Chapter 3
Hope
"Mr. King." I knock on the open door frame. "Mind if I come in?"
He turns his head. "Sure. It's Thomas."
His room is clean. Bed made, corners tucked, shoes lined up under the desk. The shoes haven't been worn—the soles are still white. I pull up the chair and sit across from him.
"Thank you, Thomas. How's your week been?"
"Good," he says. His pupils are pinned tight even in the low light. Eleven months on the same dose, no reassessment, no stepping down, no note from anyone asking whether the anxiety they prescribed it for still exists. The prescription went in and nobody looked at it again.
"Do you know when your next medication review is?"
He blinks at me. "My what?"
"Let me look into that for you." I thank him for his time and close the door behind me.
Ward A holds twenty-six patients. General population, lowest risk tier, shared common areas and supervised outdoor time. Most of these men eat together, attend group therapy, move between their rooms and the day room without an escort.
Every patient has a chart. Every chart has a medication log, incident history, and treatment plan. I go room by room. I introduce myself. I ask how they're doing. Most of them talk. A few don't. I don't push the ones who don't. I read their charts, write down what I see, and come back the next day.
A man named Bryan tells me his antipsychotic makes his jaw lock up and nobody's adjusted it. I ask how long. He says since March. It's October. Seven months of a side effect logged nowhere in his chart. His hand shakes when he demonstrates how his mouth won't open all the way in the mornings.
Another patient, Yoon, hands me a three-page letter he wrote to the governor about the food and asks if I can mail it.
I tell him I can't, but I can document the complaint.
He thinks about it and hands me the letter anyway.
His handwriting is small and precise. He's been thinking about this for a while, and until today he didn't have anyone to hand it to.
"Thank you," he says. "For reading it."
"Of course." I fold the letter and slip it into my folder. "I'll make sure it's noted."
Room by room. Chart by chart. Eight days in and I'm running out of space. The notebook I brought is a hundred and twenty pages. At this rate I'll need a second one by next week.
In the common area, a man with sandy hair looks up from a half-finished jigsaw when I walk past. He's younger than most of the ward—twenty-four, maybe twenty-five. He watches me cross the room, and when I catch his eye, he smiles. A real one. The first I've seen in this building.
"Hey." I smile back. "How are you?"
"Good." He holds my gaze a beat too long. "You're new."
"I am. Hope Turner. I'm the independent monitor."
"Casey." His smile doesn't waver. "Welcome to the madhouse." He glances at my lanyard. "Hope Turner." He says it back to me, slow and full. "That's such a beautiful name."
I give him a small wave and move on. Nice kid. I add his name to my list for chart review.
Ward B sits on the second floor. Higher security, individual cells, supervised movement, narrower corridors. I sign the clipboard at the checkpoint and the guard buzzes me through without conversation. He doesn't look at me, doesn't acknowledge me, hits the button and goes back to his phone.
George Palmer's cell is third on the left. He's a big man, mid-fifties, quiet. When I knock, he's at his desk writing in a notebook with a pencil sharpened down to a nub.
"Mr. Palmer? I'm Hope Turner. The independent monitor."
He looks at me over reading glasses that sit crooked on his nose. "The new one?"
"Yes, sir. Can I sit?"
He nods at the chair. I sit. His cell is different from Thomas'.
Books stacked along the desk, spines creased and re-creased.
A history of the American West. A collection of short stories.
A library request form pinned to the wall with a list of titles, half of them crossed out.
Denied or unavailable, I can't tell which.
His notebook is open to a page of tight handwriting, pencil marks pressed hard enough to indent the next page underneath.
I tilt my head to read what he's working on.
"Is that about the Dust Bowl?"
He glances at his own writing, then back at me. "The Okies. Their migration patterns." He taps the pencil against the page. "Most people think it was just Oklahoma, but it was Kansas, Texas, Colorado, and parts of New Mexico."
"That's a lot of ground to cover."
"Well." He straightens his glasses. "I've got time."
I ask about his treatment plan, his medication, his access to the common area. He answers everything.
"When was the last time you had an independent review?"
His pencil stops. "They told us one was coming last week. Before that?" He thinks. "A year ago. Maybe longer."
His file lists the last independent monitoring visit as fourteen months ago.
George watches me write it down. His face stays still, but his shoulders drop an inch. He relaxes into his chair.
"I'll be back, Mr. Palmer."
"I don't doubt it," he says, and goes back to his book.
Gage badges me into Ward C. The security office is the same as before—desk, filing cabinet, two monitors cycling through camera feeds.
I pull Jude's sedation record from the cabinet while Gage leans in the doorway behind me.
He doesn't ask what I'm looking for. He doesn't offer to help.
He stands there, arms folded, watching the corridor.
I open the file. The numbers run in a column—dates on the left, doses in the middle, signatures at the bottom.
Twenty milligrams IM diazepam. Logged at 06:00 this morning.
I check for a corresponding incident report. There isn't one. No Code White. No documented event. No reason for anyone to put a needle in his arm at six in the morning.
On the monitor, Jude is on the floor of his cell doing push-ups. Full range, controlled, his shoulders rolling through each rep. His breathing is even. His eyes are open.
I look at the file. I look at the screen.
Twenty milligrams of IM diazepam should flatten a man his size for hours. It should slow his coordination, blur his motor function, keep him down. The man on the screen is doing push-ups. That doesn't add up.
Either his tolerance has outrun the dosing so far that twenty milligrams doesn't touch him, or the log is bullshit.
"Gage." I don't look up from the file. "What did he do this morning?"
Silence. I wait.
"Nothing." Gage shifts his weight in the doorway. "He didn't do anything."
"Then why is there a twenty-milligram dose logged at six a.m.?"
He doesn't answer right away. When I glance back, his jaw is tight and he's looking at the corridor, not at me.
"They've been dosing him ahead of incidents. Trying to prevent them." He pauses. "Hasn't worked. He's built a tolerance."
I sit with that for a second. They're sedating him with no precipitating event. No documented behavior. No clinical rationale. Just a needle at six in the morning because it's easier than dealing with him awake.
Both are reportable.
I pull the incident records.
Three Code Whites in nine days. I was here for the last one—my first afternoon, watching a six-man team pin him to a bolted bed while a nurse pushed a needle into his shoulder.
All three reports use the same sentence.
Word for word. Patient risk assessment necessitated chemical intervention per facility protocol.
Three separate dates, one copy-pasted paragraph, no description of what the patient did, no de-escalation notes, no clinical rationale.
The third report—the one I watched—has no dosage in the field. No signature. Filed and never finished.
I spread them side by side on the desk. The dose from this morning sits above three Code White entries at forty, fifty, and blank. Preemptive doses with no incidents. Incident doses with no details. Every one climbing.
I pull a fresh page. The dosing pattern tracks staff convenience and disciplinary response, not clinical need.
I read it back. I underline staff convenience and disciplinary response. I put the cap back on my pen and sit with it.
Facilities prefer language that doesn't name what's happening. Further review recommended. Data suggests possible discrepancy. I know what careful looks like. I've written careful before.
This isn't going to be careful.
Nolan from admin finds me in the corridor on my way out.
He's mid-forties, thin-shouldered. He wears his ID badge centered on his chest pocket and walks with his elbows tucked in. He falls into step beside me without being invited.
"Ms. Turner. I wanted to catch you before you left." He holds a printed copy of my preliminary report. "Dr. Hudson asked me to pass along some feedback."
"Okay."
"Your observations in Ward A and B are thorough. Very thorough." He pauses long enough for me to understand that thorough isn't a compliment. "There are a few areas where the language could be... refined."
"Refined how?"
He opens to a flagged page. "This section. Where you reference the medication schedule in Ward C." He reads from my own words. "'The current sedation protocol appears disproportionate to the patient's observed behavioral baseline.' Dr. Hudson felt the word disproportionate was... strong."
"It's the right word."
"He'd prefer something less—"
"It's the right word." I stop walking. Nolan stops half a step later and turns.
"I understand that Dr. Hudson has opinions about my language.
My report reflects what I observed. If the facility wants to dispute my observations, there's a process for that.
But I'm not going to change a word because it makes someone uncomfortable. "
Nolan's mouth pulls tight. He folds the report and tucks it under his arm.
"I'll let him know. He asked me to suggest you... consider your language. Going forward."
"Noted."
He nods once and walks back the way he came. His shoes squeak on the linoleum. I watch him go, and I don't move until he rounds the corner and disappears.
The parking lot is half-empty by the time I push through the main doors. The sun's gone behind the ridge and the air has that thin Colorado bite. I zip my jacket and dig for my keys. My car sits in the third row. Same spot every morning because I'm one of those people.
A paper bag sits on the hood.
I stop walking.
It's a blueberry muffin from Cliffside Roast. Something I mentioned once, to one person, in the break room four days ago. He didn't even look up from his phone when I said it.
I turn around.
Gage's truck is parked three rows over. He's leaning against the driver's side door with his arms folded, looking at his phone. He doesn't look up.
"Gage."
He glances over. "Hmm."
"Thank you," I say, holding up the bag.
He nods, pockets his phone and opens his truck door. Before he gets in, he pauses.
"Drive safe, Hope."
I watch his truck pull out toward the road. I take a bite of the muffin. It's good.
In my car, I set the muffin in the cup holder and open my notebook. The pages from today are messy. Notes crammed into margins, arrows connecting observations to questions. Thomas. Bryan. Yoon. George. Three wards of charts that don't add up and a sedation log that tells a story nobody's reading.
I flip to the dosing sentence and below it, in the margin, I write a new question.
Why does the dose only ever go up? Are they trying to control him or kill him?
Years of dose adjustments. Every one an increase. Not one reduction. Not one review that concluded the patient needed less. A chart that moves in one direction, and nobody thought to ask why.
Mishel would tell me I'm overthinking it.
I close the notebook and start the car.
On my way out of the lot, I pass the Ward A common room windows. The lights are still on. Casey is standing at the glass, watching my car pull away. His hand flat against the window. His smile gone.
I don't think anything of it.