Letter E

In an Asylum

By Steven “Doc” LeShay

In an Asylum: Three Weeks Later 

“E – The fifth letter and second vowel of the modern English alphabet.”

 – Cambridge Dictionary

Three weeks have passed since Patient Number Seven–One–Nine began undergoing endless, albeit very excellent, psychogenic treatment. The overall verdict is? Positive. Even more effective results are projected over time. 

Patient Seven-One-Nine’s self-imposed perseveration – requiring the Patient himself to exterminate every personally written, spoken letter “e” – seemingly ended yesterday. The excruciating excises are over. He seems completely healed. Seriously!

Even the periodically recurring late evening “E-episodes” have been extinguished – entirely eradicated. The “miracle” happens rather suddenly when the leading medical health practitioner reveals the Patient (me) instead needs penning letters, memos, reports, e-mails, etcetera while expending extra e’s whenever, wherever possible. Every written page, every recorded correspondence needs more e’s, he emphatically states. Everywhere! (The Patient agrees). 

Already, the eager Patient manages to squeeze nearly ninety e’s when he completes several Chapter Three sentences while describing the “cure” he recently received.

Easy-peasy, he muses silently. They challenged me, then denied me exhibiting e’s before. Well, he’d educate them, beginning here. Immediately!

“Attention! Attention, shoppers! Extra, extra! Get ’em while they’re free! Yessiree!” he yells. “Seven come eleven, here are extra e’s! Large “E” ones, even wee “e” ones! Everybody gets one, ten, maybe even one hundred free e’s! Please enjoy the numerous e’s available inside these comments the extremely clever Patient Number Seven-One-Nine recently made! The e’s are scattered everywhere! They are sensational; they are interesting; they even are entertaining! These are sincerely remarkable, extraordinary, awesome e’s. Everyone gets them! Hee-hee-hee!”

He continues: “There are single, double, even triple e’s – enough letters everywhere – inside each sentence, each idea, each pondering, each reflection, each meditation, each reverie!”

Patient Number Seven-One-Nine silently enumerates them. Spoiler alert! There are maybe over three hundred e’s here already, he guesses. Every ‘e’ becomes easier, more exciting, sexier, and more compelling. He includes them everywhere. The message, the meaning, and even the tone never become incoherent. Neither (he sincerely believes) are the e’s unsettling. Perhaps they are somewhat bothersome, even tedious. However, are they wearisome? Exasperating? Vexing? Maybe. Are they maddening? Never!

Does he wonder when he started whether the e’s needed better defining (e.g., the awesome, unbelievable, exactly accurate, even the approximate number every reader requires? Maybe three hundred e’s? Perhaps five hundred? Seven, eight, nine hundred? Conceivably, even more letters e! The more, the merrier. These stupendously staggering numbers indeed test the average reader’s endurance). 

He needs more precise evidence, however. He desires some concrete answers regarding the “E-effect.”  Better authentication, greater verification.

Then he remembers the previous experiment he successfully achieved before the latest treatment began. 

He tries repeating the experiment exactly like the scream he gave yesterday. He succeeds.

Deep inside, the weak scream originates. The swelling bellow below begins ascending. The screech becomes louder, more articulated. Patient Number Seven-One-Nine’s voice creates the perfect noise; the flawlessly pitched note reverberates; the resonant tone becomes sheer excellence. The exiting shriek escapes. The scream explodes, and echoes effortlessly, everywhere, endlessly…forever. 


The (real) end?


In an Asylum: The Last Day

“They had engaged in what could not be called treatment or even discussion, but open combat, the two of them a microcosm of the great war raging in the far distance: one side that desired autonomy, and the other that took independence as a sign of madness.”

– Kathy Hepinstall

The first wave of deinstitutionalization began throughout the United States in the 1950s and targeted people with mental illness. The second wave (which ensnarled Arbor Hills Asylum) started roughly ten years later.

Arbor Hills closed its doors a year after Patient Number 719 departed. He was there for less than a month (although a “paid-in-advance-guest” is a more appropriate term). 

The morning after his final therapy with Dr. Malinski – the session with the Patient writing a piece of prose with e’s in every word and then culminating with his last E-screaming episode – Patient 719 just ups and leaves. He doesn’t escape; he isn’t discharged. He packs his few belongings, returns his library-loan book, hands in his keys, signs himself out, and vacates the premises.     

State and federal cost-cutting and cost-shifting, along with changing political beliefs, personal turmoil, overcrowding, and the spirit of the 1960s have all played a role in characterizing asylums as dehumanizing, corrupt, and unhealthy places with very poor conditions and treatment. Arbor Hills is one of the last institutions to feel this change.                              

Community services are now considered a cheaper alternative, as are many new psychiatric medications. It has become more feasible (and acceptable) to release institutionalized people into the community. Jails have become society’s primary mental institution, though few have the funding or expertise to carry out that role properly. Some state hospitals crop up, but they, too, are ill-equipped to deal with those who suffer from mental problems.  

Patient 719 is never committed to Arbor Hills by a court or any other hospital, medical, or legal entity, nor by his family or friends. Rather, he voluntarily commits himself at a time when Arbor Hills’ financing is at an all-time low, and the institution is desperate for any money to survive.

He approaches the head administrator by sending him a certified letter asking him to be admitted for a one-month-only evaluation. He offers to pay $500 daily for a private single room with a personal key, three meals a day to be served in his room, and costs for all professional treatments and any other ancillary services and medications in advance. He wants a professional evaluation and perhaps some possible help, he writes. The administrator willingly agrees. The soon-to-be “patient” sends him a check for $15,000 – a hefty sum – made out to the Arbor Hills Asylum.         

After spending his first few days getting acclimated to institutional life (albeit far from the reality of what is happening within Arbor Hills outside his room), he begins therapy.

After daily counseling and several cognitive-behavioral therapy sessions with Dr. Malinski, the “patient” is finally told on the morning of his final day at Arbor Hills that he might have a mild case of OCD (obsessive-compulsive disorder). Certainly, some of the symptoms are there, Dr. M. states. The doctor also assures Patient 719 that OCD is not a form of insanity but a very common and long-lasting chronic disorder.

“One has uncontrollable, often reoccurring thoughts or obsessions and behaviors that they feel compelled to repeat,” Dr. M. says.   

Like exorcising all the e’s from words or adding them ad infinitum, Patient 719 thinks as he feigns listening attentively to Dr. Malinski wax on about what is wrong with “his” Patient.                                                            

“You don’t necessarily derive any pleasure when performing these behaviors or rituals,” Dr. M. continues, “but you may feel some brief relief from the anxiety the thoughts cause.”     

He then prescribes Clomipramine, a relatively new oral drug discovered in 1964 by the Swiss drug manufacturer Ciba-Geigy and sold under the brand name Anafranil

“It’s good for OCD, and other problems such as panic disorder, major depression, and chronic pain,” Dr. M. says as he hands him two sample tablets and a hastily written prescription that he says can be filled at any pharmacy, including the Asylum’s, but only on the next day during business hours.

“You have some issues with perseverance and a need to control, but overall, things look positive,” he smiles. He gets up from his chair and extends his hand to Patient 719. “I expect even more effective results will be projected over time. Good luck to you.” 

As he leaves Dr. M.’s office, Patient 719 hands Dr. Malinski a folded piece of paper and shakes the doctor’s outstretched hand goodbye. On the way out, Patient 719 throws the two pills and prescription into a wastepaper basket.

Dr. M. waits until his patient leaves before opening the note. It is printed in a child-like scrawl with large capital block letters. It reads:  


Patient 719 will never see Dr.  Malinski again…alive.

If you’ve missed the beginning of Tales From an Asylum, you can read it here.

Steve LeShay
Steve “Doc” LeShay is a game inventor, retired university professor, and Naval Air Reserve Commander who lives with his wife and cat and enjoys playing tabletop board games. He is the author of Tales From An Asylum: A Memoir Unlike Any Other, and Sssnake on a Ssskate? a bedtime read-aloud picture storybook for children, ages 3 – 6. Doc can be reached at DrSVLeShay@hotmail.com

3 thoughts on “In an Asylum”

  1. Very clever!
    I once had a medic alert bracelet that identified me as being allergic to B’s. It wasn’t because I had issues with the letter. When I requested an alert that was allergic to BEES, the man at the jewelry counter wrote down B’s. Maybe Patient Seven-One-Nine needed a bracelet. (As long as he didn’t get it from the same jewelry counter. Then it probably would have read EASE.

    1. Steve "Doc" LeShay

      Thanks for the feedback, Susan, and your humorous story!
      As I posted in the first installment of my “Tales,” the word “Asylum” in the title of my book, Tales from an Asylum, is a metaphor for my mind. My “Asylum” has a Time Machine with buttons and dials that allow me to mentally move between reality and unreality – from the past into the future and always in the present.
      A memory button enables me to step back into who I was then, to myself and others, and recall and write about the past – much like you, Susan, were able to be your persona when you revisited Chicago on St. Patrick’s Day. Ben Pilla, also entertained us when he remembered his summer job on a typical day on the New Jersey boardwalk; Henry Kuhlman recounted his adventures in India with Narji; J. J. Clarke recalled her scary encounter with a flying boat as a kid on a family Memorial Day in Missouri; Mike Doyle traveled back to Pittsburgh for a conference and met the woman who became his wife; and the Happy Hikers (Betsy, Nancy, and Cloe) took on the Harding Icefield in Alaska. All good examples of creative writing!

  2. Steve "Doc" LeShay

    I just noticed that the word “and” appeared a couple of times in the chapter with words containing all “e’s.” Ooops! Mea culpa! Evidentally, I submitted a pre-final draft to Hallard. There were no words without an e in the published book.

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