Riding the elevator up to the seventh floor, Carl can smell the craziness getting stronger. What is the smell, exactly? He thinks it must be what animals pick up from terrified prey, a secretion that reeks of vulnerability, an invitation to attack. Then he wonders: is it coming from the psych ward, or from me?

The seventh-floor lobby is as small as he remembers, with off-white walls and a wide reinforced door. Carl takes a breath, presses the button next to the door, and presents his face to the camera overhead. A moment later he hears a sharp buzz. Beyond the door is a windowless waiting area: hard plastic seats against a long wall, a small reception desk, another reinforced door that leads directly into the ward. On the walls hang the same inoffensive, faded prints of flowers and seascapes that hung here years ago.

Carl approaches the desk and tells the woman that he’s here to see Richard Bailey. She eyes him suspiciously as if he must be crazy to visit this place.

“Your name?”

He hands over his driver’s license, and she copies the information into a log. “Put all your valuables in this locker,” she says, handing him a small key, “including cell phone, wristwatch, keys, wallet, et cetera,” which she pronounces ex cetera.

Along the far wall are several metal lockers of the kind we used to find in bus stations before they were removed to discourage bombers. Carl places his valuables inside locker number 12, shuts the door, and pockets the key, wondering why he can bring this key into the ward but not his own. He sits as far away as possible from the other two people waiting: a middle-aged man and woman. They appear lost, having surrendered their cell phones. The man stares at an unframed print of a large red rose. The woman looks off toward the inner door, seemingly frightened that it might open.

While he waits, Carl recalls the one previous time—it seems like a hundred years ago—that he came to the seventh floor. The arrangement was more or less the same, the reinforced doors, a nondescript woman behind a desk to buzz him through. Carl, working that summer between freshman and sophomore years as an O.R. orderly, had arrived to transport a patient down to surgery. He wore green scrubs, complete with paper booties and hair cover, and pushed a gurney. He remembers the long, narrow corridor, the empty common room with its darkened television, the bright green billiard table, and scattered chairs. He saw no patients or nurses on the ward that day, and the hair on his arms crackled.

He remembers checking the O.R. pickup slip—Johnson, Chuck, Rm. 217—and barely breathing as he neared the first of the hallway’s wide-open room doors. What would he see inside? His coworkers—full-timers, all of them—had laughingly warned him about the seventh floor, stories of drooling lunatics shitting themselves. Chuck Johnson, he was told, had swallowed a fork. Carl had seen the weirdly beautiful x-ray that, against regulations, the surgical assistant shared with the entire O.R. staff—the stark gray image of the man’s abdomen and, floating there, as if in outer space, a bright, silvery fork. “Last year,” the assistant said, smiling, “the same guy swallowed a tube of toothpaste.”

Were there really no nurses on the ward, Carl wonders now, or has time erased them from his memory, leaving only the endless corridor and the people he saw in their rooms? The girl in 703 tied to her bed with leather straps, turning her head to watch him go by. The man in 708 sitting up in bed, mumbling to himself, his long white beard stained with soup, crackers, God knows what else. The old woman in 711 lying crooked on her mattress, like a parenthesis, her face turned toward the door as she muttered, Help help help help . . .

In the waiting room, the couple has been called. The door buzzer is going, and the man grabs the knob and pushes through, but Carl can tell the woman is thinking twice (or thrice) before entering. As she finally steps through the doorway, Carl catches a glimpse of blank hallway wall before the door swings shut.

He wonders if there is still a pool table on the ward. His fellow orderlies had told him, just before he went up to get Chuck Johnson, about a patient who went berserk and started pelting people with billiard balls. Someone called a code red, and all the available orderlies in the hospital ran to the scene. By then the man had run out of balls, but it took several orderlies to wrestle him to the ground. They told the story like they were veterans recounting some great war battle they’d won.

The reception lady calls his name. “Richard is in room 721,” she tells him.

He stands and waits for the door buzzer. When it comes, the sound is like a mild electric shock. He opens the door to find the long corridor. But, unlike the hallway from years ago, this one is noisy, and halfway toward the far end, he sees people moving about. He passes four empty rooms, two on each side. The next door is shut, and from inside he hears weeping. He continues on. The hallway opens up into the wide common area, with chairs scattered around and a large television bolted to the wall, up high, where no one can reach it. There is no billiard table. A game show is playing on the TV, and half a dozen patients sit watching in their bathrobes. One of them shouts out an answer, and another one tells him to shut up. Richard is not among them.

He passes more rooms, some empty, some with patients lying in bed, seemingly peaceful but probably medicated half to death. In one room, the couple from the waiting room stand on either side of the bed looking down upon a beautiful older woman. This woman is so striking that Carl pauses outside the door to take in her angelic face, her long gray hair tendrilling across the pillow.

He wonders what Richard will look like. Carl hasn’t seen him in several years and has no idea what to expect. He recalls Chuck Johnson, whom he found lying in his bed, like any other hospital patient except for his eyes. How to describe them? Like the glassless windows of a nearly burned down house, everything inside gone to flame and smoke. Johnson was around fifty, Carl guessed, but who knew with these psych patients—he could have been thirty. His hair had been sloppily cut, and whiskers covered his pale, emaciated face. And, of course, those eyes.

“Good morning,” Carl said to him, just the way he had said it to the nine other surgical patients he’d transported that day—but they had not been from the seventh floor. The man looked at him blankly.

Carl double-checked the room number. “Mr. Johnson, yes?” The man did not nod or say anything. Carl consulted the chart at the foot of the bed: Johnson, Chuck. “Okay,” he said, “I’m here to take you down for your surgery.”

After lowering the rails, Carl maneuvered the gurney alongside the hospital bed and locked the wheels.

“Think you can scoot over?” he asked, patting the thin gurney mattress covered in the same green material as his scrubs. “From there to here?”

The patient continued to look at him and, after a moment, said, “Are you taking me away?”

“I’m taking you down to surgery, Mr. Johnson. Do you remember what the doctor told you about that?”

He tried to imagine this man swallowing a fork but couldn’t envision the metal utensil making its way down his gullet and into his stomach. Carl had read about a man who could digest metal—he’d once devoured an entire car—in an old copy of The Guinness Book of World Records.

“Are you going to kill me?” Chuck Johnson asked though he didn’t seem panicked or remotely concerned.

“Of course not!” Carl said, taken aback. “It’s just a quick procedure. You’ll be back here in no time. Now scooch on over here. They’re waiting for us downstairs.”

The patient glanced down at the gurney. He wore the usual thin hospital gown and had a blanket pulled up to his waist. A plastic line ran from a bag on an IV pole to a vein in his left hand.

“Come on, Mr. Johnson,” Carl said, holding up the edge of the gurney blanket—just a sheet, really—so that the patient could get underneath.

“I think you’re here to kill me,” he said.

“No, no. God no. I promise. I’m here to help you get better.”

Was it crazy, Carl wondered, for this man to expect the worst? Was the worst any better than locking him up in a place like this?

After some thought, Chuck Johnson pulled his blanket to the side. “That’s it,” Carl said. “Now put your hand here . . .” He patted the gurney. “And lift your rear end over.”

The patient set his gnarled hand on the gurney top and, breathing heavily, hoisted his butt across. In the process, his gown bunched up, and Carl glimpsed the man’s pale haunches.

“That’s it.” Carl covered him with the white blanket and unlocked the wheels. He raised the gurney rails and transferred the saline bag to the gurney pole. “All set?”

Carl steered the gurney into the hall. He had pushed patients down hospital corridors hundreds of times over the summer but never had he encountered a hallway so quiet and deserted. He looked straight ahead the entire time, toward the exit door, occasionally glancing down at the patient, who had crossed his hands over his chest, like a corpse. His hair was greasy, slicked over a small bald spot on top.

Carl recalls now his sense of relief as he and Chuck Johnson finally exited the psych ward into the main hall and onto the elevators. He wishes he could turn around and exit this place now, but he has reached room 721. He stops just short of the half-open door. A woman is screaming in one of the rooms farther down, a bloodcurdling holler.

“No! No no no no!”

It’s probably something simple—she doesn’t want her meds, or doesn’t want to be washed—but it sounds like screws are being twisted into her skull. A linebacker-sized orderly in scrubs passes Carl at a leisurely pace and enters the woman’s room. The screeching continues for a moment, then stops.

Carl glances through the partially open door to room 721. He sees the foot of a hospital bed, a bureau against the unadorned wall, a narrow window reinforced with chicken wire. He takes a deep breath, taps the metal door, and pushes it farther open.

“Hello?”

His brother lies in the bed, his eyes half shut, arms straight at his sides, the woolen blanket pulled neatly up to his chest.

“Richie?” No answer, nor acknowledgment. “It’s me. Carl.”

He approaches the bed. Richie continues to lie still, as if comatose. He doesn’t look like my brother, Carl thinks. Richie was always pudgy, with a round, cherubic face and lively hazel eyes. This man’s face is drawn and bony. A snow-white square of tissue sticks to his jaw where an orderly must have nicked him shaving.

“Richie?”

 When he finally tilts his head toward Carl, Richie’s eyes remain blank. The burned-out house.

“How are you feeling, Richie?”

Carl pictures his brother on the streets, where they found him several days ago. Hostile, the social worker said, even violent, though now he lay docile in a pharmaceutical smog. The Richie Carl remembers was happy, funny, popular, garrulous, good at everything except school, where his studies took a back seat to enjoying life—as if he knew somehow that, down the road, all that learning would mean nothing. The deterioration had been swift: over the course of a few years, he lost jobs, friends, girlfriends, his mind. Then he disappeared. By pure chance, one of the cops called to remove Richie from the streets recognized him from high school, where they’d both appeared in the senior musical. Carl has no idea how his brother’s old friend put together that this hollow mannequin was the same person who strutted on stage as Conrad Birdie so many years ago.

“It’s me,” Carl says again. “It’s Carl. Your little brother.” But Richie doesn’t seem to know he’s there.

Carl arrived prepared to tell Richie about their parents’ deaths—his brother should know, he’d convinced himself—but now he can see the information would mean nothing to him. Carl is angry that his father and mother have gone, leaving him to deal with this. It’s not about the money—he has none, but in any case, the state will care for Richie—it’s about knowing that his brother is in this condition, in a bed in a mental ward, his eyes blank and his mind wrenched from reality, and Carl can do absolutely nothing about it. It was better not to know, he realizes now, though he’d spent all those years thinking otherwise.

He tries again: “Richie? Can you speak?”

Richie had not yet run away when Carl worked in this hospital that summer. He’d lost another job and cracked up another car, yes, but Carl didn’t know that his brother was literally crazy. He and his parents assumed Richie was just on drugs—which he was, but that wasn’t the real problem, the real problem was what the drugs covered up. If only Carl had known that then, he might not have laughed with the others when he rolled Chuck Johnson into O.R. 10 and the tech started singing, The lunatic is on the grass . . .

“Richie?” he says one more time. “Richie, please.”

He thinks he detects a flicker, a sigh, but then he notices the deep yellow fluid coursing through the tube that runs out from beneath the blanket to a clear bag hanging at the foot of the bed. His brother is just taking a piss.

Chuck Johnson died on the operating table, having gone into cardiac arrest mid-procedure, his belly split wide open, organs exposed, the fork within reach of the surgeon’s forceps. After he’d been declared dead, they sewed him up and Carl wheeled the body down to the end of the O.R. hallway to await transportation to the morgue. The body lay there half the day, covered by a green sheet, and as he went about his work, Carl would glance down the hall, half expecting Mr. Johnson to sit up and say, “See? I was right.”

Carl quit the next day.

– Chris Belden

Author’s Note: “The Seventh Floor” was inspired by a job I had in college as an O.R. orderly. One of my duties was to transport patients from their rooms to surgery, and one day I had to go to the psych ward for a patient. The floor was eerily empty of people—the memory now feels more like a dream.