492: Dr. Gilmer and Mr. Hyde

Ira Glass

Hey there, it's This American Life. We first aired today's program in 2013. But we're going to air it again right now. Because just this week, after many, many years, there's news. Story's changed.

So what we've going to do this hour is play the original story, then we have an update for you towards the end.

As you'll hear, the reporter is Sarah Koenig, host of Serial. She did this before Serial, but you'll hear she's in here solving a mystery in a very Serial-like way.

Anyway, here's the original story.

Benjamin Gilmer was finishing his training to be a doctor and he was applying for jobs. And there was this one job that he was really excited about at a small rural clinic in North Carolina, a place called Cane Creek, about 15 miles outside of Asheville. But there were two slightly strange things about this job.

The first was that his predecessor at the position-- who was the guy who started the clinic-- had left the job after murdering his own father, strangling him and sawing off his fingers. And the other strange thing?

Ira Glass

This is Benjamin Gilmer.

Ira Glass

That's right. The murderer was Dr. Vince Gilmer. He was Dr. Benjamin Gilmer, no relation at all.

Ira Glass

This is Robin Whiteside, who works at the clinic. Benjamin Gilmer must be a very qualified young man, because they did give him the job. And sure enough, it did cause confusion among the patients, freaked a few out.

Ira Glass

Terry Ippilito sits at the front desk of the clinic.

Ira Glass

As if there is such a thing as a Halloween joke. Anyway, one patient, Benjamin was meeting her for the very first time. He walks into the exam room.

Ira Glass

Hyperventilating, heart palpitations. She thought maybe the other Dr. Gilmer, the murderer, was going to be seeing her. But as Benjamin settled in at the clinic and people got to know him, something interesting happened. Many of Vince's former patients, who were now Benjamin's patients, started talking to him about Vince.

Ira Glass

For instance, Ruth Tracy. When she first came to Vince for treatment, she had just lost her job. Her husband wasn't working either. No insurance. She told Vince, don't do tests. I can't afford it. Vince wouldn't hear of it.

Ira Glass

This is not an exceptional story about Vince Gilmer. Lots of people would tell you what a great guy he was. Generous to a fault, he'd help you pay to get your car repaired, buy you a present for no reason. If you had no money, he would take a bushel of corn as payment. He was a big, burly man. His nickname was Bear. He hugged everybody.

He was a solid guy, a gentle guy. He gave free annual checkups to the local firefighters. He made house calls. House calls! Didn't charge for them. And when one of our producers, Sarah Koenig, went around asking about Vince, she heard that some people still had a hard time believing that Vince would be capable of cold-blooded murder, even though he's serving in prison for it-- like Jerol Davis, one of his former patients. He told Sarah it made no sense.

Ira Glass

So Benjamin's doing this job. And, like, every few weeks, somebody is telling him some glowing story about Vince.

Ira Glass

He and Vince Gilmer had the same specialty, same job, same clinic, same last name. They were even the same age. Vince Gilmer was 41 when he murdered his father, the same age as Benjamin when he came to work at the clinic. And at some point-- and maybe you see where this is going-- Dr. Benjamin Gilmer started to get very curious about the murder that Dr. Vincent Gilmer committed.

He began asking questions, poking around, talking to people. He developed his own theories, theories to explain the murder that had never come up at Vince's trial. He gets pulled in deeper and deeper. And by the end-- and I don't think this is a spoiler alert-- things are very, very different from the way they look here at the beginning of the story. It is an amazing story. From WBEZ Chicago, it's This American Life. I'm Ira Glass.

And with that, I will pass things off to Sarah Koenig, who's the one who went to North Carolina and watched this all unfold. Here's Sarah.

Sarah Koenig

When Benjamin first told me that he identified with Vince Gilmer, felt connected to him, I didn't really get it until I went there to the Cane Creek Clinic and hung around and watched Benjamin with his patients. What I hadn't understood is that Benjamin is the same kind of doctor Vince was.

I don't know how else to say this, but he cares about his patients, really cares. And they can tell, so they confess things. The morning I spent there, a pregnant woman told him she did not want the baby's grandfather at the hospital when she gave birth. And so, they crafted a plan for how to keep him at bay.

A young mother of two said she'd just left her husband, which is better for everyone, even though she now had to work all the time and put her kids in daycare. You are doing good work with your children, Benjamin told her. And she almost started to cry. There was an older patient, who came in anxious about a lump in her groin that Benjamin had already assured her was benign. He gives her a sonogram.

Sarah Koenig

She does not need the sonogram. And he will not charge her for the sonogram. But he knows it's the one thing that's going to make her feel better, if she can just visualize this harmless thing. And it works. By the end of the appointment, she's laughing.

Sarah Koenig

This doctor-patient trust, it's so intimate in a little practice like this one. And now, Benjamin Gilmer and Vince Gilmer know some of the same intimate things about the same people. And that's why Benjamin started to feel connected to Vince. And then one day, last fall, one of Vince's former patients said something that rattled Benjamin. It was an older man.

Sarah Koenig

The thought of being this close to a murderer, he said, was terrifying. And Benjamin started to cook up irrational fears. He couldn't help it. He worried Vince would get out of prison and come after him in some way. At one point, a patient mentioned that Vince was, in fact, out on parole. It turned out not to be true, but for weeks afterward, Benjamin was on alert, scanning the outside of the building when he arrived.

Sarah Koenig

This is Laura Lira Hernandez, medical assistant at the clinic.

Sarah Koenig

When I met Benjamin, this is where he stood, confused about the two versions of Vince Gilmer coexisting in his head, the murderer and the good doctor.

Sarah Koenig

Benjamin needed to sort out this mystery of how a beloved family doctor with no criminal history suddenly ups and strangles his own dad, how a good man seems to turn into a bad man.

Sarah Koenig

He started with Terry Worley. She was office manager at the Cane Creek Clinic, and good friends with Vince and his wife, Karen, who was also a physician. They'd started the clinic together and worked together. Vince and Karen didn't have kids of their own, but Vince would come to Terry's kids' basketball games. She said he was like part of their family.

Sarah Koenig

Terry told us two interesting things about the year leading up to the murder. First, Vince had a bad car accident. He flipped his truck just off an exit ramp.

Sarah Koenig

Here's the strangest part. Terry said she thought Vince had maybe crashed his truck on purpose. He was scheduled to take his medical board exams at that time. And he was exceedingly anxious about them. He'd always been a bad test-taker. His mother told us he had attention deficit disorder as a kid. And Terry says it occurred to her that the accident was a way to avoid taking the boards.

Sarah Koenig

Another friend who didn't want to go on tape also told us, unsolicited, that he thought Vince might've crashed his truck on purpose, possibly as a suicide attempt. Then, not too long after the truck accident, Vince and Karen split up, which floored their friends. Terry says it came out of nowhere.

Sarah Koenig

Vince's friends said he was drinking three or four nights a week, mostly at a bar in downtown Ashville called Jack of the Wood. But Terry says he's still seemed fine at work, and that he was fine the Monday they closed the clinic early, June 28, 2004, so that Vince could go pick up his father, Dalton Gilmer.

Dalton was at a psychiatric hospital. It's called Broughton Hospital. It's not clear what exactly was wrong with Dalton. But according to court records, he was taking antipsychotic medication and he needed help taking care of himself-- dressing, bathing, even eating sometimes. And he could barely walk. He needed a wheelchair or a walker. He was 60 years old.

Vince had made arrangements to transfer his father from Broughton to a nursing home very close to the Cane Creek Clinic. So that Monday afternoon, he drove up to Broughton and collected his father. I had every intention of taking him to the nursing home, Vince said at trial. But Vince says he promised to first take his dad to a favorite lake, several hours out of the way.

He did have a big green kayak in the back of his truck, but remember, his dad can't walk. And Vince has no walker in the truck. Plus, it's getting late. So this plan didn't make much sense. The heart of Vince's story about the crime is probably something that, if you're listening with little kids right now, you might not want them to hear.

Vince says his father sexually abused him and his younger sister from the time they were 6 and three years old, respectively. The abuse he describes is maybe the most horrific I've ever heard of. Vince's sister apparently corroborated the abuse, but she disappeared just before the trial in 2005. And her family has not seen or heard from her since.

Vince's mother claims she never knew about the sexual abuse, not until after the murder. She said her husband was a Vietnam vet, who came back from the war a changed and sporadically violent man. Vince says his father was apt to make inappropriate sexual remarks and gropes, and that's what happened in the truck that day.

He kept saying filthy, filthy things, Vince said at trial. And that's when he lost it, he says. Vince said a voice in his head, like a compulsion, was telling him to kill his father. I reach over with the rope and I place the rope around his neck and pull on it and pull on it and pull on it. Then Vince says he drove around for hours, panicked, trying to figure out what to do with the body, which he'd moved to the bed of the pickup.

Eventually, he carried it onto the side of Good Hope Road, near the Virginia/Tennessee border. And he performed what the Virginia medical examiner would later describe as traumatic amputations of all 10 fingers. He cut off his father's fingers and thumbs. Vince says he used a little saw he had in the back of his truck for trees around the house. Vince said he did this to prevent the body from being identified.

And then, Vince went home. The body was quickly found, still warm, and quickly identified. In the pocket of his tanned shorts, in the inside color of his polo shirt, stamped in black ink, D. Gilmer. Name tags that Vince says he himself had arranged for.

After learning this much, Benjamin started conjuring a hypothesis about Vince. Benjamin did his master's thesis on traumatic brain injuries prior to Med school. To him, the truck accident was key to the whole thing. Maybe Vince had some lurking hereditary craziness that was unmasked by big bonk to the head. Or, in Benjamin's words, latent neurologic sequelae, triggered by brain trauma.

Sarah Koenig

If Vince snapped as he claimed, then it's hard to square his behavior immediately following the crime. Because from the sound of it, he told a cascade of lies coolly, no bead of sweat running down his temple.

On Tuesday, the day after the murder, Vince told his office manager, Terry Worley, and everyone else that he brought his father home. And that sometime during the night, his father had wandered off. He said he had people out looking. He filled out a police report, didn't cancel any appointments. In fact, the very first patient he saw was Terry's son, for asthma.

Sarah Koenig

Vince kept seeing patients all week. Then on Friday, Vince invited the staff out to lunch at a favorite restaurant called Iannucci's. While they were there, he got a phone call from a detective, telling him they'd found a body in Virginia. Again, Terry Worley.

Sarah Koenig

Benjamin and I talked to this detective. His name is Mike Martin. Benjamin was on speaker phone.

Sarah Koenig

Detective Martin says when he showed up at Vince's door, Vince was cordial and composed.

Sarah Koenig

Before Detective Martin could get back to Cane Creek with a warrant, Vince ran, took some camping equipment and hid out. The cops finally caught up with him in the woods near the Lowe's hardware store at the Asheville mall.

Sarah Koenig

Other things Benjamin and I learned from Terry Worley. Vince was his father's guardian. He was supposed to be paying his father's bills out of his father's money, but he didn't. By the time he killed his father, he owed the psychiatric hospital where his father had been staying more than $270,000. A motive, maybe. Also, Vince had planned a two week vacation to Alaska that coincided with his father's killing. Terry says the investigators questioned her about it.

Sarah Koenig

By the time we'd finished talking to Terry, Benjamin was deflated. Vince was sounding more and more like this cold-blooded killer. We debriefed.

Sarah Koenig

Soon after Vince Gilmer was caught by the police, he confessed to strangling his father. His defense boiled down to one word, serotonin. That was his excuse, his disease, his all-purpose defect, serotonin. Or rather, lack of serotonin in his brain.

Serotonin is a hormone, a neurotransmitter. If you don't have the right level of it in your brain, it can affect your mood, which is why many antidepressants increase your serotonin level. These drugs are called SSRIs, Selective Serotonin Reuptake Inhibitors. If you stop taking them abruptly, you can have suicidal thoughts, severe agitation, even psychosis.

What you believe about Vince's crime depends on whether you believe he was out of his mind at the time of the killing, whether you believe that missing his SSRI pills could transform him from a loving doctor into a psycho. Here's Vince's explanation for what happened.

He'd been struggling with anxiety for years. And after he and Karen split up, in the months leading up to the murder, he'd been taking Lexapro, an SSRI. He says a day or two before he went to pick up his dad, he stopped the Lexapro. Didn't taper it off like you're supposed to, he just stopped. And he reacted very badly.

He became extraordinarily irritable, heard voices. His brain didn't work right, he said. He felt, quote, "mentally retarded". In a letter to a doctor he wrote from jail, this is how he describes the voices he heard when he was off the Lexapro.

"These are not voices that make a suggestion. This is a compulsion. The compulsion is trying to take over my consciousness. I fight the compulsion in the front part of my head. It is a hyperanxious state. Pacing becomes mandatory, trying to walk off the pressure. The battle hurts badly."

Sarah Koenig

This is reporter Matt Lakin. Back in 2004, he was covering crime for the Bristol Herald Courier. He spoke to Vince soon after the murder, both on the phone and in person. And Matt says Vince seemed like an intelligent guy, a nice guy, pleasant to talk to. Not obviously crazy, maybe just eccentric and a little manipulative.

Sarah Koenig

This question lurked throughout Vince's initial incarceration and court appearances. Was he crazy? Or was he crazy like a fox? We asked Mike Martin, the Virginia detective in charge of the murder investigation, whether he ever saw evidence of mental illness in Vince, whether he ever questioned if the cops had gotten it wrong.

Sarah Koenig

Detective Martin said he and his fellow officers had noticed Vince shaking his arm and his head, and that he only seemed to do it around them, not around the other inmates. They were suspicious.

Sarah Koenig

A clinical psychologist named Jeffrey Feix came to a similar conclusion. Feix evaluated Vince to find out if he was sane at the time of the crime. He reported that Vince was agitated, quote, "spoke in a halting fashion, fidgeted while sitting, stood with a stooped posture, occasionally paced, and gesticulated broadly with his hands while talking. This presentation was very dramatic and not consistent with known anxiety or psychotic disorders."

Feix went on, "it appeared that the patient was exaggerating his symptoms for the benefit of the evaluator and treatment team. It is respectfully recommended that Dr. Gilmer be considered legally sane at the time of the offense." Later that fall, another psychiatrist found Vince to be quote, "evasive, dramatic, and manipulative." And by mid-2006, the prison doctors had settled on a two-pronged diagnosis-- atypical depression and malingering. In other words, lying.

From jury selection forward, the trial was a disaster for Vince. His performance, his explanations, they appeared to move no one. I talked to a man named Robert Hughes, who was called to serve on the jury, though eventually excused. When he would talk to us, Mr. Hughes said of Vince, he would act like he was nuts. Then, when he turned around to talk to his lawyers, he was as cool as anything.

Sarah Koenig

Nicole Price was one of the prosecutors. When she lists all the evidence, the state's case sounds pretty straightforward. Vince had made careful plans to pick his father up. He had all the materials he needed to carry out the crime right there in his truck. He mutilated the body to hide the identity, and then dumped it in Virginia, far from where he himself lived.

Sarah Koenig

And what is the craziest thing a man accused of first degree murder can do? The craziest, most stark-raving lunatic thing a man facing life in prison can do? The answer is dismiss his lawyers and choose to represent himself. And so, yes, that is what Vince Gilmer did.

I used to be a court reporter. And so, I read a lot of court transcripts, but none as farcical as this one. It makes you wonder if maybe he really was crazy, because any casual watcher of Law & Order could have built a better case for himself than Vince Gilmer. His witnesses are beside the point. His own testimony favors the nonsensical. Vince can barely string together a sentence before a prosecutor objects.

At one point, Vince called his ex-girlfriend, Susan Garren to the stand. He asks her, "to the best of your knowledge, have I hurt anyone or killed anyone? Just have I hurt or killed anyone that you know of?" Susan, "Your father." Vince, "OK that-- have I besides what happened with my dad?" Susan, "Can you repeat the question, please?"

His court-appointed attorney, who was there only to answer Vince's questions about court procedure, said it was agonizing to watch, like someone trying to commit suicide with a butter knife. Toward the end of the trial, Vince Gilmer says, Your Honor, I'd like to call Vince Gilmer. He talks and he talks and he talks for nearly two hours. And by the end, he loses his thread.

The prison docs have stopped his SSRIs meds, he said. "So when I came in here, I'm confused. I had trouble-- I've had trouble with the confusion all the way through this. I know you're the jury, and I know he's the judge, so that makes me in Virginia-- you're-- I'm capable to-- I'm able to say I'm competent to be here. This hasn't been the brightest of ideas, being my own lawyer."

A little later, prosecutor Nicole Price interjects. "Isn't it true that you've been found competent to represent yourself?" "I am," says Vince. "Are you fine right now?" Ms. Price asks. "No," says Vince.

The jury took about an hour to convict Vince Gilmer of first degree murder. The judge, the Honorable C. Randall Lowe concurred. Quote, "it was clear that it was malingering and faking," he said at a post-trial hearing. "The defendant would go into an act. He would look up and see if the jury was buying it. When the jury wasn't buying it, he would go back to normal. It was clear."

Judge Lowe sentenced Vince to life in prison without the possibility of parole. So that's where it ended. The entire law enforcement, medical, and legal community declared Vince a liar. He went to a maximum security prison called Wallens Ridge in the mountains of far Western Virginia.

Ira Glass

Coming up, Benjamin does not take premeditated for an answer. A hunch, a blood test, and DNA evidence. And not the kind you're thinking of. That's in a minute from Chicago Public Radio, when our program continues.

Ira Glass

It's This American Life. I'm Ira Glass. Today on our program, Dr. Gilmer and Mr. Hyde. If you just tuned in, Dr. Benjamin Gilmer is looking into a murder committed by Dr. Vince Gilmer, no relation. Where we left off before the break, Vince Gilmer was claiming that his brain was not functioning properly at the time of the murder.

Two psychiatrists and a psychologist thought he was faking his supposed symptoms of a mental disturbance. A jury thought he was faking, a judge thought he was faking. Our reporter on the case, Sarah Koenig, was inclined to think that all these people cannot probably be wrong. And the one person-- the one person-- who still thinks that maybe Vince Gilmer might not be faking is Benjamin Gilmer.

Sarah Koenig

He's still unconvinced. He's begun researching SSRI withdrawal, and found dozens and dozens of reports of people who've become violent or homicidal while either on or off their medication. He's also gathered more reports of personality changes following a traumatic brain injury. And he's dug up Vince's brain scan from back when he had the truck accident, and got over it with not one, but two radiologists.

When Benjamin calls me to talk about what he's found, he sounds to me like he's grasping for a diagnosis. Benjamin wrote to Vince in prison. And several weeks later, he got a letter back. Vince included many pages of information about SSRI withdrawal, and had written messages on the back in a mad man's scrawl, barely comprehensible.

Sarah Koenig

It seemed the only way to judge Vince for ourselves was to see him for ourselves. So in January, Benjamin and I drove to Wallens Ridge state prison to meet Vince.

Sarah Koenig

Benjamin was so nervous, he had to sit down when we were signing in at the front desk. He told me later he was imagining being face to face with a guy capable of tearing someone apart. That's the way one of the jail guards back in North Carolina had described Vince to Benjamin.

Now, at Wallens Ridge, they led us to the visiting room. Several other inmates were already there. And after a while, they brought in an old man. At least, he looked like an old man, bent and shuffling. And, of course, that was Vince. He's only 50, but he looks awful.

We spent four hours talking to him, asking him every question we had and continually fetching him food from the vending machines. Two pizza burgers with pepperoni, one cheddar cheese burger, two Cokes, and six of those pink Hostess snowballs, coated with coconut shavings.

Ever since Vince went to jail in 2004, he has been agitating. And all this time, he has never let up. It's dizzying, the amount of paperwork he's filed, protesting what he says is inhumane treatment. Inmate request forms and civil lawsuits and motions for emergency hearings.

Vince insists he has SSRI Withdrawal Syndrome, an extreme reaction to changes in his SSRI meds that can cause intolerable mood changes. If only they'd give him 60 or 80 or 100 milligrams of Celexa, uncrushed, he'd be better. A fellow inmate who tried to help Vince wrote to me. At Wallens Ridge, they call Vince Doc.

The inmate wrote, quote, "when the prison doctors would not order the treatment Doc wanted based on his self-diagnosis, he would become hostile, threatening, throw tantrums, refused to comply with orders, and just yelled that all of this was caused by his serotonin-deprived brain. Needless to say, none of that plays well in prison. Sadly, Doc has been his own worst enemy." Unquote.

We weren't allowed to record or take written notes when we met with Vince, but the following day, we were allowed to record a phone call. The sound quality is not good.

Sarah Koenig

Vince is hard to take in, because he presents so many contradictory characteristics all at once. You can see he was once a handsome guy. And at times, his speech and thoughts and affect seem completely normal. He looks you straight in the eyes. And some of his answers sound utterly reasonable, too.

For instance, no, he did not simply dump his wife and walk away from a happy marriage. They were having troubles, like many couples do. And they couldn't work out those troubles, so they split up, he said. End of story. We later confirmed this with Karen.

But then, in a flash, he'll lose his focus, lose simple words, become weepy. His face will grimace strangely, in a way that's unconnected to what he's saying. Or he's putting his index finger on his chin or forehead and looking at the ceiling like a child.

His hands are working constantly, especially his left hand, rubbing his thumb endlessly over his closed fingers. You can see the skin is red and raw from it. He's holding his arms close to his chest. He's talking and talking. And then he'll stop and say, what was the question?

Vince is missing many teeth. He says that's because his serotonin-deprived brain makes him aggressive, and so he lashes out at other inmates and then gets beaten down by prison guards. I ran this by a Virginia DOC official, who said the DOC does not respond publicly to inmate allegations. Benjamin spent a lot of the conversation trying to suss out Vince's medical history.

Sarah Koenig

That was a little hard to hear. He's saying, electric jellyfish stings. He says that's what it feels like in his brain, an electric shock.

Sarah Koenig

Then he says there's the intermittent psychomotor agitation, meaning the uncontrolled movements in his arms and face that come and go. He knows it looks fake, he says, but it's real. And indeed, the symptoms he talks about are listed in the teeny tiny print on the back of the Lexapro insert. I asked him about what Detective Martin told us, about putting cameras in the jail rec yard, and how Vince seemed to act weird only when staff came around.

Sarah Koenig

Prison staff at Wallens Ridge all told us the same thing, Vince is really like this. He wasn't putting it on for us. Also, he's gotten a lot worse in the last few years and months. When we saw him in prison, he spent the last 10 or 15 minutes of our meeting tearfully asking us-- especially Benjamin-- for help. He'd helped so many people as a doctor, he said. Didn't he deserve the same now? I'm begging you, he said.

Back in the car, a little shaky after the interview, Benjamin had come to a decision.

Sarah Koenig

All over again, Benjamin turned over the possible explanations for Vince's illness.

Sarah Koenig

Three weeks later, Benjamin was back at Wallens Ridge. This time, he brought along his friend Steve Buie, a psychiatrist. They talked to Vince for an hour. But when they were done, Dr. Buie wasn't sold on Benjamin's favorite hypothesis. Dr. Buie has seen a lot of people go through SSRI withdrawal, he said.

But whatever was going on with Vince, it didn't seem like that. And ditto traumatic brain injury. Those don't usually cause the kind of deterioration Vince was experiencing. Then, as they were leaving the visitor's room, walking between the series of locked metal doors and barbed wire fencing, Dr. Buie stopped in his tracks.

Sarah Koenig

Huntington's disease is a horrible condition, one of the worst, like a cruel trifecta of Alzheimer's, Parkinson's, and Lou Gehrig's disease rolled into one. It causes severe emotional and physical symptoms. It's progressive, it's painful, and highly inheritable. If your parent has it, you've got a 50/50 chance of getting it. According to descriptions of Vince's father's mental and physical state, it's conceivable that's what Dalton Gilmer had.

Typically, it starts to affect a person between the ages of 35 and 45. Vince's behavior began to change when he was about 40. And it's fatal. Once you have symptoms, the brain and body dwindle away. You usually die after about 20 years from a complication like pneumonia or choking. Dr. Buie and Benjamin went down a checklist of symptoms.

Sarah Koenig

Moodiness, check. Restlessness or fidgeting, check. Paranoia, psychosis, abnormal and unusual movements, including facial movements, grimacing, quick sudden jerking movements, unsteady gait, disorientation or confusion, loss of judgment, loss of memory, personality changes, speech changes, anxiety and stress. Check, check, check, check, check, all the way down the list.

Of course, the best way to tell is a genetic test, but none of us is a lawyer. We're not related to Vince. We have no standing with the Virginia Department of Corrections. So we weren't sure how to go about getting a test done. Then, three weeks later, on March 11, I found out from the DOC-- just by accident-- that Vince had been moved from Wallens Ridge to a psychiatric hospital within the prison system called Marion Correctional Treatment Center.

A few calls later, I was speaking to a social worker there who eventually told me Vince had threatened suicide. They'd found a couple of razor blades in his room. This social worker asked me what Benjamin and I thought of Vince's condition. I told her Benjamin actually had an idea, Huntington's.

Oh, she said. Interesting. We can test for that. The next day a psychiatrist at Marion met with Vince. A psychiatrist called Benjamin. And within a week, they'd drawn blood for the Huntington's test, and sent it off to a lab in Utah.

Sarah Koenig

Benjamin recorded this on his own.

Sarah Koenig

Benjamin got this news from Vince's new psychiatrist, Dr. Colin Angliker. He's medical director and chief psychiatrist at the Marion Correctional Treatment Center. He's been a prison doctor for 25 years, which you think would make him a company man. But he's just the opposite, meaning he is the perfect doctor for Vince. He's one of those guys who enjoys proving the system wrong.

Sarah Koenig

Benjamin and I went to meet Dr. Angliker in Virginia last week, and he described what happened when Vince got the news.

Sarah Koenig

Dr. Angliker says that since he put Vince on medication, he's feeling much better. He's walking better, talking better. He's less anxious. What medication, you ask? 80 milligrams of Celexa, uncrushed. What Vince has been asking for all along. Because it turns out Huntington's kills off brain cells, neurons which decrease production of neurotransmitters.

So all this time, it's possible Vince did have a serotonin-deprived brain. It's possible he was right. All this makes you wonder, to be blunt, what the hell? Benjamin asked Dr. Angliker as respectful as he could, why did this take so long?

Sarah Koenig

From what Dr. Angliker can tell, Vince was having psychiatric symptoms from Huntington's at the time of the killing. That's not to say Huntington's caused him to kill his father. It's not like Huntington's creates murderers. But Huntington's can cause erratic, agitated, and sometimes uncontrollable behavior. So, it's fair to say that Vince was not himself when he strangled his father. And he never should have represented himself in court.

Sarah Koenig

Of course, Dr. Angliker isn't a lawyer. So we asked one, Richard Bonnie, a professor at the University of Virginia School of Law and director of the Institute of Law, Psychiatry, and Public Policy. He says Vince's best shot might be for a lawyer to argue, probably in federal court, that Vince wasn't competent to represent himself at his trial, that he shouldn't have been allowed to do so.

But really, Vince might be better off bypassing the courts and just trying to get what they call compassionate release. That is, if someone can pull the right strings in government. We hadn't spoken to Vince since January. He'd been in solitary on suicide watch at the Marion Hospital until last week.

Finally, on Monday, we were able to arrange a phone call, our first contact with him since the diagnosis. It was shocking.

Sarah Koenig

Vince was laughing. When we met him back at the prison three months earlier, that Vince? It didn't even occur to me that he could laugh.

Sarah Koenig

After about a half hour of hearing how happy he was, how hopeful, it dawned on us. Vince doesn't know anything about Huntington's. We weren't prepared for that, since Vince is a doctor. But he doesn't know what's going to happen to him, and maybe to his sister and to her two kids, and to her three grandkids. Because they're all at risk for Huntington's now. So Benjamin did the hardest thing in the world. He told him. Vince's response was pragmatic.

Sarah Koenig

They talked for an hour. And Vince didn't seem defeated at all by this terrible news. For now, he's just so glad to be getting the Celexa, surrounded by people who believe what he says to them. By the end, Benjamin and Vince were just two doctors, talking about the Cane Creek clinic. Benjamin told him how his patients and friends were taking the news. Vince remembered working there, hanging out with the staff. How if they got paid in corn, they'd heat it in the microwave and dip it in butter. And how he missed working with the patients.

Sarah Koenig

Benjamin started out as Vince's freaked out replacement, but over the course of seven months, he'd become Vince's detective. And then, his physician, the physician Vince never had. Now, Benjamin wants to become his lawyer. He wants to get Vince out.

Ira Glass

Sarah Koenig is one of the producers of our show.

[MUSIC -"Call the Doctor," J.J. Cale]

Ira Glass

Our program was produced today by Miki Meek and myself with Alex Blumberg, Ben Calhoun, Sarah Koenig, Jonathan Menjivar, Brian Reed, Robyn Semien, Alissa Shipp, and Nancy Updike. Our senior producer for today's show is Julie Snyder. Production help today from Anna Martin. Mixing by Stowe Nelson and our Technical director, Matt Tierney. Music help for today's show from Damien Graef, from Rob Geddes.

Special thanks today to Jonathan Milner, Larry Traylor at the Virginia Department of Corrections, Rebecca Young at the Wallens Ridge State Prison, Wayne Austin, Gloria Hitt, Fred Taubman at the Huntington's Disease Society of America, Deirdre Smith-Gilmer, Leona McKinney, Jay Leutze, Michelle Harris, Erin Brethauer, Jamie Nicholson, Johnny Irion, Sarah Lee Guthrie, Lou Teti, Frances Walker, Bulldog Studios in Sag Harbor, and all the staff at MAHEC Cane Creek.

Our website, ThisAmericanLife.org. This American Life is distributed by PRX, the Public Radio Exchange. Thanks, as always, to our program's co-founder, Mr. Torey Malatia. You know, I just-- by coincidence-- ran into the guy who took over when Torey stopped running his Tupperware club.

Ira Glass

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