(PDF) Clinical management of alcohol withdrawal: A ...

Black Clouds

The first droplets of rain smack the plane glass window. I stand on one side, fiddling the small recorder in one hand, and nursing a glass of scotch in the other. On the other side of the window an expansive city sprawls out in every direction, and high above it the storm that has been brewing is finally starting to burst. The rain droplets will soon be a downpour. Storms make me nervous. A thin bolt of lightning rips through the sky, momentarily illuminating the fat, heavy, dark clouds. They were plenty. No stars will show tonight. Another silent streak of light, and I see the normally bustling street below has gone quiet, save for a sparse sprinkle. Yellow cabs scurry about like insects, collecting their payments as they drop off their late night patrons.
The faint sound of rolling thunder can be heard, muffled by the thick glass of my office. Eighteen stories up, I see the rain intensifying before those below. Normally, the dampening of the window prevents all outside noise...it's important for the patients to feel safe. Now, long after my office has closed, I find the thunder far more jarring than the constant whirring of the air-conditioning system, always pumping in oxygen that somehow smells fresh and artificial simultaneously. I understand. I take another short sip of my drink and turn away from the upcoming turmoil, returning to my desk. I find my eyes drawn to the framed certificates and degrees hung about my walls, questioning their ultimate meanings.
I know that I'm safe in my office, my own personal slice of the world...but again, storms make me nervous. They didn't always, quite the opposite in fact, as a child I was rather fond of the whip-cracks in the sky, the smell of fresh rain. My distaste for them, I can actually pinpoint. Its a direct correlation of one of my patients. The one patient that scared me. Now, I've dealt with some truly sick and disturbed minds in over twenty-five years as a psychologist...but only one has ever truly frightened me. I currently hold a tape recording of our one and only session in my hand. Jack Lowe. The man was a lunatic, no doubt about that. His delusions tearing his mind pushing him further and further from reality as each second ticked away.
It was in this very office that I met Jack, and sometimes, on nights like these when I find myself unable to pry his words free from my mind, I can almost see him sitting across from me, cigarette dangling in his hand. On nights like that, like tonight, the only remedy for my obsession is to listen to the recording and drink.
I loosen my tie as I place the recorder on my desk and then I sip my scotch. I pull the bottle from the small shelf hidden under my desk and place it next to the small black device, inside of which a tape labeled "Lowe, J. Ses.1" resides. I hesitate for the briefest second before pressing play, leaning back in my chair and shutting my eyes.
"Marnie, please send in Mr. Lowe." I hear my own voice coming from the speaker.
Its so vivid...the picture in my mind that hearing his name conjures. I hear shuffling before the unmistakable sound of my office door squeaking open. I remember so clearly the man who walked through, and into my life all of those years ago. He was thin, one step above emaciated in fact, baggy clothes that wore the man instead of the other way around. He clearly had Norwegian ancestry, dirty blonde shoulder length hair that was quite messy, his unshaven cheeks gave way to a thicker patch of blonde hair on his chin that I think must have been a goatee of sorts before he had let himself go. Immediately I saw a horrendous case of insomnia, the purple skin around his sunken eyes would have been a give away for even someone wholly untrained in mental illnesses.
"Have a seat Mr. Lowe." I hear the smile in my voice.
"Just Jack..." A new voice joins the cast, and I feel the hairs on the back of my neck prickle hearing his soft almost whisper once again. I down the remainder of my glass and swiftly refill it.
"Hello Jack, I'm Doctor Harkins. Your paperwork here says you're dealing with..." I hear the sounds of papers shuffling, and silently mouth the next word in tandem with my past self. "Hallucinations?"
A period of silence follows on the recording, but my clear recollection fills in the gap. Jack, with his eyes locked on the floor nodded slowly, almost imperceptibly. There was such a distraught feeling surrounding the man and I can still feel the uneasiness shoot through my veins like ice.
"How long has this been going on, Jack?" I asked, no hint of the smile in my words.
"Its...its not a... persistent thing doc, it happened one time...I can't sleep though, I can't eat, I can't..." He trailed off. I remember him placing his hands softly on his face and rubbing the heels of his palms into his eyes. "I'm losing my fucking mind, doc...I need...something." Jack said the words with a shaky, uncertain tone.
"What do you think you need, Jack?" I asked.
"That’s why I'm here, right? To figure out a way to forget, yeah?" A slight hint of agitation permeated his voice.
"Forget...let's go back Jack...you said the hallucinations were an isolated event?" I asked.
"My Dad died, yeah, and I know shrinks like to think everything is linked to something with some or another parent thing, but it wasn't that. See, dad and me, we weren't close...not since I was a kid. He always paid more attention to my sister, even back then...she's the one who called me to tell me the news." The words flowed hectically from Jack's mouth and I remember the sheer desperation in his eyes when he looked up at me, they pleaded, begged me to hear him out and not jump to conclusions.
"Alright, go on Jack, I'd like to hear about everything." My voice conveyed a sense of calm, attempting to ease Jack, help him relax.
"You uh, care if I smoke?" He asked. I recall waving my hand in a "by all means" gesture. The soft sound of metal scraping a flint followed.
"So yeah, Dani called me and said Dad died, it's sad, but it happens right? I ask her what happened..." Jack jabbed his now burning cigarette in my direction. "Cancer, of course. What else? So, I ask her about the funeral. Two days, no problem, I'll drive down to Connecticut, spend some time with the family and honor the old mans legacy. I packed up some shit...man I can't believe I'm telling you this, you're gonna think I'm out of my fuckin' mind...hell, I probably am." The soft hiss of his cigarette burning followed his words as he took a long drag.
"I'm not here to judge you Jack. I'm here to listen to you and come up with a way to help. I don't think you're crazy." I assured him.
The cold, skeptical look he gave me, crossing his hands between his knees, dangling his cigarette...it sticks with me to this day, and I truly believe that I'll carry it to my grave. I pour my third glass.
"So I'm packing some things for a few days, and I hit the road first thing in the morning. I called Dani as soon as I left the city, telling her I'd be there tomorrow, yeah? Yeah. She tells me, 'yeah, okay, let me call Ray-' that's her husband, right, so she says 'let me call Ray, see if we can get the guest room set up in time, if not, Mom still has your old room set up back home'. She tells me she's gonna call back in fifteen, all good right?" Jack paused and looked at me inquisitively. He must have been aware of his frantic, almost manic speech pattern.
I nodded, again in unison with my past self, exactly as I remember. On cue, jack continued.
"So...I do what anyone does, toss the cell in the passenger seat and crank some tunes. I remember, some 90s boy band, but I was alone...no shame. I blasted it. It was nice out too. Green trees, blue sky. I rolled down the windows and remember, doc, I remember the air tasting and smelling so FRESH...in spite of the bad news I was feeling pretty damn great." He had glanced away at this, taking another draw off his cigarette. He felt ashamed. He thought it was wrong to feel good in light of a parents death.
"So would you say it was a pleasant drive?" I asked, beginning to pry, attempting to do exactly what his eyes had begged me not to and connect his unhealthy mental state to the death of his father.
"At first it wasn't so bad. Yeah, pleasant. But that didn't last. You know, you notice shitty drivers around you. You pay attention when cars behind or in front of you merge, or exit...but you never really pay attention to NOT having anyone else around you. It took me a while to realize that in two hours of driving I hadn't seen a single car besides mine. Now, it was still pretty early, so weird but not that weird. I did notice though that not one damned commercial had played on the radio. Just straight 90s hits..." The burning sound of cigarette paper again, followed quickly by another flick of the lighter.
Jack's leg began furiously tapping, and I recall wondering if it was anxiety or substance withdrawals.
"Dani hadn't called either." He continued after a moment. "She said 'fifteen' and it had been a couple hours by then. I just figured she got caught up dealing with Dad shit and had forgotten to call me back. Whatever, no biggie, so I pick up the phone, right, and I just punch in her digits...this is where I got fucked up, doc...because after two rings I heard that automated 'number no longer in service' message. I looked at my phone and sure enough it said Dani's name. I was confused, so I tried again, and again I got the 'dododedo'..." He imitated the electronic beeps, and raised his hands into a shrugging pose "...number not in service. You think I'm some kind of nut, yeah?" He finished, dropping his hands to his side.
"Not at all, Jack." I lied.
"Yeah, right. So anyway, I'm getting a little weirded out at this point, thinking something's wrong and then boom, it hits me. I try a different number. I call my job, back in the city. You guessed it, a robot telling me to fuck off 'cause the number just ain't in service. I call number after number, nothing. I start to think my phone is broken, so I call 911...that shits supposed to work from any phone, service or not...same...fucking...message. As if that wasn't freaky enough, doc, the second I hit the 'end call' button, the radio cuts out. Almost right away it comes back on, and you know what the song was? It was nothing. There was no song, on this channel that was apparently twenty-four seven, all 90s, no commercial gem. No, I heard the fuckin' robot voice, and she was just saying random ass numbers." He said, starting to get a flustered look on his face.
"A numbers station?" I asked, enthralled with his tale. As far-fetched as it was, I could tell that he wholeheartedly believed every word was true.
"No! Not really!" Jack said abruptly, as he stood from his chair and began to pace around the room. "1...2...1...2...that's it. That's all the robot bitch would say, over and over, 1...2...1...2. Bizarre, right? I...I thought maybe binary, but no, there was no break in the pattern. Not a single double of either digit, just 1...2 repeat."
I raised my brows and allowed my eyes to track the man, who was increasingly lost in his thoughts. He continued.
"Changing the station didn't help, and the power off button worked as well as the volume, as in they didn't. Useless. Every dial was useless. It was driving me crazy, doc...I knew I had to pull over, I was getting light-headed, and then I saw it. The only building around. I was so relieved to see other cars in the parking lot. Just a few but goddamn it was a good sight to see." He said and chuckled nervously, shaking his head in disbelief.
"If only I'd known, right? So I park and get out of my ride, and do one of those fast walks up to the building. This place was like a truck stop mixed with a convenience store, you know the kind. The type a family would stop at on their way to a vacation to get their kids snacks and drinks, yeah. So I think, 'why not grab me a snack and drink'. I was already starting to shake that paranoia and was calling myself silly, pushing the unexplainable from my mind as I opened the glass door. That little jingle bell attached to it startled me, but in a good way. It was the first non-robotic sound I'd heard in a while. Inside, it looked normal, like you'd expect. Rows of candies and chips, florescent lights shining onto white floor tiles, and most importantly there were other people. I was never happier to hear a fuckin' baby cry, man." Jack said, flopping back into his chair and lighting another smoke.
I remember now, recalling everything with the recorders aide, the way Jack's face sank. There was silence, and I take the moment to top off my scotch. I know what's coming, and the warmth the alcohol fills my body with is competing with the chill in my bones.
"Jack...?" My past self urged.
"Yeah. Yeah, right, this is where everything got fucked." He said softly, almost as if asking permission.
I nodded, and he proceeded to take the reigns, determined to tell his tale.
"When me and Dani were kids, and I'm talking little, like I was maybe eight or nine, and she was probably six... there was an accident. See, you know how when you're little you're carefree and don't think about consequences or shit? So there we were playing outside right, and we come across a knife. Like a kitchen knife. We both knew we weren't supposed to mess with shit like that, especially rusty shit that looked like it had been dropped years ago by like a family moving or something. Anyway, we thought we were badasses. Long story short, I got stabbed in the belly. It was an accident, like I said we were kids. It was pretty bad though, had to get stitches, a tetanus shot, and Dani got a good hard talking to. It left this gnarly scar. It's important, so remember it, yeah?
"Anyway, back to the convenience store. I'm noticing more people, let's see, we got crying baby and mamma, overweight trucker, bald dude in a suit, a really cute lady, and a few others. Oh yeah! The tired looking guy manning the cash register, which doubled as one of those bubblegum stands with stacks and stacks of cigarettes behind him.
"Things are looking normal, right, and I'm starting to forget about the weird shit in the car. I'm sure I just had some weird cell service and the radio was just glitchy. So I grab a bottle of pop from the back cooler and grab a bag of sunflower seeds, yeah...head to the checkout.
"Dude gives me a 'hey, anything else for you?' right, and I say 'yeah lemme get a pack of smokes' and point behind him. He turns around grabs the pack and goes to hand it to me, but freezes just as he starts to extend his arm. From his mouth comes a deep but light 'Wuhhhhhhh' sound." Jack imitated the sound and produced an eerie, unsettling noise that was like a low moan.
"I was about to ask the dude what the fuck was wrong with him, but just as I opened my mouth a loud rip of thunder cracked outside. It sounded deafening, like lightning had struck right next to me. The lights went out and the glass front of the store lit up a brilliant, electric blue. I turned my attention to it, and saw streaks of lightning slashing the sky like some huge electric god was swiping it's claws across the clouds. The blue sky was gone, and in it's place was blackness.
"I turned back to the guy behind the counter. He wasn't doing that sound anymore thank fuck, but he was still frozen in place, pack of cigarettes in his outstretched hand. I reached out for them. I don't know why I did it, but at the time I wasn't thinking clearly I guess. Anyway, I did, and as soon as my fingers touched the box of cigs...its like...like my perspective shifted or something. My vision kinda adjusted, and I could see that he was...he was a standee. A cardboard cutout. My fingers sat on the flat, glossy surface and I felt the urge, the need to press. So I did, and the flat standee with the image of the cashier on it, it fell backwards, softly dropping into the floor.
"I freaked. I gasped, unable to catch my breath. I stumbled backward into what had been a display of snacks, but now was just a rectangular protrusion sticking up from the floor with the images of snacks painted on. I bolted over to the glass window as another impossibly loud crack of thunder clapped in the sky above. Rain was beating the windows, blurring the world outside, but what I could make out was just as insane as what was happening inside.
"All of the cars aside from mine were gone, and my blue sedan sat on the edge of what looked like a cliff. I scanned with my eyes squinting, and saw that it was as if the ground had been ripped from the earth. Beyond the jagged, torn earth was blackness. Nothingness. At that point I was sure that a gigantic hand had reached down from somewhere beyond the cosmos and grabbed the convenience store and dragged it into space.
"I began to scream, turning to see that all of the other patrons were static, as flat as the cashier had been. More standees, right, and I saw that everything in the store was a farce. The rows of snacks, all fake. The displays, fake. Fuck, doc, even the big round security mirrors in the upper corners of the aisles looked like circles painted grey, not a hint of reflection to them.
"Still screaming I looked for the door. Nowhere. The door was fucking gone. I looked back to my car, and the thing...it was dissolving. Being washed away by the rain. That's when I heard a voice, echoing my own thoughts. 'what the fuck is happening!?' she said. I whipped around and saw a girl sitting on her ass, lit up by the blue glow from the constant streaks of light in the sky, I could see that she was terrified." Jack took a moment to wipe the tears that were falling down his stubbled cheeks, and lit another cigarette before speaking again.
"She looked about 19 or 20. I didn't recognize her, but she wasn't cardboard and I considered that a win. I stopped screaming and ran to her, offering her my hand. I was saying 'thank god, thank god' so happy to not be alone, you know. She looked relieved too, through her tears and terror she looked happy to see me, too. She took my hand and I helped her to her feet. As soon as she was standing her eyes widened to the point I expected they'd fall out. 'What in the fuck are those...?' she asked me in a panicky whimper. I turned to see the silhouettes standing motionlessly at the window, back-lit by the blue, contrasting their glowing red eyes. They stood shoulder to shoulder, encircling the building. Silently they stood guard as the storm raged around then. With each flash of lightning I caught a glimpse of their nightmarish, metallic surfaces. Skeletons. They were metal skeletons." Jack halfheartedly chuckled at this, clearly it was forced, judging by the way his eyes continued to pour their tears.
"Felt a little like John Conner. Not as brave though, as my instinct was to pull the girl along with me to the back of the store, trying to put as much distance between us and those...fucking things...as I could. They made no attempt to chase though. They just watched as we pressed our backs to the facade that used to be coolers. The girl was breathing hard and fast and suddenly she shrieked out 'look!' pointing a finger to an ugly green door nearby.
"We had no other options, so we booked it. We got to the door only to see that it was lacking a knob. So it seemed we were fucked, yeah? Not quite. I unleashed a fury of kicks on the bastard, forcing it open with a spray of splinters. We hurried through into a storeroom, I guess is what it was. It had what looked to me like a mop bucket and spray bottles, but I couldn't be sure since they were extremely crude and appeared to be made of papier mâché . The girl had rushed to the back of the room. 'Look!' she pointed to a ladder that was attached to the back wall.
"My eyes followed it up to see a hatch. Roof access! Almost instantly, I heard the glass front of the store shatter, the sound of hurricane like winds began to fill the building. 'Hurry!' she shouted over the gale, waving me up. I did go up. I climbed and climbed. First ten feet, then twenty, then thirty. The hatch only inching closer. I refused to look down. I KNEW that I'd been climbing for way too long, much higher than I knew the trip should have been. The hatch continued to move ever so slowly closer, and I was completely aware that the room was getting smaller as I climbed. The walls closed around me until I was surrounded by a cylinder of concrete, no wider than a manhole cover. I could hear the girl following closely, but no words were exchanged.
"Finally, after climbing hundreds of feet into the air, I'd reached the hatch door. I was terrified as I grabbed for the handle. I didn't want to lose my grip and fall into whatever hell was below. I pressed it, and opened it despite the resistance. I was able to climb out of the claustrophobic hole and onto the roof. As soon as I was free, I turned to help girl. You're probably expecting me to say something like 'she wasn't there, right?' Oh no, she was there. A fucking cardboard cutout reaching up for me. As soon as I recognized it, she fell from the ladder and softly descended into an orange glow far below. I stood, feeling the wave of anxiety crushing me, and I watched the hatch slam closed. Before I could react, a brilliant white light from above blinded me. I felt myself fading from existence, my atoms separating. I lost myself.
"The next thing I remember is the white light dissipating, and my eyesight coming back, blurry at first, but it focused as my hearing returned. I can't quite explain what I heard. It was organic but mechanical at the same time. Clicks and whirring. I blinked a few times, and blinking felt so weird, like my eyes were different. I flicked them around, and when they landed on the two absurdly tall, scale covered insectoids, I was thrown into a panic attack. I tried to move, to get away...but I found that I couldn't. I was restrained, apparently on my back, my limbs and head tightly fixed to whatever I was laying on. My rattling had drawn the attention of the creatures, who looked at me with bulbous eyes. The clicking and buzzing sounds had been coming from them, and I found that thought especially horrifying. They began frantically pressing buttons on a panel seemingly connected to whatever was holding me in place...some kind of operating table or medical bed I assume.
"Then, the strangest thing happened, doc...my head cleared and the buzzes and clicks...I began to comprehend them. I was almost able to understand. I was getting words like 'awake' and 'hurry'. Then, the most intense pain of my life ripped through my brain. I screamed, and was terrified to find that the scream wasn't my own. I heard one of the creatures clearly through the pain, and it said 'put it back in. If it crashes again we'll deal with it at that point' and the other replied 'there may be errors' as it pulled a lever. The instant that happened, I felt the sensation of dissolving again, my molecules separated and rearranged...the intense light filled my vision once more.
"Next thing I know, I'm hearing a ringing. My vision unblurred and I saw that the sound was coming from my phone, already in my hand. I look around to find that I was free of any restraints, and back in my apartment here in the city. I answered the phone and Dani's voice filled my head, distant and muffled at first, but rapidly becoming sharp and clear. 'Hey bro, just checking in on you, what have you been up to...?' she asked. 'Dani, Dani, I was on my way there, and something happened!' I shout. 'Whoa calm down, what's going on? Why were you coming here? Is everything okay?' she said. She sounded concerned, but a bit standoffish.
"I told her I was coming to the funeral. 'Who died?!' she asked. I was quiet for a moment, remembering what the insect creature had said. 'There could be errors'. I lied and told Dani it was an old friend of mine from school, and that I'd call her about it later.
"That's about it doc. That's what I've been dealing with. I don't know what to think. Am I some kind of experiment? Am I a criminal among a race of bug-aliens and this world my prison? Is this whole world, no, universe some kind of simulation just for me? Doc, I don't think I'm human, hell I'm not convinced the human race ever even existed. If I die, is it possible that all of this gets blinked out of existence? Is that possible, doc?!" Jack said through a torrent of tears.
"Jack, isn't it much more likely that this was a psychotic break? Tell me, do you have a history of drug abuse?" I ask, but just as I do, a voice from the recorder interrupts.
"Doctor, your next appointment is here." Marnie says.
"We'll pick this up next week, Jack." My past self says, and I hear myself stand from chair. I wince, dreading the last thing Jack ever said to me.
I clearly remember him standing, and raising his shirt, revealing a smooth, thin, but unscarred stomach. "Errors. There may be errors." Followed by the sound of my office door opening and closing.
A long moment of silence followed, before I heard myself ask Marnie to please cancel my remaining appointments for the day.
The recorder clicks and brings me back to the present. The storm continues outside. I find myself contemplating Jack's story for the millionth time. He never came back for his next appointment. Its entirely possible that he had simply lied about the stab wound, but the look on his face, I don't know. Is there a chance that he really did experience these outlandish things? If so, what does that imply?
Maybe that's why I decided to share this with the world tonight. I no longer wish to bear this alone. I think chronicling this, while it's definitely a breach of my confidentiality agreement, is the healthiest thing for me. I wish I could purge his story from my mind, but I can't help but be uncomfortable when it storms.
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