is that you?”

Both Timothy and his mother had looked up in surprise.  The ER nurse doing their discharge just glanced up and smiled as a tall, balding man in horn-rimmed glasses and a long, white coat approached.  Timothy could not recall the man’s name—though he was impressed that the man had recalled his—but he recognized this as the primary care doctor who had been willing to give the rubber-stamp referral to the endocrinologist.

“Oh, uh, hi, doctor…” Timothy had stammered.

“Putnam,” the man had replied.  “I’m Dr. Putnam.  Not sure if you remember me…”

“Sure, I do,” Timothy had said.  He held up a hand to wave, but it was his right hand, so his injury and dressing were prominently displayed.

“What happened?” Dr. Putnam asked with a sardonic smile.  “Did you get into a fight at school?”  He was speaking in a jocular tone, but Timothy thought his eyes looked too sharp for a casual inquiry.

Before Timothy could respond, his mother jumped in.  Timothy judged her to be embarrassed—he supposed she probably recognized Dr. Putnam as well as he now did—for she said, “No, actually, he got in a fight with a door at school.  Well…the window of a door, anyway.”

Dr. Putnam raised an eyebrow, and Timothy thought that the man suspected that his mother was not being completely forthcoming.  Apparently weighing his further inquiry to avoid discomfiting Timothy’s mother, he simply asked, “How on earth did that happen?”

Timothy felt embarrassed, could even feel the heat in his own face, but he decided to continue with his mother’s minor fiction and replied, “Well…I got really mad about something one of my friends said, and I…I kind of just punched the door.  The window, I mean.”

“Good lord,” Dr. Putnam had said.  Looking at Timothy’s bandaged and braced hand, he said, “You must have hit it pretty hard.”

“Yeah,” Timothy said, his voice barely audible even to himself.

His mother, on the other hand, took this point up with greater enthusiasm.  “Oh, yes,” she said.  “He broke the window…and it was some kind of plexiglass, apparently.”  Looking with motherly contempt at her son, she added, “Twenty-eight stitches and three fractures.  That’s in him.  I only hope the school doesn’t bill us for the window.  That wouldn’t be covered by insurance.  If they do, I can promise you that you’re going to pay for it out of your allowance and any after-school job you might get, with interest added for my trouble.”  Timothy thought that she was being quite serious.

Dr. Putnam’s eyebrows drew down in concern, and with a tilt of his head, he looked at Timothy and asked, “How did things go with Dr. Barrett?  Any…well, not good news exactly, but any revelations?”

Timothy hung his head, somehow ashamed that Dr. Barrett’s and Mrs. Gibson’s speculations had been incorrect.  He didn’t say anything, but let his mother reply, “None.  Not a thing.  He peed into a jug for twenty-four hours on three separate weekends, and I don’t know how many blood tests they did, but they didn’t find anything.  Not a trace of one of those stupid theological tumors or whatever they are.”

Timothy knew that his mother was merely pretending not to know the name of the tumor that had been speculated as possibly causing his fits of fury.  She had done a fair amount of research on it herself, wondering aloud whether such things could be genetic and whether one might have explained the behavior of her son’s father, the cause of his eventual untimely death.  Her mispronunciation was an act of defiance and contempt at the fact that her hope—both current and retroactive—had been dashed.

Dr. Barrett, instead of correcting Timothy’s mother, had laughed strongly in response to it, drawing an answering smile from her.  It was clear that he understood the reason for her renaming of the negated diagnosis.  Then, still smiling, he had said, “So, I guess there’s still no clear cause of the outbursts, then?”

Timothy was impressed that the man, who had after all been only barely involved in his previous care, recalled his case so clearly.

His mother, weary and exasperated, said, “Nope.  Nothing.  I guess he’s just got a rotten temper.”

Timothy again looked down, but not before he noticed Dr. Putnam regarding him sympathetically.  The man’s voice was soft and empathic as he said, “Well…maybe.  But I’d like to think of that as a diagnosis of exclusion.  It’s pretty unusual for someone to have such a forceful temper that they break a window and their own arm over something a friend said.  A girlfriend, maybe, but a high school pal?  That seems more unlikely.”

“What is it then?” Timothy’s mother said, her voice conveying no hope at all.

“I’m not sure,” Dr. Putnam had said.  “But I think I might have some ideas.  Do you think…well, would you mind Timothy coming to see me at my office?”

Timothy’s mother sighed and said, “I don’t know.  How are we going to justify it?  I don’t want to have to fight with the insurance company.  I can barely afford the food he eats.”  Timothy knew this to be an exaggeration; he and his mother were not quite so on the verge of poverty as she was pretending, but they were far from comfortably well off.

“Well, for starters, we can have it just serve as an ER follow-up visit,” Dr. Putnam replied.  He turned to the nurse, who had patiently stood waiting, an indulgent smile on her face, while the doctor had spoken with the two living members of the Outlaw family.  “Emma,” he said, “have they made any appointments for follow-up?”

“No, Dr. Putnam,” she said.  “We were just going to have him come back to the ER for suture removal.”

“Oh, no, that’s no good,” Dr. Putnam had said playfully.  “No offense, but there’s no way to know how long he’ll have to wait when he comes back.  I sometimes get a little behind schedule in the office, but not as badly as someone with a follow-up is going to face in the ER.  Wouldn’t you say?”

“It depends on how busy the day is,” the nurse had replied, smiling, clearly fond of Dr. Putnam.  “But, yeah, it can be a wait sometimes.”

“All right, then,” Dr. Putnam said.  “Since I am, officially, young Mr. Outlaw’s primary doctor of record, why don’t you set him up with an appointment in my office?  Tell them I told you to work him in.”

“I’d be happy to,” the nurse—Emma, apparently—said.  “Why don’t I do that right now?”

“Thank you very much,” Dr. Putnam said.

As the nurse went around the desk to call Dr. Putnam’s office, Timothy’s mother said, “Are you sure this isn’t a bother?  I mean, we’re already taking you away from your work here.”

Dr. Putnam looked honestly startled by her comment, then he gave a quick laugh and said, “No, not at all.  Actually, I just finished admitting a patient of mine for what is, I suspect, nothing too severe, but we can’t be too careful.  Otherwise, this is my afternoon off.  I’m not even supposed to be on call, but…well, you can take the doctor out of the hospital, but you can’t get the hospital out of the doctor.  Or something like that.”

Timothy’s mother had laughed, clearly drawn in more by the doctor’s demeanor than his words.  The man positively radiated warmth and compassion, rather the opposite of the way Earl had described Timothy when he was angry.  How Timothy wished he could have that attribute rather than the one he possessed.  There were no doubt many teenage boys who would have thought that being utterly terrifying to those around them—even only upon occasion—was a wonderful thing.  Timothy knew better.  He knew that fear and anger made people distant, kept a person lonely, and only drew in twisted people like Allison, more frightening in her way than Timothy himself.

He would go on to develop a serious “man-crush” on Dr. Putnam, as he was sure many others had before him—and eventually to consider him a friend and one of his only confidants.  Without Dr. Putnam, he might well have met an end similar to that of his father, but probably at a younger age.

He would later come to suspect that this might have been the better fate…but that would be much later.

Emma came back from around the desk and told them that Timothy had an appointment for two weeks from that coming Thursday, at two in the afternoon.  Dr. Putnam gave this his strong approval, told Timothy that he looked forward to seeing him, and then bid the trio of Timothy, his mother, and the nurse goodbye.  They all watched him go rather breathlessly, like fans who’d just met a celebrity.

One thought on “Outlaw’s Mind – Part 3

  1. Pingback: This tempest will not give me leave to ponder on blogs would hurt me more – Robert Elessar

Please leave a comment, I'd love to know what you think!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s