Chapter Text
"Open your fucking locker, or I will have security smash it open."
Langdon entered the key code. He looked like a cornered animal.
Robby saw the pills in the locker and felt his face flush and his skin burn. He sighed deeply. "Are the imprint codes on these pills gonna match Louie's Librium?"
"No, it's not like what you think." Langdon launched into an explanation. He had been brimming with energy all day—speaking fast, moving fast—but he was now speaking so quickly that Robby couldn't even understand him. Even when Robby could make the words out, it was difficult to understand Langdon's train of thought. He had to raise his voice just to get a word in edgewise.
"You are going to have to slow the fuck down, because I did not get any of that."
"I was just weaning myself off. It was for maintenance. I'm sorry, I fucked up. I was just trying to—" Langdon's speech was still pressured, but it had slowed to a comprehensible rate. His tone was desperate, almost pitiable, but Robby was unmoved.
"Trying to what? Steal pills without getting caught?"
"It's not like you think! I'm not high. You've seen what I do, Robby. I'm fucking great at my job. I'm killing it, all the time. Could a drug addict do what I do?"
At this point, something clicked. Robby had never seen Frank manic, but all the signs were there. Was the benzo taper what set him off? Or was he replacing his mood stabilizers and self-medicated with benzos? "If I get lithium blood levels on you, are they gonna be under point 6?"
"That has nothing to do with this and you know it. I have my mental illness under control, unlike you!" Langdon's voice was getting louder and faster.
"Unlike me? Langdon, what the fuck are you talking about?"
"Fuck you. You've been a nightmare to work with since Addamson died." This really stung. When Langdon told Robby about his diagnosis at the beginning of his residency, Robby had given him so much grace. He'd kept it quiet from the rest of the department, he'd made sure to set schedules that worked with Langdon's social rhythm therapy, and he'd even stayed on the phone with him for long hours during Langdon's depressive episodes. Now Langdon no longer showed any sign of gratitude or even mere acknowledgement.
"I'm a nightmare? Oh, I'm a nightmare? You're the one blowing up on interns and stealing fucking drugs from patients. I'm not letting you leave without a psych evaluation, and preferably an inpatient stay for detox. Go to BH-2, or I'll call security."
"You're seriously putting me in a glass cage, in front of the whole department? You're just doing this to humiliate me after I criticized you." Langdon was now shouting loud enough to be audible to the whole department, and speaking fast enough that Robby couldn't get a word in edgewise. His voice choked for a moment. "You're trying to ruin my career!" He pushed Robby against the lockers to underscore his point.
How the fuck was this happening? God, what a shitshow.
Robby was taken off guard, but in a moment he pushed back, pinning Langdon to the wall. Langdon had the speed and of strength of someone too agitated to know their own limits, but his reaction time was impaired by the benzos, and Robby was heavier and much stronger.
"I'm trying to get you help because you need it, and honestly, the whole department needs it." Robby's voice had raised to match Langdon's in volume, if not in speed. "If you don't like it, I will go through the process to get you involuntarily committed, which will be much worse for your career."
Most of the department heard the end of their conversation. Many of them had dropped their work to watch. They stared as Robby and Ahmad forcibly brought Langdon to BH-2. "It's her," Langdon shouted as he gestured his head in the direction of Santos. "She's trying to fuck me over."
Santos watched apprehensively. Presumably being frog-marched into a behavioral health room means Langdon was fired—but she had a target on her back. How were people supposed to understand that this isn't about revenge?
Then again, writhing against his restraints and ranting at an exhausting pace, Langdon looked exactly like one of the patients she had seen during her psych rotation. Everyone else here would see him that way, right? Even though he was their beloved colleague? Santos didn't even know if Langdon seemed that charming on a normal day, or if that was just mania shining through. She'd had enough friends with bipolar to recognize that sparkle. Honestly, it was really fun to ride their hypomanic energy vicariously—but her friends weren't fucking stealing benzos from a fucking hospital.
She could barely focus on her work. People would just see her as an incidental target of Langdon's manic irritability. They might not even know she reported him at all. When he got back, they might think of him as a sympathetic figure who was just sick, not a thief and a liar.
"What's happening to Langdon?" Mel's mouth was dry. Their heart raced.
"You know how he crashed out on me earlier?"
"Crashed out?"
"Went apeshit, lost his cool, threw a hissy. Apparently, he fucked up big-time and when Robby called him out on it, he exploded. He might be having some kind of episode." As usual, Mel took Santos at 100% face value.
"I thought he was a good mentor." Mel was hesitant.
"Maybe to you he was."
Mel grimaced and squeezed their sides tight. They would get close to their mentors, like Baran at the VA, but Baran told them she wouldn't get that close to them because it would create a dual relationship. Langdon seemed different. Langdon seemed like he could be an actual, real friend—and Mel didn't have a lot of experience having friends at all.
"Wait, an episode? Is he sick?" Mel had an idea of where this was headed. They once had to take Becca to the hospital for behavioral dysregulation. Even though it turned out to be caused by the flu, both siblings got a brief view of psychiatric hospitalization: Becca as patient and Mel as visitor. The acute psych floor had been bleak and overstimulating.
"Guess we'll find out, huh?" Santos left the room to work on a case. The lights in the ED were piercing. A heart monitor several rooms away sounded like a car alarm right next to Mel's ear.
They also left the room, heading for the stairwell.
McKay could remember the first time she was hospitalized, but not quite the events leading up to it. What she was told was she was causing a disruption on the T. What she remembered was the feeling of some kind of revelation that she had to spread to the world. She remembered a sense of power and possibility, a belief that everything was in her grasp, but it was always hard to remember what actually transpired when she was manic. The crash afterwards is what she would remember in brutal, painstaking detail.
Langdon was young. He probably hadn't been through enough episodes to recognize the destruction they caused. He might not even have a diagnosis yet. It would be unfair to think that he just didn't have his shit together.
She reminded herself that even after years of Depakote and sobriety, on an off day after a bad night of sleep, this could have been her. McKay wondered if she looked like that during her manic episodes: struggling, raving, almost possessed by an inhuman force.
She looked at her ankle monitor, thought of the wired, edgy state that led up to it, and looked back at Langdon. She couldn't reminisce any longer. There were patients to get to.
As Caleb approached BH-2, he hoped that the EM docs had gotten the patient adequately sedated without knocking him out, but given their track record, he wasn't betting on it.
Hell of a coincidence that a psych case named Frank Langdon shows up in the ER during one of Langdon's shifts. Caleb had treated more than a few Jeffersons before, a few Calebs, and even one Dr. Jefferson (a Ph.D. in computational linguistics at CMU, as it turns out), and it tickled him every time.
No.
Not a coincidence. Is that why Robby wasn't giving any details on the phone?
From outside the glass he could tell that his patient—his colleague—was sedated enough. Tired, but not asleep; still angry, but not pacing or shouting. At the sweet spot of olanzapine dosing, mania and psychosis evaluations were usually easy. Check for SI and HI, administer the Young or Altman scales, put on the waiting list for a psych bed.
This was not going to be the same. Technically, this was going to be easier. He had plenty of collateral on Frank's baseline and he could easily get some on his current behavior. Ethically, it was fraught to treat someone he knew—but all the psychiatrists in PTMC would have the same problem.
Emotionally, it was brutal. His heart sunk seeing Langdon sedated and trapped like a caged animal. Well. Time to open the door. Can't hold off any longer.
As Caleb entered the room with Ahmad, Frank immediately turned to him and pleaded, "Caleb, you've gotta help me. Robby and this new kid, Santos, they're trying to get me fired for some made-up bullshit. She doesn't like that I called her out for not being a team player, so she's manipulated Robby and gotten me." He spoke rapidly, as if a dam had broken inside his head.
Okay, he could check off one item on the scale, for talking much more than usual—and this was after 5 of olanzapine, so he knew Frank's speech had to be even more pressured just 10 minutes ago. Paying attention to the technical details—the scales, the drug dosing, the diagnostic criteria—helped Caleb detach himself from the actual emotional experience of seeing Frank one of his worst days. "Frank, you know I want to help you out, but I need you to take a few deep breaths. Can you do that for me?"
Frank was irritated at the request, but he seemed to still trust Caleb. At first, he looked like he wanted to crawl out of his skin just at the effort of staying still and silent, but after a minute he had calmed down noticeably.
"I can tell you're really stressed out by this. How have you been sleeping?"
"I can keep kicking ass here on only 2 hours a night. I've figured out a trick everyone else in the Pitt hasn't." Definitely checking the boxes for 'much more confident than usual' and 'decreased need for sleep.'
Caleb had heard this from dozens of patients. There's no trick. The trick is mania. But Caleb has to stay curious about what Frank's internal experience is, and that includes his overvalued ideas, or even delusions, about his own capabilities. He was reminded of every time he saw a college kid come in, usually during finals week when their circadian rhythms were completely shot. It was heartbreaking every time—it was even more heartbreaking when it was an acquaintance, a colleague, even a friend. "And what's that?"
"I've totally locked in. And people here are jealous of it. Like that new intern, Santos, so she's trying to undermine me and it might cost me my job." Caleb noticed that Frank neither answered his question nor was able to keep to a consistent topic of conversation, but his speech was slowing down and his demeanor was becoming calmer and calmer. Now he might have the space to determine whether the story about Santos was a paranoid delusion or based in reality.
"Can you say more about what she's done, and why you're worried about getting fired?" Caleb knew was important to take this seriously as a sign of the world that Frank was living in, even if it wasn't currently the same world as everyone else.
"She told Robby that I was manic and that I was stealing benzos from the hospital. Then Robby was fucking gullible enough to believe it and sent me here." That's a serious accusation, and Frank could be so charming that Caleb's first thought was that it couldn't possibly be true. A second later, he remembered Robby even told him over the phone that he had proof. If he had even the slightest doubt, Robby wouldn't accuse his favorite resident of a serious violation of patient safety.
Caleb paused for slightly too long, and Frank took over the conversation again. "I'm not an addict! I was on muscle relaxers but I've been tapering off—you know it's a tough taper, I've seen you come in as a consultant-liaison on benzo withdrawal seizure cases several times—but I've got it under control! I have everything under control right now!" Caleb quickly checked Frank's chart: no current benzo prescriptions on file.
Frank was finally talking at a normal pace, allowing Caleb to continue the interview, but he was still emotionally revved up. Questions like 'have you been stealing them from the hospital' or even 'where did you get them' might be enough to agitate him—not into violence, not at this point, but enough to make the rest of the interview very unpleasant and difficult for both of them. He chose his words delicately. "Do you know why Robby would accuse you of stealing them?"
"He just believed a stupid fucking story that Santos made up. Then he confronted me in the locker room and pushed me against the wall and had security force me into this corral." That's not the story Robby told. Caleb had seen it before—patients with mania could have difficulty keeping track of the sequence of events, so Frank might not have even been consciously lying. Yet from the guilty look on his face, Caleb surmised that even if Frank's memory was mistaken about today's events, he was still trying to hide the fact that he stole benzos from patients. That's not just excessive involvement in risky activities, it's something that should be reported to the board of emergency medicine.
Caleb had seen enough to make up his mind about what was going on. The rest of the interview was just to pacify Frank enough that one of the nurses could come in and get his lithium levels. Then he would be admitted, with an order for either lithium—enough to get his blood levels above 0.6—or risperidone. Maybe both.
Langdon could recognize the olanzapine starting to hit him. He suddenly felt tired. Multiple days without sleep had blended into one day spent running at maximum capacity, and he was out of fuel.
The drug muffled most of his emotions, but the red sting of humiliation still broke through.
He fucked up and everyone saw it—everyone saw him upbraided by Robby; everyone saw him behaving like that. He knows what's next: the crash, the regret, weeks of self-loathing and exhaustion.
If only he could just make it stop; if only he had any control when he was withdrawing. None of his colleagues staring at him had any idea what withdrawal was like. Feeling like every nerve on his skin was running hot and cold simultaneously. Heart racing like he was running for his life. Completely unable to tolerate any frustration, anger out of control, convinced that something awful was about to happen to him. Can't eat, can't sleep, can't sit still, can't focus well enough to do anything but pace. Withdrawing felt even worse than what he was going through now.
He thought maybe people would be more understanding if they knew. But everyone here had seen a list of signs and symptoms of benzo withdrawal; there was no way to make them actually feel it.
Nothing to do now but sit on the bed and wait for a psych bed. He watched Dana make a phone call. He could barely make out what she said, but he thought she started the call by asking "Is this Abby?"
He remembered her face the last time he had an episode. He remembered his kids' faces, uncomprehending and disillusioned. He felt like he would tear up if it weren't for the olanzapine.
He was still thinking about what it's going to be like to see his family's faces, whether they'll even visit him in the hospital, when he saw Robby assemble the doctors and nurses. "There's an active shooter at Pittfest." Robby is speaking loud enough to hear even through the glass.
Langdon should have been out there. He was part of the team—one of the best on the team, Robby's favorite resident for a reason—and they needed all the hands they can get.
Abbot enteres the room, accompanied by two techs wheeling in massive boxes of supplies. "There's been a mass casualty incident."
"I heard. Listen, I—"
Abbot didn't let him finish that thought. "We need to use the behavioral health rooms to store supplies. We've got to get you out of here."
"So I can get back to doing what I do, which you need, especially right now."
Abbot shook his head. "No, you're getting transferred upstairs to psych."
"You're going to be better off with me out there, trust me." Langdon's head was still fuzzy, still spinning, but he thought he could do a better job than a med student. An hour ago, he knew this. He was getting less and less sure of it the longer the olanzapine stayed in his system.
"This isn't a negotiation."
As he was forcibly escorted from the room, he noticed the ongoing conversation between Robby and Mel. Mel had a worried grimace. He didn't catch what she said, but he did hear Robby's response.
"Trust me, he's in no state to practice medicine. There are other reasons I don't want him here right now, and I'm not going to discuss them with you."
Then Langdon and Abbot reached and entered the elevator.