An excerpt from Mars Hospital: A Doctor’s Novel.

“Patient’s ready. This one will be interesting,” Sally said with a smirk. “Mom brought her nineteen-year-old son in, and she says he’s the devil.” I rolled my eyes.

Terrific. I entered the room with trepidation and saw the patient sitting quietly on the exam table. He had bright yellow hair fluffed up and was wearing a Metallica t-shirt, all of which made him look like Beavis from the old MTV series Beavis and Butt-head. His mom sat in a chair across from the exam table. “Hello. What may I do for you today?”

Mom spoke right up. “My son is drinking our cat’s blood. He’s possessed by the devil.”

My eyes widened, and my gaze turned toward the patient. “Is this true? Are you drinking your cat’s blood?”

“Why do you think the cat runs away from me?” he answered. I guess that’s a yes. “Satan. Satan,” he shouted in-between cackles.

“You see? He’s possessed!” Understandably, mom’s tone was distressed.

“I am building the Ultrafire. I will be gone soon.” His mother explained her son was trying to build a spaceship he called the Ultrafire. He had taken apart her washing machine to construct it. He planned on flying from the city Mars to the planet Mars, where his wife lived. She was a true Martian. He denied taking drugs. Later, testing confirmed this to be true. On further questioning, the mother added the following history: Over the past few years, her son’s mental condition had steadily deteriorated. He had been an active, normal kid but around the beginning of his adolescence, he changed. He developed odd, ritualistic behaviors. He talked to himself. His grades in school plummeted. And, of most concern to his mother, he worshipped Satan. Of most concern to me, his mother reported he heard voices.

“This could be schizophrenia.” While treating anxiety, depression, and other common mental disorders was in my wheelhouse, schizophrenia was beyond my level of training. I ordered an immediate psychiatric evaluation. The psychiatrist agreed with my preliminary assessment, and the patient was hospitalized at the Mars Mental Treatment Center, an inpatient psychiatric facility adjacent to Mars Hospital. The center had a poor reputation, but it was the only center that would take him. Inpatient treatment for psychiatric conditions is difficult to obtain unless you have a lot of money or very good insurance. He and his family had neither. I hoped hospitalization would make things better for this troubled young man, but alas, it only made things worse.

A couple of weeks after the troubled young man’s visit, Sally read an online news report. “Guess who got arrested last week?”

“A patient scheduled to come in today?”

“No. It’s the devil himself.” Sally showed me a local news story about my young patient. He had been arrested at the mental hospital. According to the story, he’d assaulted two orderlies when they tried to prevent him from building an altar in his room. Staff had called the police, but before they’d arrived, he had barricaded his door using the bed and two chairs and had tried summoning Satan.

The police arrived, busted down the door, and forcibly restrained him. He became combative in the process and allegedly punched an officer in the face, all the while screaming “Satan will kill you all!” The punch had broken the officer’s nose. My patient was subsequently charged with attempted murder of a police officer. Bail was set high, despite his mother’s pleas. He was currently in the county jail, in solitary confinement.

According to the report, he’d pleaded not guilty and claimed he hadn’t hit the officer. His defense was mistaken identity. Satan himself had broken the officer’s nose, not him.

“How can they charge him?” I asked. “He’s mentally ill.” Unbelievable. “Surely this won’t go to trial. The police arrested him inside a mental hospital, for crying out loud. There’s no question he’s mentally incompetent. And attempted murder? For a broken nose?”

“This is Mars. He slugged a cop, so he’s going to prison. You’ll see.”

“This can’t stand. I’m calling his public defender.”

What the public defender said shocked me. “I’m not his public defender. He’s representing himself.” The public defender explained. He had initially been assigned to represent my patient, and he had demanded a competency hearing. He’d presented affidavits to the effect that his client had schizophrenia and wasn’t fit to stand trial. His client, however, had taken issue with this defense. He’d told the judge he was just fine and wanted to represent himself. Shockingly, the judge had ruled in his favor. It was a travesty.

When the case went to trial. It was a spectacle. People lined up early in the morning at the courthouse to get a seat to watch the show. And what a sad show it was. My schizophrenic patient sat alone at his defense table. The judge allowed him to wear a black hooded cloak with an upside-down cross necklace so he could look like a Satanist, which he claimed was his religion. During the trial, he motioned to call a coven of witches as character witnesses. Motion denied. He motioned to be allowed to build an altar to Satan in front of the witness stand in order to summon the devil. Satan, he proclaimed, would then take the stand and, under cross-examination, confess to committing the crime. Motion denied. When the arresting officer testified against him, he motioned to be allowed to slug the officer in the face in order to prove it was not his fist that had hit the officer but the “fiery fist of Satan.” Motion denied.

The jury quickly found him guilty. The judge gave him fifty years, the maximum sentence. The earliest he would be eligible for parole, according to Nebraska law, would be in twenty-five years, assuming good behavior. Given he was dragged kicking and screaming out of the courtroom, good behavior seemed unlikely.

Lloyd Flatt is an internal medicine physician and author of Mars Hospital: A Doctor’s Novel.