A Country Doctor Writes:

At 3 o’clock in the morning the emergency room was quiet. The aroma of fresh coffee from the staff lounge seemed welcoming and reassuring as I slowed my steps walking down the long, chilly corridor from the on-call room in the old psychiatric wing of the hospital.

One week into my psychiatry rotation, with almost two years of residency experience behind me, I was on call for psychiatry for the first time.

All I knew about the patient I was about to see was that he was a middle-aged man who was “seeing things”.

I poured myself some coffee and took a few sips. My sleepiness dissipated as the coffee warmed my chest. Walking into the nurses’ station I got sassed about working on the psych ward now instead of where the real excitement was.

I gulped a few more sips and put my cup away in a corner where I might find it again later. Grabbing the chart, I scanned the available background information on Jan-Erik Melander, a married 45-year old engineer, who was “seeing things”.

He rose politely as I entered the room. His wife sat next to him, red-eyed and quiet. She looked sad and tired.

I introduced myself and we sat down. “What’s been happening?” I asked, in Swedish.

Jan-Erik sighed and pulled his long-fingered hands through his thick, unruly hair. His eyes were dilated and he must not have shaved for several days.

“Nothing has happened”, he answered with an impatient tone in his voice. His wife looked at me, then back at her husband.

“Tell him about the TV”, she said quietly.

He gave her an irritated look.

“You don’t believe me”, he hissed.

There was silence.

“Believe what?” I asked.

“It’s not just the TV. That just confirms it”, he said emphatically.

“Tell me”, I suggested.

“OK, I’ll tell you what I know”, he said in a low, controlled voice, pulling his chair closer while fixating his eyes on mine.

“I have come to realize”, he explained calmly, “that we are not alone in our solar system.”

I made myself nod.

“Analyzing various coincidences I have realized there is a planet at the opposite point in the solar system from Earth with the exact same molecular composition. Everything there is an exact replica of everything here, even you and me!”

I nodded again and let out a “huh”.

“It cannot be seen, because its location is exactly at the opposite point of Earth’s orbit around the sun.

I found myself in no hurry to end my encounter with Jan-Erik. It was an interesting thought, perhaps the plot of a sci-fi movie, and I didn’t feel alarmed.

As if reading my mind, he looked furtively around the room, moved within inches of my ear and whispered:

“In three days our planets will switch places. They will be here and we will be there, and then we will be annihilated!”

His eyes widened again and he raked his greasy hair with his long fingers.

“I happened to intercept one of their radio signals on the UHF band on the TV in the den a few nights ago.”

He got up and started pacing.

“Jan-Erik, please stop!” his wife sobbed. “You’re not eating, you’re not sleeping. You’re driving us all crazy!”

“None of you believe me”, he accused, his pale blue eyes boring into mine.

It was my turn to speak, to do something as the resident on call for psychiatry. Nothing in my medical school training had prepared me for choosing the right words.

“Are you the only one who knows?” I asked.

“Yes. Nobody else knows. Nobody else believes what I tell them.”

I thought for a moment.

“I don’t know what to believe”, I said. “You must be exhausted, the only one with knowledge of something this huge…”

“You’ve got to help me stop this”, he said. “There isn’t much time. We need to tell the government and the military!”

“I can’t help you get through to them, and I can’t help you convince them. I’m just a small town doctor manning the fort until 8 am”, I said. Inspired, I continued:

“What you need right now is to avoid exhaustion. You are already running on empty. If you hope to get through to someone in charge and have them take you seriously, you need to be clear-headed. My suggestion is that you stay here tonight, get a couple of hours’ sleep and figure out in the morning how to proceed. Nobody in charge is going to be available at 3:30 anyway.

He seemed suspicious.

“You’re safe here”, I reassured him. “You can sleep in one of our observation beds. Then, in the morning I will introduce you to the head of our clinic and he can help us deal with the situation.”

He hesitated. My heart pounded and my mind raced. Swedish law, at least in 1980, made it impossible to commit psychiatric patients involuntarily from within a hospital that provided psychiatric services. An outside physician had to petition the legal system for this. Besides, there was no indication at this point that Jan-Erik was homicidal or suicidal. Maybe he wasn’t even dangerous to himself or anyone else – yet.

“Maybe just a couple of hours”, his words interrupted my internal dialogue.

“A wise decision”, I affirmed.

Suddenly he flew out of his chair and darted toward the exam room window that overlooked the highway between the hospital and the nearby soccer arena. Before I was even out of my chair, he had opened the window and climbed up on the marble windowsill.

“Wait!” I called out as his wife ran over and grabbed his arm. “Don’t get hurt, and don’t wear yourself out!”

“OK”, he resigned. “I’ll stay until eight.”

I called for the nurse and an orderly and we brought Jan-Erik over to the psychiatric ward, where he was checked into a room near the nurses’ station.

I slipped away to the on-call room and laid down on top of the bed with my already rumpled scrubs still on.

An hour later, my pager went off. The charge nurse wanted me to come and see Jan-Erik. When I arrived on the unit he was standing on a chair, talking loudly to a couple of patients in the TV room. Their interest seemed to be fading quickly and as they turned away from him, he caught sight of me.

He put one foot on the back of his chair and reached for the skylight molding. Heaving his lanky body up into the light well, his legs wiggled in all directions. The wooden chair fell to the floor with a loud clatter and there he hung, legs still flailing about.

“You’ve got to get some rest”, I said as calmly as I could.

“OK, just help me down”, he said.

Together, the nurse and I guided his descent and he allowed us to lead him back to his room, where he finally settled down.

After morning rounds I was no longer responsible for Jan-Erik Melander’s physical or emotional safety. The assistant chief of the psychiatric clinic took over with a slight nod of approval after I presented the case history to him.

Driving home, I thought about the twin planets at opposite ends of the solar system and how Jan-Erik’s life had taken such a drastic wrong turn out of the blue.

At home I showered and fell into bed. I must have fallen asleep instantly.

I woke up at noon to the smell of fresh coffee. The sheets were twisted around my body. My heart was pounding and I felt clammy all over. My throat was sore and my muscles ached. I remembered running, screaming desperately to warn people about the impending switch of the twin planets.