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579: My Damn Mind

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Prologue

Ira Glass

On a Thursday morning in August, 2015, a staffer at a big hospital in downtown Houston, St. Joseph Medical Center, heard a Code Green on the intercom and did what they always did-- ran over to the room. Then it was a Code Blue. Code Blue means somebody needs immediate medical attention. Same room.

Scott Shepherd

And I just see blood everywhere, all over the floor. I was actually shocked. It was just kind of smeared here. There was some there. But it was all over the floor. We had to put on-- we put shoe covers on in order to walk in the room. That was just how much it was.

Ira Glass

They walked in and saw a 26-year-old college student on the floor, handcuffed, with a bullet wound in his chest. He'd been tasered by police before he was shot.

Scott Shepherd

And he still had the taser things attached to his chest. And I mean, that was the first time I'd ever seen what taser lines look like-- just a bunch of wires coming from him. And I remember the surgeon screaming at the cop to take his handcuffs off. He was like, "take the cuffs off now. We have no time to waste." And he said it multiple times. "Really? He's cuffed on the floor? We can't do anything with him cuffed. Just take the damn cuffs off him."

Ira Glass

Police had shot an unarmed patient in his own hospital room. The fallout from this incident was enormous. Federal investigators came in. The hospital's funding was threatened. It was so contentious that I recorded an interview with this hospital staffer, and to protect their identity, we have replaced the person's voice with an actor saying the exact same words. The story I'm about to tell you is one that we put together in collaboration with The New York Times, last year. The actor, by the way, is named Scott Shepherd.

To explain what happened in that hospital room, I want to back up to the day before, 20 hours before the shooting, and tell you about the patient. The doctor saved his life. His name is Alan Pean. He's alive and talking about what happened.

And when he does, before you get to the very interesting story about how he ended up with a bullet in his chest, it's also incredibly interesting to hear him describe the day that led up to the shooting, because during that day, over the course of just a few hours, basically his mind slipped away from him. Bit by bit, he stopped understanding what was real and what wasn't real. And he describes what that feels like in this way I have never heard anybody describe before.

It's This American Life from WBEZ Chicago. I'm Ira Glass. Today's program, "My Damn Mind." We have two stories on our program today-- in one, the brain working for you, and the other, this story, the brain very much not working for you, not being a helper, not being a pal. And let's get right to it.

Act One: When Your Hospital-Borne Infection Is a Bullet

Ira Glass

This is Act One, "When Your Hospital-Borne Infection is a Bullet." The week before this happened, Alan Pean was starting his last semester at college, in a new school in a new city. He'd just moved to Houston two weeks before, anxious to do well.

Alan comes from a family with a lot of doctors-- his dad, his uncle. Both his brothers are on their way to becoming doctors. In this family of overachievers, Alan's the one who's still figuring out what he wants to do. He plays video games with a group of friends from high school, smokes weed, soft-spoken, thoughtful, considerate.

And he moved to Houston with a plan to get things done-- finish school, get to grad school. He stopped smoking weed, time to buckle down. And he was stressed out, sleeping only four hours a night. But at the same time, he had all this energy, which I guess is something that just happens to him sometimes.

Alan Pean

I recognize it as a mania. OK, Alan. You're manic right now. But I didn't think much of it. I was like, OK, this is just going to happen for a little bit, and it'll go away.

Ira Glass

And that's because in the past, sometimes this would happen for a couple of days, and then it would go away.

Alan Pean

And it would go away. Exactly.

Ira Glass

So he's trying to hold it together. He's going to class. He's forcing himself to talk to people at this new school. He's making himself do all the things that he's supposed to do.

And it's working. On August 26, the day before the shooting, in his philosophy of science class, lots of people want to be in his study group. And when class ended, they made a plan to meet over the weekend.

Alan Pean

And everyone was exchanging emails. And I was like, "all right, OK. So I'll see you guys later." And you know, it's like, we were in the quad, and I'm walking out to go to my car. And I just continue walking. I feel great. This is good. I finally have my group ready to go. I'm going to go ahead and get home and continue being productive. I have a book that I really like to read. I'm going to go finish that. And then--

Ira Glass

This is the moment that we're roughly 20 hours before the shooting in the hospital room. When Alan gets in the car, he starts thinking about all the things that he needs to read and do and study, and something in him just kind of tips, he says.

He starts to panic. But you know, he gets home, he starts to cook some food, he tries to calm down. He's got a plan to play a video game online with his buddies. He hooks up the PS4, gets on FaceTime with his friends.

Alan Pean

So I'm trying to play on the game, but it's like my wires start getting crossed. Things start getting confusing. Confusing like I have this controller, but then a thought would interject.

Ira Glass

He thought this controller somehow switches on a processor inside of him.

Alan Pean

Like I'm this bionic being who had been reprogrammed by the enemy. It's like where you have the delusional thoughts competing with your rational thoughts. And then you disproving your delusional thoughts, but then another one comes up. And it seems more likely.

Ira Glass

His computer, he thought, was not his computer. It was a state-of-the-art device that could summon drones to destroy his apartment complex. Meaningless coincidences seemed like signals that he was on a secret mission.

Now, Alan had had delusional episodes before-- two times. The first was in 2008, when he was a freshman at the University of Texas at Austin. It lasted about a week.

Alan Pean

Where I thought that I was President Barack Obama. That I was either a lookalike or someone that could be used as a replacement. But it's not so much like--

Ira Glass

I should tell you that you're a light-skinned black man with short hair. You look nothing like President Barack Obama.

Alan Pean

Yeah. So--

Ira Glass

The next summer, it happened again. And it was more of a biblical-type deal this time, Alan says, a delusion with demons in disguise, and he was on the verge of being sent to hell. Alan was briefly hospitalized, diagnosed as possible bipolar and put on anti-psychotic medications for a while.

And he recovered. Six years passed without another incident. But that night, on the PS4 with his friends on FaceTime, it was all kicking in again.

Ira Glass

And what are your friends seeing? Do they know you're going through this freak-out?

Alan Pean

They start asking, Alan, what's wrong? They had realized that I was acting strange. Like, why can't he log on to the computer? Why can't he log on to the PS4 or whatever? Why can't he do that?

Ira Glass

Oh, because you're unable to do it?

Alan Pean

Yeah. I was like, no. I shouldn't do it, because if I do, they'll triangulate on my position.

Ira Glass

But you didn't say that to your friends?

Alan Pean

I couldn't tell it to them because I didn't know who exactly they were.

Ira Glass

So he gets off the FaceTime call. It's now 13 hours before the shooting.

Alan Pean

And I was like, who can I trust? Well, obviously, you trust your brother, your unit, right? So he's my little brother, Dominique. And I call him and I tell him, "hey, man, I'm having a panic attack. I'm having a panic attack. And I don't know what to do. And I think it's getting worse than that."

Dominique Pean

So he called me at 10:00 PM. I had just got back from class.

Ira Glass

Dominique says, actually, there's a fair amount of "how was your day" kind of small talk with Alan taking these weird, deep, deep breaths before Alan actually admitted he was having a panic attack.

Dominique Pean

And I was like, "oh, OK." Well, I get anxious kind of often, too. So I walked him through some just relaxation exercises. So I was like, take a deep breath-- in, out. Lie on your back. Put some water on your face.

Ira Glass

Water on your face? Like cold water?

Dominique Pean

Yeah. Cold water on your face.

Alan Pean

And he was like, "oh, OK. Well, put some cold water on your face. Cold water on your face." And I was like, "what?" And I'm like-- I actually go to say-- I'm, like, "is it because I'm overheating?"

Ira Glass

Like you're some sort of robot?

Alan Pean

Right. And he might also know that. And he knows what I need to do in order for my circuits to calm down. [SIGH]

Ira Glass

It continues like this. The part of Alan's brain that looks at the world and draws conclusions about what he sees doesn't stop doing that. It's like he's still in there, thinking and applying logic. It just keeps arriving at the wrong answers. So innocent statements said to him, like "I don't know anybody in Houston who can come over to your apartment," Alan inserts into the delusion.

Alan Pean

I took that as code. There's no agents in your area that could come to your assistance. Then I'm thinking, like, well, wait a minute. Like, what if-- what if he's not really my brother? It could be some sort of trap.

Ira Glass

Alan hangs up on his brother. Dominique gets their dad to reach out. Here he is.

Dr. Harold Pean

So I call him, and I try to calm him through it on the phone to try to relax him.

Ira Glass

This is Alan's dad, Dr. Harold Pean. He's originally from Haiti, hence the accent.

Dr. Harold Pean

I ask him, "Alan, how you doing? You're having some problem, they're telling me," and try to relax him to get his mind off. But he was very anxious. He was not able to focus, to control it. And then suddenly, he say, "well, I think I'm going to just go drive to the hospital or something."

Ira Glass

Alan doesn't tell his dad or his brother that he's having delusions. He doesn't say what he's really thinking, which is that he's in greater and greater danger if he stays at his apartment, that there are snipers outside watching the front of the building, that if he walks out his front door he'll get shot, and they're moving in.

Alan Pean

I thought at that point that time elapsed too long and that they're closing in on my position, and they're going to be there any moment. So I'm talking with my dad, and I call him Pop. So I'm like, Pop-- and then the following word in my mind was pop, which made me believe that the phone was going to explode, right? And then I run out, throw my phone into the toilet, and run out into the balcony and close the balcony door behind me.

So I'm on the balcony. It's the third-story balcony. And I'm like, OK, well, just remember your training. And I start to climb over on the other side and essentially let go and catch myself again on the second balcony area. And--

Ira Glass

What?

Alan Pean

Yeah.

Ira Glass

I'm just trying to picture this. So you're in a suburban apartment complex. You're on the third floor. You're on a balcony. You're holding on to it. You let go. And you're able to drop one floor down and catch--

Alan Pean

Catch myself.

Ira Glass

And not break your arms?

Alan Pean

Nothing happened. Yeah. All my muscles must have been-- you're like high. You're just-- adrenaline pumping. That's what I'm trying to say, like an adrenaline high, and it's just--

Ira Glass

OK, then?

Alan Pean

So then after that, I catch myself on the second story. And I look down. And I keep telling myself, just remember your training. You trained for this.

Ira Glass

And that refers to nothing, right?

Alan Pean

What, my football training? No, I don't know. I never trained for anything. So I'm just here, like, remember your training. You know, so--

Ira Glass

Yeah.

Alan Pean

And I look down, and there's these two AC units down there. And I basically, from the second story to the AC units, I do a parkour stunt, like jump off of it and then jump onto the sidewalk. And I start running.

Ira Glass

OK, I know it's a cliche, but the mind, it is powerful. By the way, this story about jumping down the balcony seems to be completely true. We checked with the property manager of the building. And for a bunch of reasons that I won't bore you with here, the way Alan's apartment was locked, the only way he could have gotten out was off the balcony.

So after Alan action-heroes his way down the balcony, he makes his way to his car-- not a direct path, of course. Too dangerous. Evasive maneuvers, under cover of night. He believes that he called in a drone strike using Google Maps, and any second the whole apartment complex is going to be blown up. So he's racing against the clock.

And it's interesting. I didn't know what I thought a delusion would be like. I thought it might be like a hallucination or something. It might make no sense when you look at it later. But in this case, it's a totally logical story with consistent details, like a movie or a video game.

Alan Pean

I'm kind of jogging, running.

Ira Glass

And you're full-on delusion? You're not ever coming to--

Alan Pean

Yeah. At this point, I do believe I'm a bionic person. I'm a cyborg. I'm a secret agent on a mission to break himself out from behind enemy lines. So I get in my car, and I basically peel out. And I get to the gate.

Ira Glass

The gate of your suburban apartment--

Alan Pean

Apartment complex. And I'm like, why isn't the gate opening? They locked it. They locked it, of course. You know, so I just rammed the gate open.

Ira Glass

You rammed the gate with your car?

Alan Pean

That's right. Boom, it opens. Get out. Take a left, and there I am. I'm driving. I'm driving, and I'm having these thoughts, like, that place is about to explode.

However, as I'm driving, I tell myself, you were supposed to go somewhere before. Where's the rendezvous point? And it's at the hospital. It's at the hospital that you're supposed to go to. That's where the good guys are.

Ira Glass

But then he has a moment. He remembered, he and his dad had talked about going to the hospital for a different reason.

Alan Pean

I had a moment of clarity. I need my medication. I need that. It's like-- it's Geodon. It's an anti-psychotic.

Ira Glass

Then the delusion kicks back in. So he's driving, looking for a hospital. Remember, he's just moved to town that month. And he sees St. Joseph Medical Center, Houston's oldest hospital, and the only one downtown.

Alan Pean

It's like I just lost control of the car. I don't really remember-- for me, it was like I was in the car, and the next thing I know, the car has crashed, and I'm falling out.

Ira Glass

That's it? That's all you remember of the accident?

Alan Pean

Yeah.

Ira Glass

How badly damaged was your car?

Alan Pean

The car was totaled.

Ira Glass

The car was totaled?

Alan Pean

Totaled.

Ira Glass

You just rammed into--

Alan Pean

The side of a wall.

Ira Glass

He had actually hit a bunch of cars before he slammed into the side of the hospital at high speed. The front of the car caved in, airbags inflated. Even in his psychotic state, Alan wore a seat belt.

Alan Pean

I mean, I'm religious. I thank God that I didn't hurt anyone else there. I thank God that people there just miraculously did not get hit at all.

Ira Glass

So you get out of the car. You walk to the hospital, which is how far from you?

Alan Pean

10 feet. I'm at the hospital. I crashed into the hospital. And there's an EMT guy right there.

Ira Glass

The EMT sees that Alan just crashed his car and probably needs medical attention. They put Alan on a stretcher, take him into the ER.

This is where this turns from one kind of story, a story of Alan losing control of his mind, to the other story we're telling here, of how you can show up in an emergency room needing psychiatric help and end up shot by the police in the hospital. And from this point in the story, for the 11 hours before the shooting, we don't have to rely on Alan's recollection. There's documentation of what he looked like from the outside to people who were not in his head, people who did not think that he was a robot cyborg on a secret mission.

We have Alan's medical records. He gave permission for the hospital to turn them over. And there's a 50-page report, prepared by federal investigators, of what happened from the time Alan arrived at the hospital until he was shot.

Alan gets to the emergency room at 10 minutes before midnight. And St. Joseph is a big downtown hospital. It gets lots of trauma patients, lots of mentally ill patients, some homeless people. Staff often have to quickly assess what a patient needs to be treated for.

And even though the staff notices all kinds of things that might lead them to treat Alan for his psychiatric problem, they don't do it. What they treat Alan for is the car crash, which must have seemed pretty urgent. The diagnosis in his medical chart is hand abrasion, substance abuse, motor vehicle accident.

They do a CT scan of his head, spine, chest, abdomen, and pelvis, looking for injuries. They test him for drugs and alcohol. Those come up negative, except for marijuana, which can linger in the body for weeks. Alan says that he tried to tell the ER staff what it is that he came for, that he was having a manic episode.

Alan Pean

It's like I snapped back into myself. I just say, "I'm manic, I'm manic, I'm manic." And I say it multiple times. And I'm saying that. And there's people around me. There's nurses and stuff who are putting needles and things into me. And it never clicked.

Ira Glass

There's no mention of that in his medical records. And there's no mention of phone calls that his brother Christian and his father say they made at 1:00 AM and 1:14 AM, respectively, to alert the hospital about Alan's psychiatric issues-- though that's not unusual that phone calls like that wouldn't be mentioned in the chart.

But the medical records do include all kinds of things that could have tipped the staff off about what was really wrong. On Alan's arrival at the ER, the first handwritten notes from a resident on duty include that Alan is someone who has manic depression. Then Alan is so incoherent, making so little sense, that the attending physician notes in the chart that he can't get Alan to describe his medical history or even a basic rundown of his symptoms. By 1:30 in the morning, the nurses' notes say that Alan is acting weirdly, trying to pull out his IVs and his lines. They, quote, "educate him on his behavior and ask him not to remove any equipment."

He doesn't stop. He tries to pull out his own catheter. This continues for hours. He starts telling the staff that he feels all better, no need for any equipment.

But they still don't treat him like a psychiatric case. Alan and his family told me, their sense of the staff's attitude was, this is just a guy, drunk or on drugs, crashed his car. Happens all the time. Alan's put into a hospital room for observation of his injuries. His father booked a plane to Houston from their home in McAllen, Texas.

Dr. Harold Pean

We decide to fly right away, yeah, 6:45. We went to Houston at 6:45 in the morning.

Ira Glass

Dr. Pean and his wife, Paloma, get to Alan's hospital room around 10:00 AM.

Dr. Harold Pean

Well, I say, "Alan, we are here. You know, we've come to see you." He say, "hi, Pop." But he would not-- I say, "how you doing?" He would not tell me anything. And he was different than usual. So I say, well, that's not him.

Ira Glass

He's totally withdrawn. Didn't hug them hello. Alan explains why.

Alan Pean

I do recall my parents showing up. And I don't actually believe it's them. I don't think it's them.

Ira Glass

In Alan's mind, he's still on his mission, which is evolving. The TV in his room is sending coded messages. And the IV tubes he's hooked up to?

Alan Pean

They're putting the serum that I needed in order for the morphing process to begin, to morph, to look more like Barack Obama. Because if he is taken out, they don't know where he is. But they need someone to speak out as though the government is still functioning as normal.

Ira Glass

Now his dad knows none of that. All he knows is something is wrong. He goes to the nurses' station.

Dr. Harold Pean

So I talk with the nurse, and I told them, look, I think he's having some kind of anxiety or panic, and I wanted to talk with the doctor. And I say to her that I think he may need some kind of psychiatric help.

Ira Glass

Did you say, I want a psychiatric evaluation?

Dr. Harold Pean

That's right. I told her, I think he needs to be evaluated by a psychiatrist.

Ira Glass

And what did the nurse say?

Dr. Harold Pean

Oh, she just didn't pay attention to me. She said he's going to be discharged. That's all she said.

Ira Glass

According to the report by federal investigators, the nurse confirmed he did ask for a psychiatric evaluation, and she did tell him Alan was going to be discharged.

Dr. Harold Pean

And I asked what medication they were giving him. They said they were giving him cyclobenzaprine. And I told her, well, I don't think that's appropriate. Maybe that will make it worse.

Ira Glass

What was your fear that it would do to Alan?

Dr. Harold Pean

That's a muscle relaxant. But some people, it may cause psychosis, actually, because that's part of the side-effect-- confusion, dizziness, psychosis. I think it would probably make him more disoriented, confused. But she said, well, that's what the doctor prescribed.

Ira Glass

Did you identify yourself as a doctor?

Dr. Harold Pean

Yeah. I told the nurse that I'm a physician from McAllen, internal medicine. But she just didn't pay attention. She thought maybe I was lying. I don't know what was in her head.

Ira Glass

He said the nurse said to him-- maybe hearing his accent-- you might be a doctor somewhere, but you're not a doctor here. So Dr. Pean and his wife figured, OK, no help here. They would drive Alan back home to McAllen and get psychiatric help there. They left to arrange for a car rental.

The doctor did come looking for them, according to federal investigators, but they'd already left. Alan gets shot in his own hospital room less than 40 minutes after they go. Here's how that goes down. I'm going to read you a little bit from the 50-page report issued by federal investigators.

Quote, "At 11 o'clock, the patient was encouraged to put on his gown after he had a shower, but refused and started dancing in his room. The patient came out of his room naked four to five times. The nurse stated at this time, the patient was calmly responsive. She stated each time she redirected him, he would say, yes, ma'am. Radio. OK, ma'am. When asked what year it was, he said, 1989.

Some time later, the patient came out in the hallway naked, except he had shoes on. He was told to go back to his room, and the nurse would come in to assist him with his gown. She stated she went to the room with another nurse and was trying to help the patient into his gown.

They told him to turn around so they could tie the gown. The patient started to dance and would not comply. The nurse said the patient was acting inappropriately. She said he would not comply with her orders to turn around so his gown could be buttoned up."

Ira Glass

Do you remember why you were going out into the hallway naked?

Alan Pean

I don't remember-- I don't recall dancing, but I do know that I was going out there because whenever I finished taking my showers, well, where's the suit?

Ira Glass

Remember, he's morphing into Barack Obama. He's about to address the nation. You need a suit for that kind of thing. In the hallway--

Alan Pean

I'd expect other people to be there that would help me with the changing process, just to look professional or to hand me my script.

Ira Glass

If the patient doesn't comply with orders, it's protocol in the hospital to ring for security. And the nurse does that. Now at this particular hospital, calling security usually gets you uniformed guards who don't carry weapons, but also might get you off-duty cops who are on the security team. It depends on who's available.

This time, it's the cops who arrive, in full Houston Police Department uniforms with guns. They go into his room and close the door. This, by the way, is not standard hospital procedure, I was told. A nurse, a doctor, somebody treating the patient, should have been in there with them.

Now at this point, once the cops are inside that room, the story gets a little hazy. It's not totally clear what happened inside the room. Police turned down our interview request. And Alan's lawyers told him not to talk about the details either because the whole thing is going to court.

But there are some things we know for sure. We know the cops were not in that room for long, a few minutes at most. We know there was a scuffle. Several people told investigators that. And the staffer I interviewed, whose voice we're replacing with an actor's, said you could hear it from outside Alan's hospital room.

Scott Shepherd

We heard noise. And we couldn't identify exactly what it was. We didn't know if it was maybe a table hitting a wall. it was just like a pop and all kinds of stuff.

Ira Glass

One nurse told investigators she heard a scream. On the day of the shooting in August, the Houston Police Department issued a brief statement about what happened next. It's still on their website.

It says, when the officers arrived, Alan attacked. Quote, "The patient suddenly physically assaulted Officer Ortega, striking him in the head, causing a laceration. At that time, Officer Law deployed his conducted energy device--" that's the taser-- "which had no apparent effect on the suspect who continued to assault the officers. Officer Ortega, fearing for his and his partner's safety, then discharged his duty weapon, striking the subject one time."

Alan disputes this account. He and his lawyers say he did not attack the officers first but they charged him first, and he responded.

Soon the door to his hospital room opened. That, by the way, is when the hospital staffer who I interviewed arrived in the hallway outside Alan's room. Again, we've replaced the staffer's voice with an actor saying the same words and-- I hope this isn't weird-- you're hearing my original questions from the recording of the original interview mixed with the actor's voice.

Scott Shepherd

Apparently, they had probably just opened it. And the first thing I seen was a cop fall out of the room on the floor.

Ira Glass

So you're out in the hallway.

Scott Shepherd

Correct. Well, I didn't go that close to the room because when you see a cop with a bloody eye on the floor, that states, stay where you are. Don't go any closer.

Ira Glass

He was bleeding from his eye?

Scott Shepherd

His head. Like right above his right eye. We weren't sure if it was the eye or the head. It was just this huge, red, fresh gash. It was big.

Ira Glass

This is from the account by the federal investigators. Quote, "Inside the room, the other officer was standing over the patient, who was lying on the floor. He had a taser on his upper chest. There was blood on the wall and floor. The patient was conscious, trying to get up, saying he was Super-Man and needed to get up.

The doctor who rushed into the room and treated him told investigators--" again, I'm quoting the federal report here, quote-- "he heard a Code Blue page overhead while he was walking upstairs. He realized it was his patient's room and went to the floor. He went to the patient's room and saw him lying on the floor on his back with a drape over him.

The patient was quiet. His eyes were closed. The doctor says he took the drape off the patient and saw he was handcuffed. When he asked what happened, he was told the patient was just tasered.

He asked if the patient was shot, because of the blood and multiple wounds. The response was that the patient was tasered. When the doctor began to assess the patient, somebody mentioned that he was shot."

While Alan was recovering in the Intensive Care Unit, police handcuffed him to his bed and restricted his family's visits to just 10 minutes a day, and they couldn't enter the room. They had to look at him through a window. That's because police saw him as a criminal. They charged Alan with two counts of aggravated assault, one for each officer.

Alan Pean

I couldn't believe it.

Ira Glass

Again, here's Alan.

Alan Pean

I was expecting an apology. I was expecting 100% an apology. And that is not what happened. And I could not believe it. I couldn't believe it. I don't know if you-- how is it that you have these officers who shoot an unarmed patient in the hospital, and then he is the bad guy, he's the guy who needs to go to jail? And it's jarring. I just don't understand.

Ira Glass

Later, when federal investigators asked Alan about the shooting, he said, quote, "He forgave the police officers. But what he cannot understand is why police officers were in his room, when he was an ill patient trying to get well."

So what were armed police doing in a patient's room? This is something a New York Times correspondent, Elisabeth Rosenthal, has been looking into. As I said earlier, the story that you're hearing right now is a collaboration between our radio show and The New York Times. And when Elisabeth Rosenthal heard about Alan Pean, she wondered how common this kind of thing was.

Elisabeth is also a doctor and has worked in hospitals, but none that allowed guns. And she just started calling hospitals and looking at the few surveys that exist on this stuff. The one national survey on this subject found that about half of all hospitals now allow guns.

Elisabeth Rosenthal

And the evidence suggests that that's about doubled in the past three years.

Ira Glass

Doubled. Lots of hospitals now have police and ex-military doing security with guns. Hospitals aren't required to keep records on how many of their patients are injured or killed by those guns. But Elisabeth looked for that as well by digging through old police blotters, court documents, news accounts, and surveys, and found over a dozen cases, most of them mentally ill patients.

Elisabeth Rosenthal

First, on the very same day that Alan was shot, there was another psychiatric patient who was shot and killed at a hospital in suburban Cleveland. And then, just in January this year, there was another patient with bipolar illness who was shot and paralyzed by security in a Virginia hospital. And then sometimes people die when they're shocked with tasers. So there's two cases, one in Utah and one in Ohio, where patients were actually killed after repeated tasering.

Ira Glass

Both were by hospital security. Both were psychiatric patients. Of course, we all would hope that police would know how to deal with people who were mentally ill. They have to do it on the street all the time. But they don't always do it so well.

In December, The Washington Post published the results of a huge, yearlong investigation into police shootings nationwide. They found that last year, officers fatally shot at least 243 people with mental health problems. And in most of those cases, the cops who pulled the trigger hadn't received any training in how to deal with the mentally ill. And their tactics escalated the situation rather than calmed it down.

So why are hospitals turning to police? Why have the number of guns in hospitals apparently doubled in just three years? Well, for one thing, violence in hospitals has also nearly doubled in that same period. It's up 40% according to statistics gathered by the International Health Care Security and Safety Foundation. Most of that violence is against hospital staff. A study last year by the Occupational Safety and Health Administration revealed that there is more violence in hospitals than any other workplace.

And the way hospitals have responded to this violence, Elisabeth found, is a hodgepodge. One national survey found that half of all hospitals have tasers. They have them partly thanks to an aggressive marketing campaign directed at hospitals by TASER International. In New York's hospital system, which has several of the busiest emergency rooms in the country, security carries no weapons. And lots of hospitals, as I've said, have decided they're comfortable with guns.

Elisabeth Rosenthal

Someone said to me-- and I think this is true. It kind of reflects the divide in American society right now about guns, whether they make you feel safer or not.

Ira Glass

Right. And that just varies around the country, depending on--

Elisabeth Rosenthal

That varies a lot by your background, where you live in the country. Do you feel safer when you see a person with a gun at the door of the emergency room? I think the second issue, then, is if you decide you need weapons in your emergency room or in your hospital, how are the people trained who are using them?

Ira Glass

This may actually be a bigger issue than the guns themselves. Have the people carrying the guns been trained to work in a health care setting? Because it's different. It's not like law enforcement. When there's a patient who's psychotic or acting up from mental illness, like Alan Pean, there are standard techniques that nurses and hospital security use to get control of the situation, non-confrontational ways of speaking to patients, restraints, medicines. Simply warning a patient that you're going to give them a shot can calm them down.

And in her research, Elisabeth found some hospitals that taught these techniques to the security officers when they brought in tasers or guns and set clear rules about when to deploy weapons and how armed security would interact with staff and patients. But that definitely wasn't every place.

Elisabeth Rosenthal

I mean, that's the thing that shocked me. As I called around to different hospitals, there was no pattern to this. It was all over the map. And sometimes there had been a lot of thought put into the process. And sometimes, in fact, there seemed to be very little thought.

Ira Glass

When it comes to Alan Pean's case in St. Joseph Medical Center, the federal investigation notes that police officers were supposed to be trained to deescalate situations and restrain confused patients. But there's no evidence that it ever happened.

This is quoting from the federal investigation report. Quote, "The facility failed to provide evidence that contracted police officers were trained in dealing with confused, disoriented, and aggressive patients. The facility failed to ensure contract police officers were trained in the use of safe, acceptable health care interventions for confused and aggressive patients. This resulted in the tasering, shooting, and handcuffing of a confused, aggressive patient." End quote.

This is actually what was galling to the staffer that I talked to from St. Joseph Medical Center. This person said that these cops were walking into a totally normal situation for the hospital that any trained staff or the regular hospital security could have handled without firearms.

Scott Shepherd

That's an everyday thing for us. We see that all the time. You see it all day. You see confused, demented people that can be very combative. I mean, hospital staff, we get abused and we're put in more danger than-- or just as much danger as cops on the street.

We don't walk around with guns. We get hit. We get hit by patients all the time. As long as that person doesn't have a weapon to harm someone else, why should you have a weapon? Or why should you use your weapon?

Ira Glass

To be clear, this medical staffer thought that it was totally appropriate. They liked it. It made them feel safer that a couple of cops with guns would be in the emergency room in case somebody with a weapon came into the hospital. But sending cops to the room of somebody like Alan Pean? That's totally different.

Scott Shepherd

First of all, if someone's delusional and two cops walk into the room, it's a normal reaction for that patient that's having delusions, or that psychotic, to react violently. That's how they are. That's what they do.

So you kind of give that space. You stay back. You find out what's going on. You try and talk to them to see if they're safe to approach or not. And that's what-- I'm not sure if that was done or not.

Ira Glass

To paraphrase an old saying, guns in hospitals don't kill people. Guns in hospitals wielded by people who are not trained to have guns in hospitals kill people.

So better training of the officers in Alan Pean's case might have prevented the shooting. But in this particular case, there was something else that could have stopped this from happening, something simple. Alan could have been given a psychiatric evaluation.

Remember, the ER staff noted Alan's erratic mental state in his chart but didn't get him evaluated. And Alan's father asked for a psych evaluation, but he was ignored. The St. Joseph staffer that I talked to said it's hard to understand why.

Scott Shepherd

I hate to say it because we never want to talk bad about anyone that we work with-- and I wasn't there, but if that was said to a medical professional, then their wishes should have been complied with immediately. That's the protocol. That's what's supposed to happen.

Ira Glass

And is it true that if he had been diagnosed as a psych patient, he would have been in a psych ward where no guns are allowed?

Scott Shepherd

Correct.

Ira Glass

So that would've prevented this whole thing?

Scott Shepherd

Correct.

Ira Glass

You don't want guns in psychiatry wards for common sense reasons. It's too dangerous. You don't want a patient to grab the gun. And seeing firearms might agitate certain patients.

Because of that, almost universally guns are banned from state mental hospitals in the United States. When officers enter those facilities, they check their guns at the door. Possibly the one exception is Texas, where Alan was shot, where just last month on January 1, four months after Alan's shooting, it became legal to carry licensed firearms in state-run psychiatric hospitals.

When the Pean family filed a complaint against the hospital with the federal government, specifically the Centers for Medicare and Medicaid Services, or CMS, CMS felt the shooting raised serious enough questions about St. Joseph Medical Center that they had investigators at the hospital within five days of the shooting and publicly raised the possibility that St. Joseph might lose its federal funding. When the investigators interviewed St. Joseph's Chief Executive Officer Mark Bernard about the incident, he told them that he stood by the officers.

This from the report, he said, quote, that "the minute the patient hit the uniformed police officer, it became a criminal offense, and the officers went into police mode and were justified in the actions they took to protect themselves." When asked what other interventions could have been used by the security staff, the CEO said, quote, "if it should happen today, they would not have done anything different."

I wondered if the CEO still felt that way, given the evidence in the federal report that police officers may not have been properly trained to deal with a patient like Alan Pean and that hospital staff failed to do a psychiatric evaluation. The hospital referred this and all of our questions to an outside crisis manager they work with named Rhonda Barnat. I was told that CEO Mark Bernard declined to answer that question.

I ran CEO Mark Bernard's statement, quote, "If it should happen today, they would not have done anything different," by Alan's father. Remember, as a physician and familiar with hospitals and how they work, his response is that of a doctor and a father.

Dr. Harold Pean

That's crazy. That's totally crazy. Can you believe that? So he didn't see anything wrong. He said that was normal procedure. I mean, can you believe a CEO saying that? That's terrible. I don't understand it. So that would be standard procedure for a patient who's sick, instead of sending their doctor, send police officers and shoot them. That's totally absurd.

Ira Glass

We sent what Alan's dad said to the hospital's crisis manager to give CEO Mark Bernard a chance to respond, along with a long list of other questions. In reply, the hospital issued this statement, which it said came from CEO Mark Bernard. Quote, "In the wake of this sad event, we are reviewing our practices and procedures as we continue to provide the best possible care to those we serve."

Change is happening at St. Joseph. According to the report by federal investigators, St. Joseph is now limited where police officers can go in the hospital to peripheral areas. They can't go to patients' rooms unless staff has tried everything else to calm a situation. St. Joseph also has to do crisis prevention training with staff and police. They have 17 months to get their act together, or they lose their federal funding.

Ira Glass

OK. So basically, you drove yourself to a hospital. And when you're at the hospital, you said explicitly, you're having a manic episode. You're unarmed. And you end up shot.

Alan Pean

Yep. Correct.

Ira Glass

OK. I don't even know what my question is. I just want to say, that seems bad.

Alan Pean

On a whole bunch of levels. And that opened my eyes in a way that I sort of never want it to.

Ira Glass

What do you mean?

Alan Pean

Well, I'm black.

Ira Glass

Because you don't think this would have happened if you were white?

Alan Pean

No, I don't.

Ira Glass

Yeah.

Alan Pean

That the only reason this guy was able to look at me and decide that, hey, he needs to be shot in the chest. I think they just-- another black guy acting crazy. Angry black guy.

Ira Glass

In the immediate wake of the shooting, Alan's father says that one of the questions that police asked him over and over was, did Alan have a criminal record? Alan told me that, of course, he's seen all the news stories about young black men being shot by police.

Alan Pean

I would think outrage. It's an outrage. It's a complete outrage. But I would never think that it would happen to me. I'm privileged, right? I acknowledge that. I acknowledge I'm privileged.

Ira Glass

This is a family of doctors, a family with money. That car that he crashed into the hospital was a 2010 Lexus.

And it's interesting. Of the four black men in the family, three of them thought that they were living a life where they would never have this kind of run-in with a cop. One of Alan's closest friends is a cop. His dad is friends with cops. Only Christian, the oldest son, thought it could happen to him. In fact, when his father texted him the day of the shooting to say that something had happened-- Alan was in the ICU, they didn't know what happened yet-- Christian's first text back was, wait, what? What? Did they shoot him?

Alan Pean nearly died. The bullet hit him squarely in the chest. It missed his aorta by millimeters. He lost a third of the blood in his body.

Alan Pean

I can't believe that I'm even here, walking around, standing. And I don't know why he would shoot me in the chest unless he was trying to kill me. That's a kill shot, so that's-- I don't think too much about it. I try not to, I think, actually, honestly.

Ira Glass

Because it just freaked you out?

Alan Pean

It does.

Ira Glass

Yeah.

Alan Pean

And I really can't handle it sometimes. Well, I can take it. I heard you say it like that. It's just, I still think I'm in shock, that I don't know how to handle it. I don't know how to handle it.

Ira Glass

Well, yeah. That day in August, Alan had a delusion that people were out to kill him, that if he walked out of his apartment, he'd be shot. There were assassins after him. He was going to get shot. And then, he was shot. This literally crazy thought came true. How do you make sense of that?

The New York Times' version of this story is online at their website. It's great, with great photos, at nytimes.com/hospital. Since we first aired this story in 2016, the assault charges against Alan Pean were dismissed by a grand jury. Another grand jury looked into the behavior of the two officers involved in this shooting and did not indict them. The Texas State Legislature is currently considering a new bill that would allow state-run psychiatric hospitals to ban guns again.

Coming up, consciously telling yourself things that you know are not true as a way to use your mind and its power. That's in a minute from Chicago Public Radio when our program continues.

Act Two: Don’t Need to Know Basis

Ira Glass

It's This American Life. I'm Ira Glass. Today's program, "My Damn Mind."

Our first act was about somebody whose mind was sending him jumping off of balconies. And now, in this part of our show, we're turning to a very different story-- still about a man and his brain and the awesome and confounding power of one's own mind. In this case, though, it is about a man harnessing that power for a constructive purpose of his own. This is Act Two of our show. Act Two, "Don't Need to Know Basis."

The man in this story is Michael Kinsley-- writer, editor, known for, among other things, starting the online magazine Slate and for being just a very sharp, funny observer of American politics and human nature generally, including his own nature. He is a human. Nancy Updike talked to him.

Nancy Updike

Michael Kinsley wrote an essay years ago-- it was funny, naturally-- in which he announced that he had Parkinson's Disease. The essay was called "In Defense of Denial," because what he was really announcing was that he had already had Parkinson's for the previous eight years. In that time, he said, the way he had chosen to use his mind, his deliberate strategy for dealing with Parkinson's, had been denial. And he was not writing to confess or apologize or to vow not to engage in denial in the future. He was talking about the benefits of self-deception and secrecy.

His argument was, when it comes to serious illness, like with all terrible things that happen to us, sure, yes, the goal is to get to acceptance-- eventually, if you can. But acceptance is not a strategy, he said. It's not something you can just do. He said, really, there are only two strategies, denial or confrontation.

Michael Kinsley

Confrontation, it's the strategy that everything in our culture pushes you toward, fighting it all the way. And also joining the community of sufferers of whatever, making it your life. Who are you? I'm someone with Parkinson's. And I'm going off to my support group.

Nancy Updike

Right. They really engage.

Michael Kinsley

Yes. Michael J. Fox is an example, and a thoroughly admirable example of how to react. He's made it his cause, both his public cause and his personal cause. And that's great. But I just decided, that is not for me.

Nancy Updike

You went with denial.

Michael Kinsley

Denial, which is the opposite. You don't think about it. You don't get involved. You don't learn everything you can about it. You try to live your life and spend your time outside of that world. And in many ways, this was a cowardly choice. But it was the choice I made.

Nancy Updike

I really appreciate a person who's prepared to use every mental trick in dealing with sickness. Mike's essay spoke to me. I have experienced the clear benefits of denial. I know what it's like to choose that option.

I had a tumor in my abdomen three years ago-- cancer. In the week before the surgery, denial-- carefully executed not thinking-- was my only goal. I wasn't graceful or even logical about it. For some reason, my denial involved making several trips to the drugstore, Duane Reade, to buy dental floss, and yet more dental floss. Not sure why floss. Mike suggested maybe I was stockpiling a message to myself. You will live to floss long into the future.

When he chose denial, Mike did feel bad about deceiving other people, not just the general public but also people he knew. And he said he tried not to lie outright. But denial was very good to him. It gave him eight years of privacy, eight years of relative normalcy. Nothing else could have done that. And he saw another benefit.

Michael Kinsley

If you're lucky, you have good friends and close relatives who are going to help you get through it. But the best person in the world's sympathy is going to be limited. So you do think, well, do I want to use that up?

Maybe that's a crazy way to look at it. But I thought, I'm going to need their sympathy in years to come. And I don't especially need it now.

Nancy Updike

As Mike's symptoms progressed, bit by bit, some tremors, some stiffness, he told more people, bit by bit. And he ignored each person's advice in turn because every person was saying the same thing-- no more denial. The upshot was that Mike continued not reading up on Parkinson's, continued trying to know as little as possible, while his friends were reading up. Thanks to a couple of them, he ended up at the Cleveland Clinic to get brain surgery, basically because his friends had been badgering him to go there and see a doctor who was surgically placing electrodes in the brains of people with Parkinson's to help slow down the progress of the disease's physical symptoms.

Michael Kinsley

Well, it was sort of a slippery slope. They said, why don't you just go and let him examine you and see if you're suitable for it.

Nancy Updike

It's like a blind date. Maybe just go meet her. She's nice.

Michael Kinsley

Yeah. Yes. Well, I did. And they wanted to make sure you were up for this. And after I had been to Cleveland two or three times, they suddenly said, well, how about July 12? I'm making up the date. But they--

Nancy Updike

Wow. They got very specific all of a sudden.

Michael Kinsley

Yeah. And I didn't think about it nearly as long as I should have. There is a controversy about which particular spot in the brain you should go to. And different surgeons do different spots. But that's a perfect example of something I didn't research but that many people would and do. But I said, OK. And the next thing I knew, I was in Cleveland.

Nancy Updike

And were you nervous?

Michael Kinsley

Yeah. I mean, I'm not that good at denial that I wouldn't be nervous about brain surgery. So they just-- they said we're just going to make a little hole. And they said it's just dime-sized. And that took me back, because I think of a dime-sized hole as being pretty big.

Nancy Updike

Large. For them it's small. For you, it's big. Because it's your brain.

Michael Kinsley

Yeah. But I thought, well, this is how they do it.

Nancy Updike

OK. And they screw your head to the table so it won't move while the surgery is happening right? Even though it's general anesthesia, it's not local or anything.

Michael Kinsley

No. No, it's not general anesthesia.

Nancy Updike

You were awake?

Michael Kinsley

For most of the time.

Nancy Updike

Oh, my god.

Michael Kinsley

Because they had to-- well, it's like you're down in the basement trying to replace a fuse. And someone has to go upstairs to see if the light comes on. And so that was me.

Nancy Updike

Right. You were the test about whether they were getting it right.

Michael Kinsley

Yeah. And it was quite weird. They could press a button or something, and my hand would start to wave.

Nancy Updike

The surgery did what it was supposed to. It slowed the progress of the physical symptoms which then allowed Mike to continue his project of exercising however much denial he possibly could at every stage.

Parkinson's isn't usually fatal. Or, as Mike has cheerfully written over the years, Parkinson's gives you a decent chance for something else to get you first. But Parkinson's does get worse over time.

And maybe even more galling, Parkinson's is not just one thing. Eight years after the brain surgery, Mike wrote another essay about Parkinson's in The New Yorker. It's called "Have You Lost Your Mind?" Look it up if you haven't read it. It's great. It's about the research, more and more of it over the last couple of decades, indicating that Parkinson's can include cognitive symptoms. It can affect your thinking.

Nancy Updike

A doctor once said to you when you asked him-- I think it was a him-- when you asked him about the cognitive issues associated with Parkinson's, he said, well, you may lose your edge.

Michael Kinsley

Yes. That was the most terrifying moment, I think, in the whole process. I mean, I make my living off of my edge. And also, it's part of my sense of who I am.

Nancy Updike

He thought he was sort of soft-pedaling something, saying, oh, you might lose your edge, as though you're still an intact thing with just a slightly softer edge. And meanwhile, for you, you were thinking, but I am my edge. My edge is me. I'm not a thing with an edge. The edge is-- that's me. That's what feels like me.

Michael Kinsley

Yeah, that's exactly it. But let me say to anyone who cares who's listening that I have not lost my mind.

Nancy Updike

Mike says the rallying cry for his generation is death before dementia, only after a very long life, of course. He wrote in his New Yorker essay that the kind of thing you'd want people to say about you, looking back, would be something like, "he was 102 years old when he was accidentally shot by a neighbor and still sharp as a tack."

Parkinson's is different from Alzheimer's. The cognitive issues vary a lot from person to person, and they're still being researched. But dementia is one possibility. And a big reason we know that is because other people with Parkinson's-- the confronters, not the deniers-- are talking about it.

Michael Kinsley

Most of our information about cognitive problems comes from the patient, him or herself. And I'm thinking, are these people out of their minds?

Nancy Updike

You want to send a mass email to everybody with Parkinson's just saying, can we all just not talk about this? Why are we talking about this?

Michael Kinsley

Yes. Well, when I hear people talking about this, I think, shut up. Shut up.

Nancy Updike

You actually think "shut up" at them?

Michael Kinsley

Yeah. It doesn't work. I switch back into denial when it comes to the cognitive thing. And yet here I am, discussing it on a national radio show, so obviously my motives are mixed.

Nancy Updike

Do you not want to talk about it?

Michael Kinsley

Well, we have nothing else to talk about, Nancy.

Nancy Updike

I'm sure we could find something.

Michael Kinsley

Yes, well, we've got the New Hampshire primary.

Nancy Updike

Yes, yes. Did you watch the Super Bowl?

Michael Kinsley

No.

Nancy Updike

No? Beyonce? Anything?

Michael Kinsley

Eh.

Nancy Updike

No?

Michael Kinsley

No. What's she done?

Ira Glass

Nancy Updike is one of the producers of our program. Michael Kinsley is a contributing columnist for Vanity Fair and The Washington Post. His latest book is Old Age: A Beginner's Guide.

[MUSIC - "FORMATION" BY BEYONCE]

Credits

Ira Glass

Our program was produced today by Chana Jofee-Walt, with Zoe Chace, Sean Cole, Neil Drumming, Stephanie Foo, Miki Meek, Jonathan Menjivar, Robyn Semien, Alissa Shipp, and Nancy Updike. Our senior producer is Brian Reed. Our editor is Joel Lovell. Julie Snyder is our editorial consultant. Our technical director is Matt Tierney. Production help from Lyra Smith. Seth Lind is our operations director. Emily Condon's our production manager. Elise Bergerson's our business operations manager. Elna Baker scouts stories for our show. Kimberly Henderson is our office coordinator. Research help today from Christopher Swetala and Benjamin Anastas. Music help today from Damien Graef and Rob Geddis.

[ACKNOWLEDGEMENTS]

Our website, thisamericanlife.org. This American Life is delivered to public radio stations by PRX, the Public Radio Exchange. Thanks, as always, to our program's co-founder, Mr. Torey Malatia. You know, how do I get through this program every week? Let me tell you, I just come in to the studio, I look up at the photo of Torey Malatia that is here in the radio studio, and I can hear his voice in my head, saying--

Alan Pean

Just remember your training. You trained for this.

Ira Glass

I'm Ira Glass. Back next week with more stories of This American Life.

[MUSIC - "WHERE IS MY MIND" BY VANILLA FUDGE]