MANCHESTER - Mental illness may explain why a rural Manchester man allegedly cut the pacemaker out of his father's chest last weekend.

Jesse Lewis Fierstine, 32, is charged with attacking his father, Charles Fierstine, in what Delaware County authorities are calling one of the more unique and gruesome crimes they've ever handled. Jesse Fierstine was arrested April 25 for attempted murder.

Jim Fierstine, Jesse's uncle, and law enforcement say Jesse suffers from bipolar disorder but was not on medication at the time of the incident. Officials said he struggles with reality.

"He (Jesse) asked me to take him for a walk (outside) today," Deb Lynch, Delaware County Jail administrator, said Wednesday. "He doesn't comprehend anything."

Jesse Fierstine is being held on $750,000 cash bond. Delaware County Attorney John Bernau anticipates to formally charge him Monday with trying to kill his father.

On Wednesday, Jim Fierstine of rural Garber visited his nephew in jail. While waiting for Jesse to finish talking with investigator Shane Fleshner of the Dubuque County Public Defenders Office, he provided The Courier more details about the attack, why the family thinks it occurred and what they hope the outcome will be.

Jim said Jesse was at his parent's home at 2338 Jefferson Road about 3 miles southeast of Manchester the night of the attack. Jesse lives next door in a mobile home. The properties are separated by a creek and connected with a foot bridge.

At about 10:30 p.m., Jim said, Donna Fierstine found her husband and son fighting. She ran to the nearby house of another son, Jayson, to call 911.

Court documents said Jesse allegedly struck his father in the head with a flashlight and piece of firewood. Jesse then produced a jackknife and went after his dad's pacemaker. The 63-year-old retired dairy farmer has a history of heart problems.

He cut a gash nearly 6 1/2 inches long and more than 3/4-inch wide and removed the device, which helps regulate the heart rate. When deputies arrived, they observed wires protruding from Charles Fierstine's chest, documents said.

"You see shootings and stabbings all the time. You don't see this type," Bernau said, trailing off while searching for the right words to describe the crime. "A family member involved in this gruesome of an attack."

Charles Fierstine is recovering at University of Iowa Hospitals and Clinics in Iowa City, his brother said. Charles has undergone medical procedures to repair the damage.

"He's coming along fine. We think he will pull through," Jim said.

Emotionally, the family is doing "as well as possible," Jim added. While the Fierstines are still coming to grips with the incident, Jim said, the family doesn't hate Jesse. In fact, Jim said, it's the exact opposite.

"They (family) want help for Jesse, especially his dad," Jim Fierstine said.

That means treating Jesse once again for bipolar disorder. At one time Jesse was seeing mental health professionals and taking lithium, a commonly prescribed medication to manage the problem, law enforcement and family said, but not recently.

Jim said he and other family members are sure Jesse's mental state caused the violent outburst. Police said Jesse also admitted he drank a bottle of wine prior to the attack.

Jesse and his father are close, Jim said. He said Charles' health problems bothered Jesse.

By going after the pacemaker, Jim believes, his nephew thought he was helping his dad in some way.

"I think that was on his mind, but who knows what was going on in there," Jim said. "If he intended to (just) murder him, one good blow to the heart would have done that."

Patrick O'Conner, a licensed psychologist with Psychiatric Associates in Waterloo, said bipolar disorder is caused by an imbalance of brain chemicals called neurotransmitters. It is characterized by extreme mood swings from mania - anger, restlessness, etc. - to depression.

In extreme cases, O'Conner said, bipolar patients can be psychotic and cannot distinguish reality. He said the Fierstine family's hypothesis about the crime makes sense.

"(Bipolar patients) may do some very strange things," O'Conner said.

According to Jim, Jesse struggled to hold full-time jobs. On his application for a public defender, Jesse said he was self-employed making less than $200 per month. Jim said his parent's supported him in exchange for help around their acreage.

O'Conner said bipolar disorder is treatable with medication and counseling. Jim recalls his nephew's warm side, eagerly helping family with chores like mowing and shoveling snow. Jesse saved an abandoned baby squirrel by having a cat that recently had kittens nurse it, he said.

"That's the Jesse I know," Jim Fierstine said.

Then there's the Jesse who police say beat his ailing father and cut his chest open.

Paula Geise, director of Cardiac Services at Allen Hospital, said a pacemaker is normally oval shaped and about 2 inches long and wide and a 1/4-inch thick. It's typically implanted above the heart just below the collar bone, Geise said.

Surgeons make "a pocket" and place it under some fat. In time, scar tissue surrounds the pacemaker and wires that go to the heart, she said.

"It would take quite a bit of effort to get it out," Geise said.

Sgt. Larry Gronwold said the sheriff's department has participated in at least two mental health committals for Jesse in the past.

"He'll be hearing voices soon. There's a history there," Gronwold said.

Jail staff said they've requested mental help for Jesse through his attorney and that he be put back on lithium. However, since Jesse missed his last three mental health appointments, officials said, he needs to be seen again by a psychiatrist so a new prescription can be obtained.

Jesse has been segregated from other inmates for their safety and his own, Lynch said. The jail's capacity is 12, two of which can be female.

"I don't think he has the mental capacity to be with other inmates," Lynch said. "He's very polite to me."

Contact Matthew Wilde at (319) 291-1579 or matt.wilde@wcfcourier.com.