Do you know anyone who’s crazy? I don’t mean wild, fun-at-a-party crazy, or angry and yells-a-lot crazy, or quiet and likes-to-be-alone crazy. I’m talking mentally ill, a serious and sometimes tragic illness. Mental illness comes in many forms, with odd names like schizophrenia and bipolar disease. Often, it can be challenging for doctors to diagnose and effectively treat.

I’m an ER doctor, an emergency physician. I worked for many years in a busy emergency room near Seattle where we would treat up to two hundred patients a day. The arrival of patients suffering from mental illness was a common occurrence. In most communities, the ER is where a decompensating mentally ill person first encounters medical care. It is often the only available resource for such patients, especially after hours and on weekends. Primary care doctors and urgent care doctors usually send such patients to the local emergency department. Families bring their loved ones and the police bring people wandering the streets who are not acting right.

We knew the police well in our community. Few days went by, or more often nights, when the police didn’t bring us patients who could no longer take care of themselves, who were out on the streets, being disruptive, or putting themselves in dangerous situations. Often, drugs and alcohol were part of the problem.

Many people suffering from mental illness have delusions. They lose touch with reality, and develop a variety of false beliefs, fears, and hallucinations. Paranoid delusions are common (aliens have landed, there’s a radio in their
head and someone is controlling them, the devil is after them, etc.). They hear things, voices telling them to kill themselves, the belief that horrible insects keep buzzing around their head, and worse.

Such false thoughts and feelings are very real to these suffering souls and no amount of persuasion will change their minds.

Heartbeat is my exploration of such a descent into madness, the story of an ER doctor, Leon Mendel, who finds himself becoming delusional. He suffers from Brief Reactive Psychosis, an impairment that can occur in otherwise normal people under extreme stress.

It is a time of great emotional trauma in his personal life, which compounds the stress of working in an inner city trauma center. He begins hearing the voice of his twin brother who died in an accident at age six.

Leon becomes preoccupied with thoughts of his twin and the lingering death he suffered. As Leon has to deal with particularly difficult patient situations in the ER, his feelings of fear and depression grow. He begins hallucinating;
experiencing more than voices. Soon he is no longer able to hide his situation from his colleagues…

Written in the first person, present tense, the book brings the reader deep inside this delusional mind, exploring what this means to an otherwise high functioning, intelligent character.

Leon meets the mother of a young patient who recognizes his illness, and reaches out to help him. Theirs is an unlikely relationship. She suffers herself from alcoholism, and struggles with its ramifications, both emotional and physical. This, too, is a disease familiar to all ER doctors, with its myriad ramifications. But, she is otherwise a uniquely sensitive woman with her own challenging past.

As their relationship deepens she is able to help Leon work out the current dilemmas of his personal life, as well as explore and resolve the misplaced guilt and hidden memories of his childhood.

Heartbeat is also inspired by my hope to bring to life, for the reader, the workings of an inner city emergency department, the kind but determined people who work there, and the constant challenges they face. Heartbeat is a psychological drama, an adventure of the mind, a medical thriller, and a unique love story.

Samuel Finn is a retired emergency physician living in Seattle. He grew up in Dayton, Ohio, and attended medical school in Cincinnati, where Heartbeat takes place. He is currently writing a science fiction series.