This article is a bit different for the Town Crier, but we felt it was important to reach those in our community who knew Dr. Vince Gilmer, and also to those who know Dr. Benjamin Gilmer. Through his tenacious effort, there is now an understandable reason for a completely unbelievable occurrence.
This is not the typical health article that we write from MAHEC Cane Creek, but I feel compelled to share this story — one that has profoundly affected our community and our clinic over the last several years. It is a tragic story of a man once beloved by our community, who discovered a darker side of his personality. The story reminds us of a very important humanistic lesson that we try to respect in family medicine: to approach each patient without judgment or preconception.
Today, I am writing to you because I promised Vince Gilmer that I would share his story directly with the community that he loved so much.
Many of you know from personal experience, either as patients or as members of our community, that the founders of the first Cane Creek Family Health Center, Dr. Vince Gilmer and his wife Dr. Karen Bartley, served their patients with integrity and commitment. Tragically, on June 28, 2004, Dr. Gilmer killed his father. The Cane Creek community was stunned, responding in pure disbelief, and the practice quickly crumbled. The event affected the Fairview/Fletcher communities very deeply because Dr. Gilmer was revered by his patients. Few could make sense of what happened, and many have continued to wonder how such a good man could have committed such a horrific act.
In 2009, I started building my practice at Cane Creek; MAHEC had revived the Family Health Center due to the evolving need for primary care in the community. At age 40, I had finally finished my training in family medicine and was planting roots in a community that I hoped to serve for a career.
It was a very strange coincidence to discover that my predecessor shared the same last name, Gilmer, and even stranger to learn that he was now serving life in prison for a brutal murder. At the time that Vince left and I arrived, we were even the same age. My patients were confused at first, wondering if we were somehow related. They told me their stories, and it was apparent that they needed to tell me about their experience with “the other Dr. Gilmer.” At first, my own preconception of Vince Gilmer was that he was a murderer, but I knew nothing more. However, almost universally, patients’ stories reflected a profound reverence for their previous physician because he cared deeply about them. He and Karen worked nights, on weekends and were perpetually on call. But this is what they wanted — to serve a community.
Increasingly, the whole picture of the murder just didn’t made sense. People very close to Dr. Gilmer told me that he “became a different person,” and still, after 9 years, they couldn’t reconcile the person they knew with a murderer. Some remained adamant that he could not have done it; “the cops got it all wrong.” As a naturally curious person and physician, I felt compelled to figure out what happened to this seemingly good man, this revered physician. Ultimately, I accepted an invitation from one of the producers at “This American Life,” Sarah Koenig, to help me interview people and take a more focused approach to learning about Vince and the events that led up to June 28, 2004. The full details of our story were recently broadcast on the program. Over the last year we spoke to many of Vince’s friends, family, patients, lawyers, detectives, police officers, guards at the prison, his psychiatrist, other psychiatrists, neurologists, radiologists and ultimately Vince. You can listen to “Episode #492, Dr. Gilmer and Mr. Hyde” at thisamericanlife.org.
After the tragedy, Vince went to jail, was tried in Abingdon, Virginia and made one of the craziest legal decisions ever — he decided to represent himself for his own murder trial. The trial was farcical, and his defense could be distilled to one word: serotonin, an essential neurotransmitter he described as lacking in his brain. He pleaded that he had “serotonin brain syndrome” and that his “brain was not working right at the time of the murder.” Prior to the murder, he and others had noticed some subtle changes in his personality and mood. Eventually, he started antidepressant therapy, which helped him “feel more balanced.” Later, he described stopping the medication days before he was scheduled to transport his father from Broughton hospital in Morganton to an assisted living facility in Cane Creek. According to him, this is when he started to experience delusional thoughts that “told him to kill his father.” When his father reportedly made sexual advances toward him that day, he “snapped.”
While in jail and throughout the trial, he started to exhibit profound symptoms of anxiety and was noted to have unusual jerky movements in his arms and face; Vince reported that he might be having a seizure. Everyone, including the initial prison guard, the prosecuting attorney, the prison psychologist and finally the jury, believed that he was faking these symptoms. The jury’s conviction of Vince Gilmer was decisive, and he was sent to a maximum security prison at Wallen’s Ridge, deep in the mountains of southwest Virginia.
Nine years later, Vince continued to serve his time in prison and still had the same bizarre muscular twitches, although more profound. When I met him for the first time in January of this year, he was not the strapping “bear” that people affectionately called him, nor was he the killer who had rattled my sense of security. He was an old-appearing man, with only a few teeth remaining and a spirit that was completely broken. He shuffled in to meet Sarah and me, his head down, with clenched, restless fists and bizarre, dramatic facial grimaces. The facial movements, which we call dyskinesia, were so dramatic that I could not help thinking at first, “was this real?” After speaking to him for 3 hours, it was clear that he could not be faking these symptoms or the amnesia or profound anxiety — impossible.
Later in the week, I was reminded by one of my colleagues that one quality that most primary care providers share: we want to believe our patients and listen to their stories. We cherish the responsibility of listening to people in their most vulnerable moments of life. Perhaps I am naïve, but I trusted Vince. I began to investigate more, looking at various events that could have influenced his behavior. Although he continued to serve his patients well, he was starting to exhibit behavior that was not normal for him, including worsening symptoms of depression and anxiety. His personality was slowly changing.
Before going to medical school, I was a neurobiologist and studied the brain under toxic stress. It seemed plausible that Vince was experiencing symptoms that were perhaps neurologic in nature, rather than simply psychiatric. These two worlds can be intimately tied to one another and are often hard to tease apart. As the interviews continued, those who were either part of the trial or in the judicial system continued to describe him as simply a pre-mediated murderer. The “faking” of his symptoms was evidence that he continued to be a “highly manipulative inmate” in the words of one of the Virginia doctors. As for one of the detectives, premeditation was clear; Vince had a rope, gloves and pruning shears already in his truck. After speaking to him that day, I realized that I also had a rope, gloves and gardening tools in my car.
During our first visit, as he was leaving with the guard, Sarah and I caught a glimpse of him walking. His gait didn’t appear normal, but rather unsteady. During that encounter, he struggled to articulate his thoughts and clearly had big holes in his memory. His “serotonin brain” mantra continued. Several weeks later, I asked an Asheville psychiatrist, Dr. Steve Buie, to join me on an expedition to Wallen’s Ridge. His task was to shed light on Vince’s movements, to help determine if he was faking the symptoms and to try to observe any behavior that might be sociopathic in nature, a diagnosis that had become popular. Our interview lasted about one hour before the guard ushered him away and again, Dr. Buie and I both noticed his strange gait as he exited, the same bizarre facial twitching and restlessness that were perfectly consistent with his previous behavior. Afterwards, we were both convinced — he was not making this up. While leaving, both a little shell-shocked and still sealed up in one of the locked corridors, Dr. Buie looked up and said, “is it possible that he has Huntington’s?” “Yes,” I said, “It is possible.”
Huntington’s disease (HD) is a progressive, inheritable disease that can have a variety of symptoms, including jerky movements called chorea as well as dementia, ataxia (disturbance in gait), and profound psychiatric symptoms. Interestingly, it is an autosomal dominant genetic disease, meaning that if one of his parents had the disease, Vince had a 50% chance of getting it. His mother, with whom I had spoken, didn’t have any symptoms; his father was never diagnosed, but was thought to have schizophrenia, according to Vince. The onset of HD is typically around 40 (Vince was 41 at the time of the murder) and its expression can be highly variable. Woody Guthrie was famous for his music and also because he had HD.
Confirming this diagnosis is easy; it’s a simple blood test. To make this diagnosis as an outsider to the prison system, however, is very hard. Serendipitously, when Vince was moved only a few weeks later to a different prison in Marion, VA, he inherited a different psychiatrist, who solicited my opinion because he had heard that Dr. Buie and I believed Vince might have Huntington’s disease. For the first time in almost a decade, someone inside the Virginia prison system stepped out of the box to consider another clinical reason for Vince’s behavior, dementia and restlessness.
Two weeks later, Vince’s blood test revealed that he had 43 CAG repeats, a genetic hallmark for HD – undeniably.
I must note that HD in itself is not a “killer” disease as titled in the WLOS-TV piece three weeks ago. It is a very complex disease that can manifest in a wide variety of ways depending on the number of the CAG repeats on that gene; this is one of the reasons it can be an elusive disease to diagnose. Since Vince was positive, so was his father, which explains his “schizophrenic” behavior and inability to walk at age 60. My opinion is that multiple factors contributed to Vince’s delusional behavior. His evolving HD process may have been the most important, but was just one of them.
Vince took the diagnosis well but curiously did not have much medical insight. For 3 weeks now, he had been on serotonin medication, the same dose that he had been asking for almost daily since 2004. Now he was sleeping well, gaining weight, his anxiety was melting away, his cognition and memory were improving and he was tremendously less shaky. In his own words, he was feeling “ridiculously better.” When I saw him this time, he was smiling and showing off how well he could walk, and we had a conversation that was fluid, insightful and fun – very different from our first conversation. He reminisced about how he loved to be in the outdoors and particularly how he cherished being a doctor and taking care of his patients in Fairview. He sends greetings to all of you and hopes that you are well.
As for me, I am now at peace with the memory of Vince Gilmer in our building, and I strive to bring the same type of kindness and open eyes to my patients that he did. As a result of the “This American Life” show, we have attracted the attention of several lawyers, including the Innocence Project in Virginia, who are currently working on his case. Our goal is to get Vince to a facility that will be better suited to needs and will allow him to experience the outdoors again and live the rest of his life with some dignity. If you would like to reach out to him, he would love to hear from you.