Could this patient have been saved?

Wiley Boynton is dead. I first heard the news when Katie, a colleague, called me on my cell phone. Wiley had been taken to the hospital with a knife wound.

I asked her right away: “Self-inflicted?”

“I think so,” she said.

A self-inflicted knife wound might be possible, I figure with someone like Wiley, considering the violent world he came out of. I know quite a lot about him.

Wiley is around 40 years old. Most of his adult life was spent in prison, some very hard prison time, too.

First thing in the morning, I call the coroner’s office, identified myself, and asked after Wiley.

“We’ve been trying to get you,” the man tells me.

They had found an appointment card on Wiley with my name on it. I inform the coroner I am a case manager for Wiley.

The body is about to undergo an autopsy, and the coroner tells me while Wiley has a knife wound to the abdomen, it is not deep. He had recently been diagnosed with cirrhosis of the liver (I hadn’t heard this), and if the knife penetrated the diseased liver, even slightly, that could be the cause of death. The coroner found frothing of the mouth — and that is often a sign of an overdose

When a death is ruled an overdose, an investigation often follows. Our agency makes you feel as if they are looking for a culprit, a determination of who screwed up.

The truth is, community mental health (what we are) is a loose operation at best.

Lots of medicine is floating around, and not so many checks and balances exist (labs and the like). Probably it has something to do with the people we serve — very poor, uneducated people and often people with serious physical ailments as well as severe mental illness.

We see much heart and lung disease. Diabetes abounds, hepatitis is rampant, and obesity and alcoholism are very common.

Did I leave anything out?

Yes, almost everyone is a heavy smoker.

Treating such people can often seem futile, although no one in our agency would admit to such a thought. Then there are the sheer numbers, staggering numbers of such folks.

Next, I phone Wiley’s sister, Molly, in Indianapolis. I had met her before. I remember her as a dark-haired woman who looked younger than her 30s.

She has four children, at least one grown, so she had to have begun having children fairly early in her teens.

Molly is sobbing on the phone. She had spoken already to the coroner, and he had told her that the knife wound had not killed Wiley. Probably it was the pills, he said.

“They said they found pills in his throat and in his stomach. I just know he didn’t kill himself (with a knife, I guess she meant). He was so hopeful all the time. He talked about moving to Indianapolis to be with me and the kids. He loved the kids.”

I tell Molly what I know — that the coroner has not yet ruled a suicide. And I remind her of what she already knows — that Wiley was in poor health overall, especially for a man barely forty years old.

“Wiley could not climb a set of stairs without being exhausted,” I say to her.

“I know,” she sobs.

“So it is entirely possible the coroner will rule Wiley suffered a heart attack while ingesting the pills. You said yourself he was very agitated and had called you at 4:30 a.m.”

“Yes, he was.”

She had also said he told her he loved her, and that might indicate a man saying goodbye.

I change the subject. “I have the name and number of the funeral home in Floyd County. The Ferguson Home. Do you have money for the funeral?” I knew Wiley had no insurance and little money in the account we kept for him.

“I am sorry we don’t.”

“None?”

“No, none. I had hopes Wiley had a bit of money left in his account.”

“He does, maybe as much as four hundred dollars. I am only guessing, though.”

I assure her that I will do what I can to locate some money for funeral costs.

I plan to call a woman I know in Frankfort at the state mental health offices and try to scare up seven hundred dollars. My goal is to locate one thousand dollars total to put toward the funeral (that’s counting what is already in Wiley’s account).

As I am about to make the call, my phone rings. It is the Ferguson Funeral home in rural Kentucky. I speak to the owner, Sandra. Soon we are talking about money.

“You know there isn’t much money in this case?” I say.

“I know,” she says.

“How much do you need to bury him?” She doesn’t answer me directly.

“Well, we are sending a car for the body, and that and embalming will cost $562.00.”

$562.00, a curious figure I think.

“I haven’t yet met the family,” Sandra tells me. I guess she means Molly in Indianapolis but I know there are others. Wiley’s mother is still alive in the mountains someplace, and he has a son who is a Marine. Last I heard he was in Iraq.

She continues. “I have no information about the deceased.”

“Well, I can help you there, Sandra.” And I do.

“Look, we have about 300 dollars. I believe that that money can be spent, don’t hold me to that though. And I am about to call Frankfort to see if more can be found, maybe a total of a thousand dollars.”

It is simply my goal. I tell her: “I am worried that you won’t have enough money to collect the body, and he will remain in the morgue until all of this gets sorted out.”

Wiley had his troubles and caused his share of trouble, but he deserved more than I sensed he might get. My worries were misplaced.

“That won’t happen, sir,” Sandra says to me, getting very formal. “I have already sent the hearse for him, and if we don’t get a penny, he will be taken care of. Please understand, though, that we know this family, not the deceased, just the family he comes from, and feel if any more money is allowed and it is given to them to pay us, it won’t arrive.”

I almost laugh at the way she says this.

“No chance that will happen,” I say, and I am sure there is a laugh in my voice.

“Any payment made to you will be by check and by mail with nobody in between.”

“Thank you, sir,” and she hangs up.

It is Friday afternoon. I cannot get through to my Frankfort connection. Her secretary promises me she will call me on Monday first thing.

Come Monday, I talk to my friend. We find a way to send the funeral home the 700 dollars (on top of the three hundred we have), what is required for Wiley’s burial.

Wiley was short and stout like the proverbial teapot. He was a mountain boy, largely uneducated, although he could read a little. He told me this a bit proudly one day, and how it was he came to learn to read and write.

It happened in prison.

A black Muslim inmate taught Wiley to read using the Bible, the only book available.

The Muslim man said he didn’t believe in the Bible, but words were words and so it would do. Wiley learned the rudiments of reading from this fellow, but at something of a price.

The white prisoners disliked the association between these two, and as a consequence, Wiley was assaulted with a knife. He managed to avoid the attack and then picked up an iron bar and clobbered his attacker. He was thrown into solitary and shortly thereafter transferred to another facility — to Eddyville, Kentucky’s maximum-security prison. It was more than this one assault that got Wiley sent to Eddyville. Prior to this incident, and while drunk, he had attacked a guard.

He described to me the ride to Eddyville. “There is this steep road down a hill to Eddyville,” he said.

“God it was depressing,” he continued. “It looked like some dark, scary castle, an awful looking place, someplace from hell, and I was going there and to solitary confinement, and I didn’t know for how long.”

Raymond Abbott is a social worker and novelist.

Image credit: Shutterstock.com 

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