[NOTE: It is unclear whether Dr. Mercer recorded any notes for Days 1-4, as it is possible that he was unable to personally interact with the patient until the patient’s 5th day at St. Augustine. Such delays are fairly common in psychiatric facilities.]

 

Day 5
Patient reports having the persistent urge to self-immolate. He says that ever since he was five years old, fire felt safe for him. He described the feeling as similar to how he felt whenever he went camping with his father. They liked to sing songs together around the campfire while his father played on guitar. The patient thinks fondly on those moments, as they are one of the few good memories he has of his childhood.

Day 6
Patient reports that when he interacts with others around him, he can’t help but feel irritated by them. When asked, he denies having thoughts of harming other people, but he remarks that it would not bother him if they “somehow vanished from this material plane.”

 

Patient reports that ever since he entered our facilities, he has felt the sensation of itchiness, as if insects were crawling beneath his skin. He has asked nurses multiple times to check his mattress for bed bugs, though he now agrees with their assessment that nothing is there.

 

Despite his acknowledgement of that fact, he reports that the sensation begins at his feet and then proceeds up the calves, thighs, and stomach until it spreads across his chest and arms. The desire to burn his own skin seems to occur shortly after the itchiness begins. He says that he tries to dig his fingernails into the palms of his hands to stave off that desire. But when that fails, he imagines taking his favorite lighter (the one we confiscated upon his arrival) and burning his skin until it ripples and blisters.

Day 7
The patient seems even more agitated than on previous days. Today when he speaks, he scowls,
mutters to himself before speaking to me. He says he doesn’t want to answer any further questions. The nurses say that he has also been refusing to eat. I was not able to get any further information from him today.

Day 8
The patient stared me down for nearly an hour today. I thought it best to try to let him speak first. But all he said was, “I didn’t do it.” I asked him what he didn’t do, but he began to pull out fistfuls of his own hair. We promptly administered an intramuscular injection of Lorazepam to calm the patient down.

After the acute agitation subsided, the patient began to describe a recurring dream he had, unprompted. He said he was standing in his childhood bedroom, holding a box of matches. The walls around him were swaying with perfect colors of orange and red. “Everything around me was perfect,” he kept saying.

I asked him what made it perfect, and he replied, “I could no longer feel anything but the heat.”

 

In police records that we were able to get unsealed, they noted that although the lead investigator initially believed that my patient could have set the fire that killed his parents, he ultimately concluded that the boy could not have done so due to his young age and the fact that he showed no signs of sociopathic tendencies. Furthermore, the father was a known smoker of cigarettes. Several neighbors also told the police that they were certain the boy could not have done it. His First Grade teacher was interviewed during the investigation, and she said, “He’s a good boy. Very kind and honest. I know he wouldn’t hurt a fly.”

 

[NOTE: the document from Day 9 is heavily burned, leaving only the following:]

incident

                                    has only

​

                                                                        accused

​

           burned his roommate

                                                                                                            third degree burns

three more weeks

 

                                                   denies                           danger to others

can no longer

​

                            imminent risk

 

I’m afraid that the patient will

 

[NOTE: The rest of the entry is too burnt to decipher]