Breaking the Silence

by Diane Chamberlain

  “Who says you can’t talk about her?” Might Alzheimer’s patients, in their childlike condition, create imaginary friends? Did Janie fit that category? Maybe someone had told Sarah she’d be thought crazy if she talked about her.

  “Dr. P.,” Sarah answered. “And Gilbert.”

  Who was Gilbert? Laura was saddened by how out of touch with reality Sarah seemed to be today. She put her arm around her shoulders. “I’m your friend, sweetheart,” she said. “You can tell me about Janie, if you like.”

  Sarah looked at her as if assessing the truth in her words. And then she began to talk.

  Sarah, 1958

  Finally, after nearly three years of marriage, Sarah became pregnant. Joe was every bit as excited as she was, buying more things than they could afford for the baby, wallpapering the little room they planned to use as the nursery and running out in the middle of the night to assuage Sarah’s cravings for olives or chocolate bars.

  Sarah worked at Saint Margaret’s until her sixth month, when she was showing too much for it to be considered proper for her to continue in her job. She and Joe had frequent talks about whether or not she would go back to work after the baby was born. She knew Joe was ashamed of the fact that he didn’t make enough money to support all three of them without her income as well. It would be possible, but they would have to stretch every dollar. It saddened her, though, to think of leaving her child with a sitter while she went to work.

  Yet, she knew she wanted to go back. She was good with the patients, and as Colleen had said, Dr. P.’s treatment methods needed to be balanced by her own empathetic approach. She sometimes lay awake at night, worrying about what the patients might be enduring without her to advocate for them.

  Colleen was a good role model. She had a young son, yet still worked full-time. Of course, Colleen had to, having no husband on whom she could rely for support. And she had a mother-in-law to leave Sammy with during the day. Joe’s mother had cut all ties with them, but Sarah and Joe’s neighbor, an older woman who lived next door, was begging to take care of the baby when it came. Sarah finally suggested to Joe that she take six months off after the baby was born. They would budget very carefully during that time and see how they fared. Then she would decide.

  One April night, while she and Joe were watching Gunsmoke on television, Sarah’s contractions started. She was barely eight months pregnant. It was too soon, and she was frightened.

  Joe rushed her to the hospital, where they told her she was having “false labor.” They kept her overnight, more to calm Joe’s anxiety than her own, then sent her home.

  The following night, she went to bed with a backache that wouldn’t let her sleep. Joe rubbed her back as she lay on her side, but the pain was so intense that she barely felt his attempts to soothe her.

  Just before dawn, the contractions started again.

  “We should go to the hospital,” Joe said.

  “They’ll only send me home again,” Sarah said. But then she realized that the bed was wet, and she remembered from nursing school that some women had back labor. A new contraction followed close on the heels of the last one. “I think you’re right,” she said, gasping, trying to rise from the bed. “We’d better go.”

  Joe was up in an instant, grabbing some of Sarah’s clothes from the closet and racing over to her side of the bed.

  She was already standing, and she knew there was no way she was going to make it to the hospital.

  “Joe.” She kept her voice as calm as she could. “The baby’s coming too quickly for you to drive me to the hospital,” she said. “I’m going to lie down again while you call the rescue squad.”

  “What?” Joe, usually so calm, looked frantic. “You’re going to have the baby here?” He tried to help her back into bed, but she shooed him away.

  “I’m all right,” she said. “Go make the call.”

  She was not all right, though. By the time she lay down again, she knew the baby was going to beat the rescue squad. And it was too soon. The baby would be too small. Pain and fear forced tears from her eyes.

  Joe ran back into the room. “They’re on their way,” he said, hurrying to her side.

  “The baby’s coming now, Joe,” she said.

  “What do you mean?”

  “Just what I said.” She felt suddenly irritated with him, then immediately contrite. She shouldn’t take it out on Joe; he was all she had right now. “I mean, you’ll need to help,” she said.

  There was a flash of panic in her husband’s eyes, but it was instantly replaced by the calm strength she’d seen in him many times before.

  “All right,” he said. “I’m here. Can you tell me what to do?”

  She was moaning now, barely able to answer, and Joe took her hand helplessly in his own. She had seen only a few births during her training, and none, of course, under these circumstances.

  “Get clean towels from the linen closet,” she said, breathless from the sensations low in her belly. Throwing off the covers, she hiked her nightgown up to her hips as Joe left the room.

  “It’s coming too fast,” she said when he returned, his arms full of yellow terry cloth.

  “What should I do?” Joe asked.

  “Towel…under me,” she said, suddenly lost in a swirl of pain and the need to push. Was it too soon to push? She had no idea, and she no longer cared. She was only vaguely aware of her husband sitting on the edge of the bed, his entire being focused on the world between her legs.

  “Use another towel to catch the baby,” she panted. “He’ll be slippery, and—”

  “I can see the baby!” Joe cried. “What should I do? Should I try to get it out?”

  “No,” she managed to say. “Is it his head, or…?” Her teeth were chattering so hard she felt the vibration in her temples.

  “Yes, his head. Lots of hair.”

  “Don’t let me tear,” she said. “Hold your hand against his head. Don’t push. Just put your hand there so he doesn’t come…” She let out a scream, and knew it was too late to prevent herself from tearing, but within an instant, she didn’t care. The baby was in Joe’s towel-covered hands.

  “Is he all right?” she gasped, raising her head, trying to see.

  “She,” Joe said. He was smiling.

  “Is she all right?” Sarah raised herself to her elbows, but could see nothing more than a blur of red in the yellow towel.

  “I…I don’t think she’s breathing.” Joe’s voice was calm, but there was terror in his eyes.

  “Use the towel, the corner of the towel, to clean out her mouth,” she said, panicked. She remembered one of her co-workers who had lost a baby at birth the year before. Dear God, let my baby be all right.

  Joe did as he was told, and in a moment, the baby let out a squeal, then a hearty cry. Sarah lay back in relief, shutting her eyes, and the world outside their little house filled with the wail of a siren.

  Sarah and the baby spent nearly a week in the hospital, although both of them were truly well. Joe visited constantly, leaving his office during the day, staying until they kicked him out at night. Sarah thought the nurses let him stay a little longer than they did most fathers because he was so involved with his daughter. He had delivered her, after all, while the other fathers hadn’t been allowed within shouting distance of the hallowed delivery room.

  They named the baby Jane, after Sarah’s beloved aunt, and Sarah was relieved to see that her daughter seemed to resemble Joe and not herself. The bond between Joe and Janie went far beyond the bond shared by most fathers and daughters, and Sarah could only attribute it to the fact that Joe had been first to hold her, to admire her, to weep over her. He was as capable and enthusiastic in caring for Janie as Sarah was. Janie was going to grow up to be his little princess.

  It was obvious, though, that in order to continue living in their house by the park, Sarah would have to go back to work. She felt torn. The thought of leaving Janie with their neighbor, Mrs. Gale, and being apart from her five
days a week, made her body ache. Yet, she knew deep down that she was not a woman meant to stay at home. She wouldn’t admit that to anyone except Joe, because that feeling seemed so wrong to her. So selfish and unmotherly. But she needed the stimulation of her job, and the patients at Saint Margaret’s needed her, too.

  Her feelings had nothing to do with being a woman, Joe told her. He felt the same way and doubted he would feel any differently if he were a woman. He would shift his work schedule so he could be home with Janie for a few hours each morning. Then she would only have to be with Mrs. Gale for the afternoon.

  One evening, shortly before her return to work, Sarah was feeding Janie in the living room when Dr. Palmiento appeared on the TV news. Quickly turning up the volume, Sarah stared in shock as she watched Palmiento shake hands with President Eisenhower. The newscaster reported that Palmiento was receiving an award for his research at Saint Margaret’s. Sarah sank back in her chair, torn between pride that she worked with the man and dismay that his questionable methods should be rewarded.

  “I am so glad you decided to come back to work,” Colleen told Sarah in the cafeteria line on her first day back. They’d moved Colleen to ward three during Sarah’s absence, and she seemed disturbed by the experience. “Things have gotten worse here,” she said as they sat down with their sandwiches. “I need one other sane person working on ward three to let me know I’m not going completely out of my mind.”

  “What do you mean by ‘worse’?” Sarah asked.

  Colleen rolled her eyes. She’d let her hair grow out from its pixie cut, and now it framed her face with short blond waves. “This man…this kid, actually, was hired while you were gone,” she said, “and he’s suddenly Dr. P.’s right-hand man. His name’s Gilbert.”

  Sarah laughed. “Gilbert?” she repeated. “And he goes along with Dr. Palmiento’s methods?”

  “Goes along with them?” Colleen asked. “He’s even inventing new ones. He’s the head of the Psychic Driving Program.”

  “Psychic driving? What’s that?” In the eight months she’d been gone, things seemed to have changed a great deal.

  “No one except Palmiento and Gilbert seem to know for sure, but it involves—” Colleen leaned forward as if what she was about to say was a secret “—these helmets.”

  “Helmets?” Sarah laughed again, still lighthearted from her time off with her husband and new daughter but knowing that feeling could not last long at Saint Margaret’s.

  “They look something like the helmets football players wear,” Colleen said. “But inside each helmet is a headset that’s attached to a big tape player they put on the patient’s bedside table. The tape plays constantly, and when it stops, they start it over again, and the patient listens to it for fifteen hours a day!”

  “You are making this up,” Sarah said, suddenly suspicious. It was too ludicrous.

  “You’ll see for yourself soon enough.”

  “What’s on the tapes?”

  “Messages Dr. P’s recorded for them. Each tape is specific to that patient. Things like, ‘You’re an imbecile. You destroyed your marriage. You’re worthless.’”

  “What?” Sarah asked.

  “That plays over and over on the tape, and they listen to it for about a month. Then they get a positive tape. ‘You love your family. You are an excellent wife and mother. You worship your husband.’”

  Sarah’s jaw had dropped nearly to the table. “Tell me you’re joking,” she said.

  “The patients who aren’t drugged or shocked into oblivion sometimes cry or even scream when they’re listening to the tapes,” Colleen said.

  Sarah let out a sound of exasperation. “When are they going to come up with something that will actually help people get better?”

  “They say this will,” Colleen said. “It’s one of those ‘get worse before you get better’ sort of treatments.”

  “Just like everything else they do here,” Sarah muttered. “Palmiento will probably win an award for this, too.” She looked down at her sandwich, then pushed it away. Her appetite was gone. She was back at Saint Margaret’s.

  Dr. Palmiento seemed pleased to have her back and had her assist him in two lobotomies that first week. It worried her that she no longer fell apart as she observed someone’s spirit being destroyed. She feared she had grown hardened to the experience.

  One of her new patients was a woman called Cinderella by everyone on the staff, because she thought she had cinders in her hair and on her clothes and was constantly trying to brush them off. A middle-aged woman, she was unkempt and overweight, but her face and demeanor were very sweet, and Sarah was drawn to her. It was through Cinderella that she finally met Gilbert, although she’d been hearing about him since her return.

  Gilbert called her into his office to discuss Cinderella. His office was next to Dr. Palmiento’s, and nearly as large. Sarah knew immediately what Colleen had meant about him being a “kid.” He looked nineteen, at best, although everyone said he had to be older than that, since he was in a doctoral program studying psychology. Hard to believe, though. His cheeks were still dotted with acne.

  “Please sit down.” Gilbert remained standing as he waited for Sarah to take her seat on the other side of his desk. He wore an engaging smile, and she felt herself soften toward him. “I’m pleased to finally meet you, Mrs. Tolley,” he said. “I’ve heard fine things about your nursing skills.”

  “Thank you.”

  “I wanted to explain to you our treatment plan for your patient, Mrs. Lucas. Cinderella, I guess she’s known as.” He spoke like someone much older, his words a bit stilted. She’d expected him to be cocky; what young man in his position wouldn’t be? Cocky was not a word that fit him, though.

  “Cinderella, yes,” she said.

  “We plan to enter her into a program that is probably unfamiliar to you, since you’ve been gone a while. It’s called psychic driving.”

  “The tapes,” Sarah said.

  “That’s right. It’s quite exciting.” His cheeks flushed with color. “We will give her whatever combination of medications Dr. P. decides is appropriate in her case and put her in the slumber room. Then we’ll fit a helmet to her head with earphones fixed inside it. The earphones will be connected to a tape recorder, and she will listen to the tape for most of the day. She can have occasional bathroom breaks, and she can take the helmet off for her meals and sleep. But the rest of the time she’ll be listening to the tape. You, of course, will be providing the usual slumber room care—turning her to prevent bedsores, bathing her and such.”

  Sarah squirmed in her seat. “What will be on her tape?” she asked.

  “Something from her sessions with Dr. P. We’ll pick whatever she revealed that’s most emotionally charged for her. We’ll also attach a wire to her lower leg, and each time she hears the negative message, she’ll receive a small electrical shock.”

  “Oh, Gilbert,” Sarah protested. “That’s too much.”

  “Not at all.” He leaned toward her, smiling, his black hair catching the light from above, his dark eyes gleaming. Even with the acne, he was a handsome young man. “This is a way to wipe those negative thoughts from her mind and replace them with positive ones,” he said. “It’s a way to change her behavior without thousands of hours of therapy.”

  And without human contact, Sarah thought, but she kept the words to herself. He was a kid, yes, but he was already in a position of power, and she had the distinct feeling she should not challenge him.

  “Have you seen this treatment help anyone?” she dared to ask, keeping her voice as even and pleasant as possible.

  “We’re still in the early stage of our research,” he said, averting his eyes and shuffling a few of the papers on his desk. “But we’re beginning to see some improvement.” Piling a few of the papers together, he stood up, and she knew she was being dismissed.

  He was a not a good liar, she thought as she left his office. He believed everything he’d said up to his last comme
nt about patient improvement, when his eyes shifted and his anxiety betrayed him. Good. At least she would know when he was trying to pull the wool over her eyes.

  In three weeks, Cinderella no longer brushed imaginary cinders from her clothing. As a matter of fact, she did nothing except lie in the slumber room, eyes closed or staring at the ceiling, listening numbly to the tape playing in her helmet. Her features were flat. She ate her meals in silence. Was this improvement? Sarah didn’t think so.

  “They kill the unique personality in each of their patients and call it progress,” she said to Colleen in the cafeteria one day.

  “I know.” Colleen raised a spoonful of soup to her mouth.

  “I think we need to do something,” Sarah said.

  “What can we possibly do?”

  “We need to tell someone what’s going on here.”

  Colleen laughed. “Saint Margaret’s is considered one of the top psychiatric hospitals in the nation, and Dr. P. won the coveted whatever-it-was award,” she said. “Who’s going to think a couple of nurses know better than someone like Palmiento what’s best for the patients? And maybe we don’t, Sarah. Maybe we are old-fashioned. Maybe this sort of treatment is going on at all the best hospitals.”

  “I certainly hope not.” She leaned toward Colleen. “Even if it ultimately worked, the cost is too high. I don’t think we’ve succeeded if we’ve taken away a patient’s dignity in the process of treating them.”

  “Well,” Colleen said, “if we make waves, you can bet we’ll lose our jobs. I don’t know about you, but I need this income. We’d probably never be able to get a job anywhere else, either. Palmiento’s hardly going to give us sterling references after he fires us.”

  Colleen was right, on all counts. And yet, Sarah could not shake her discomfort over what was happening at Saint Margaret’s. Even when she was home with Joe and Janie, her mind was often filled with concerns about work. Occasionally, she’d awaken in the middle of the night, having dreamt that she was in the isolation room, and she’d have to reach out to reassure herself that Joe was lying next to her. She’d get up to bring Janie into bed with them. Only when the three of them were cuddled together, safe and warm, did she feel truly at peace.