Stephanie said, “Vicki—”
“Sure,” I said, smiling. “It’s a perfectly normal reaction, but sometimes normal anxiety can be helped by behavioral treatment.”
Bottomley gave a small, tight laugh. “Maybe so. Good luck.”
Stephanie started to say something. I touched her arm and said, “Why don’t we get going?”
“Sure.” To Bottomley: “Remember, nothing P/O except food and drink.”
Bottomley held on to her smile. “Yes, Doctor. Now, if it’s all right with you, I’d like to leave the floor for a few minutes.”
Stephanie looked at her watch. “Break time?”
“No. Just wanted to go down to the gift shop and get Cassie a LuvBunny—you know those stuffed bunnies, the cartoons on TV? She’s crazy about them. I figure with you people in there, she should be fine for a few minutes.”
Stephanie looked at me. Bottomley followed her glance with what seemed to be satisfaction, gave another tight laugh, and left. Her walk was a brisk waddle. The starched cap floated along the empty corridor like a kite caught in a tailwind.
Stephanie took my arm and steered me away from the station.
“Sorry, Alex. I’ve never seen her like that.”
“Has she been Cassie’s nurse before?”
“Several times—almost from the beginning. She and Cindy have developed a good rapport and Cassie seems to like her too. When Cassie comes in, they ask for her.”
“She seems to have gotten pretty possessive.”
“She does have a tendency to get involved, but I’ve always looked at that as a positive thing. Families love her—she’s one of the most committed nurses I’ve ever worked with. With morale the way it is, commitment’s hard to find.”
“Does her commitment extend to home visits?”
“Not as far as I know. The only home things were a couple I did, with one of the residents, at the very beginning, to set up the sleep monitor—” She touched her mouth. “You’re not suggesting she had something to do with—”
“I’m not suggesting anything,” I said, wondering if I was, because Bottomley had chapped my hide. “Just throwing out ideas.”
“Hmm … well, that’s some idea. Munchausen nurse? I guess the medical background fits.”
“There’ve been cases,” I said. “Nurses and doctors looking for attention, and usually they’re the really possessive ones. But if Cassie’s problems have always started at home and resolved in the hospital, that would rule her out, unless Vicki’s a permanent resident at the Jones household.”
“She isn’t. At least not as far as I know. No, of course she isn’t—I’d know if she was.”
She looked unsure. Beaten down. I realized what a toll the case was taking.
“I would like to know why she was so hostile to me,” I said. “Not for personal reasons but in terms of the dynamics of this family. If Vicki and the mother are tight and Vicki doesn’t like me, that could sour my consult.”
“Good point … I don’t know what’s eating at her.”
“I assume you haven’t discussed your suspicion of Cindy with her?”
“No. You’re really the first person I’ve talked to about it. That’s why I phrased my no-meds instructions in terms of drug reactions. Cindy’s also been asked not to bring food from home for the same reason. Vicki and the nurses on the other shifts are supposed to log everything Cassie eats.” She frowned. “Of course if Vicki’s overstepping her bounds, she might not be following through. Want me to have her transferred? Nursing Ad would give me hell, but I suppose I could swing it pretty quickly.”
“Not on my account. Let’s keep things stable for the time being.”
We walked behind the station. Stephanie retrieved the chart and studied it again.
“Everything looks okay,” she said finally. “But I’ll have a talk with her anyway.”
I said, “Let me have a look.”
She gave me the chart. Her usual neat handwriting and detailed notes. They included a family-structure chart that I spent some time on.
“No grandparents on the mother’s side?”
She shook her head. “Cindy lost her parents young. Chip lost his mom, too, when he was a teenager. Old Chuck’s the only grandparent left.”
“Does he get up here much to visit?”
“From time to time. He’s a busy man.”
I continued reading. “Cindy’s only twenty-six … maybe Vicki’s a mother figure for her.”
“Maybe,” she said. “Whatever it is, I’ll keep a tight leash on her.”
“Don’t come down too hard right now, Steph. I don’t want to be seen by Vicki—or Cindy—as someone who makes anyone’s life harder. Give me a chance to get to know Vicki. She could turn out to be an ally.”
“Okay,” she said. “This human relations stuff is your area. But let me know if she continues to be difficult. I don’t want anything getting in the way of solving this thing.”
The room was inundated with LuvBunnies—on the windowsill, nightstand, the bed tray, atop the TV. A bucktoothed, rainbow-hued welcoming party.
The rails of the bed were lowered. A beautiful child lay sleeping—a tiny bundle barely swelling the covers.
Her heart-face was turned to one side; her rosebud mouth, pink and parted. Buttermilk skin, chubby cheeks, nubbin nose. Her hair was sleek, straight, and black and trickled onto her shoulders. The bangs were moist and they stuck to her forehead. A ring of lace collar was visible above the blanket hem. One hand was concealed; the other, dimpled and clenched, gathered the fabric. Its thumb was the size of a lima bean.
The sleeper sofa by the window was unfolded to a single bed that had been made up. Military corners, pillow smooth as eggshell. A flowered vinyl overnight bag sat on the floor next to an empty food tray.
A young woman sat cross-legged on the edge of the mattress, reading TV Guide. As soon as she saw us she put down the magazine and got up.
Five five, firm figure, slightly long-waisted. Same shiny dark hair as her daughter’s, parted in the middle, tied back loosely and gathered in a thick braid that nearly reached her waist. Same facial cast as Cassie’s, too, stretched by maturity to something just barely longer than the perfect oval. Fine nose; straight, wide, unpainted mouth with naturally dark lips. Big brown eyes. Bloodshot.
No makeup, scrubbed complexion. A girlish woman. Twenty-six but she could easily have passed for a college student.
From the bed came a soft, breathy sound. Cassie sighing. All of us looked over at her. Her eyelids remained closed but they fluttered. Threads of lavender vein were visible beneath the skin. She rolled over, facing away from us.
I thought of a bisque doll.
All around us, the LuvBunnies leered.
Cindy Jones looked down at her daughter, reached over and smoothed hair out of the child’s eyes.
Turning back to us, she ran her hands over her clothes, hurriedly, as if searching for unfastened buttons. The clothes were simple—plaid cotton shirt over faded jeans and medium-heeled sandals. A pink plastic Swatch watch. Not the post-deb, VIP daughter-in-law I’d expected.
“Well,” whispered Stephanie, “looks like someone’s snoozing away. Get any sleep yourself, Cindy?”
“A little.” Soft voice, pleasant. She didn’t have to whisper.
“Our mattresses have a way to go, don’t they?”
“I’m fine, Dr. Eves.” Her smile was tired. “Actually, Cassie slept great. She woke once, around five, and needed a cuddle. I held her and sang to her for a while and finally she fell back around seven: Guess that’s why she’s still out.”
“Vicki said she had a headache.”
“Yes, when she woke. Vicki gave her some liquid Tylenol and that seemed to work.”
“Tylenol was the right thing to give her, Cindy. But in the future all medications—even over-the-counter stuff—will have to be approved by me. Just to play it safe.”
The brown eyes opened wide. “Oh. Sure. I’m sorry.”
“Hello, Dr. Delaware.”
“Hello, Mrs. Jones.”
“Cindy.” She extended a narrow hand and smiled shyly. Likable. I knew my job wasn’t going to be easy.
Stephanie said, “As I told you, Dr. Delaware’s an expert on anxiety in children. If anyone can help Cassie cope, he can. He’d like to talk with you right now, if this is a good time.”
“Oh … sure. This is fine.” Cindy touched her braid and looked worried.
“Terrific,” said Stephanie, “If there’s nothing you need from me, I’ll be going.”
“Nothing I can think of right now, Dr. Eves. I was just wondering if you’d … come up with anything?”
“Not yet, Cindy. Yesterday’s EEG was totally normal. But, as we’ve discussed, with children this age that’s not always conclusive. The nurses haven’t charted any seizurelike behavior. Have you noticed anything?”
“No … not really.”
“Not really?” Stephanie took a step closer. She was only an inch taller than the other woman but seemed much larger.
Cindy Jones passed her upper lip under her top teeth, then released it. “Nothing—it’s probably not important.”
“It’s okay, Cindy. Tell me anything, even if you think it’s irrelevant.”
“Well, I’m sure it’s nothing, but sometimes I wonder if she’s tuning out—not listening when I talk to her? Kind of staring off into space—like a petit mal? I’m sure it’s nothing and I’m just seeing it because I’m looking for things now.”
“When did you start noticing this?”
“Yesterday, after we were admitted.”
“You never saw it at home?”
“I … no. But it could have been happening and I just didn’t notice. Or maybe it’s nothing. It probably is nothing—I don’t know.”
The pretty face began to buckle.
Stephanie patted her and Cindy moved toward the gesture, almost imperceptibly, as if to gain more comfort from it.
Stephanie stepped back, breaking contact. “How often have these staring episodes been occurring?”
“Maybe a couple of times a day. It’s probably nothing—just her concentrating. She’s always been good at concentrating—when she plays at home she concentrates really well.”
“Well, that’s good—the fact that she’s got a good attention span.”
Cindy nodded but she didn’t look reassured.
Stephanie drew an appointment book out of a coat pocket, ripped out a back page and handed it to Cindy. “Tell you what, next time you see this staring, make a record of the exact time and call in Vicki or whoever’s on duty to have a look, okay?”
“Okay. But it doesn’t last long, Dr. Eves. Just a few seconds.”
“Just do the best you can,” said Stephanie. “In the meantime, I’ll leave you and Dr. Delaware to get acquainted.”
Pausing for a moment to look at the sleeping child, she smiled at both of us and left.
When the door closed, Cindy looked down at the bed. “I’ll fold this up so you’ll have somewhere to sit.” There were delicate lavender veins under her skin, too. At the temples, throbbing.
“Let’s do it together,” I said.
That seemed to startle her. “No, that’s okay.”
Bending, she took hold of the mattress and lifted. I did likewise and the two of us turned the bed back into a sofa.
She smoothed the cushions, stood back, and said, “Please.”
Feeling as if I were in a geisha house, I complied.
She walked over to the green chair and removed the LuvBunnies. Placing them on the nightstand, she pulled the chair opposite the couch and sat, feet flat on the floor, a hand on each slender thigh.
I reached over, took one of the stuffed animals from the window ledge, and stroked it. Through the glass the treetops of Griffith Park were green-black and cloudlike.
“Cute,” I said. “Gifts?”
“Some of them are. Some we brought from home. We wanted Cassie to feel at home here.”
“The hospital’s become a second home, hasn’t it?”
She stared at me. Tears filled the brown eyes, magnifying them. A look of shame spread across her face.
Shame? Or guilt?
Her hands shot up quickly to conceal it.
She cried silently for a while.
I got a tissue from the box on the bed table and waited.
4
She uncovered her face. “Sorry.”
“No need to be,” I said. “There aren’t too many things more stressful than having a sick child.”
She nodded. “The worst thing is not knowing—watching her suffer and not knowing … If only someone could figure it out.”
“The other symptoms resolved. Maybe this will too.”
Looping her braid over one shoulder, she fingered the ends. “I sure hope so. But …”
I smiled but said nothing.
She said, “The other things were more … typical. Normal—if that makes any sense.”
“Normal childhood diseases,” I said.
“Yes—croup, diarrhea. Other kids have them. Maybe not as severe, but they have them, so you can understand those kinds of things. But seizures … that’s just not normal.”
“Sometimes,” I said, “kids have seizures after a high fever. One or two episodes and then it never recurs.”
“Yes, I know. Dr. Eves told me about that. But Cassie wasn’t spiking a temp when she had hers. The other times—when she had gastrointestinal problems—there were fevers. She was burning up, then. A hundred and six.” She tugged the braid. “And then that went away and I thought we were going to be okay, and then the seizures just came out of nowhere—it was really frightening. I heard something in her room—like a knocking. I went in and she was shaking so hard the crib was rattling.”
Her lips began to quiver. She stilled them with a hand. Crushed the tissue I’d given her with the other.
I said, “Scary.”
“Terrifying,” she said, looking me in the eye. “But the worst thing was watching her suffer and not being able to do anything. The helplessness—it’s the worst thing. I knew better than to pick her up, but still … Do you have children?”
“No.”
Her eyes left my face, as if she’d suddenly lost interest. Sighing, she got up and walked to the bed, still carrying the crumpled tissue. She bent, tucked the blanket higher around the little girl’s neck, and kissed Cassie’s cheek. Cassie’s breathing quickened for a second, then slowed. Cindy remained at the bedside, watching her sleep.
“She’s beautiful,” I said.
“She’s my pudding pie.”
She reached down, touched Cassie’s forehead, then drew back her arm and let it drop to her side. After gazing down for several more seconds, she returned to the chair.
I said, “In terms of her suffering, there’s no evidence seizures are painful.”
“That’s what Dr. Eves says,” she said doubtfully. “I sure hope so … but if you’d have seen her afterwards—she was just drained.”
She turned and stared out the window. I waited a while, then said, “Except for the headache, how’s she doing today?”
“Okay. For the little she’s been up.”
“And the headache occurred at five this morning?”
“Yes. She woke up with it.”
“Vicki was already on shift by then?”
Nod. “She’s pulling a double—came on last night for the eleven-to-seven and stayed for the seven-to-three.”
“Pretty dedicated.”
“She is. She’s a big help. We’re lucky to have her.”
“Does she ever come out to the house?”
That surprised her. “Just a couple of times—not to help, just to visit. She brought Cassie her first LuvBunny, and now Cassie’s in love with them.”
The look of surprise rem
ained on her face. Rather than deal with it, I said, “How did Cassie let you know her head hurt?”
“By pointing to it and crying. She didn’t tell me, if that’s what you mean. She only has a few words. Daw for dog, bah-bah for bottle, and even with those, sometimes she still points. Dr. Eves says she’s a few months behind in her language development.”
“It’s not unusual for children who’ve been hospitalized a lot to lag a bit. It’s not permanent.”
“I try to work with her at home—talking to her as much as I can. I read to her when she’ll let me.”
“Good.”
“Sometimes she likes it but sometimes she’s really jumpy—especially after a bad night.”
“Are there a lot of bad nights?”
“Not a lot, but they’re hard on her.”
“What happens?”
“She wakes up as if she’s having a bad dream. Tossing and turning and crying. I hold her and sometimes she falls back to sleep. But sometimes she’s up for a long time—kind of weepy. The morning after, she’s usually jumpy.”
“Jumpy in what way?”
“Has trouble concentrating. Other times she can concentrate on something for a long time—an hour or more. I look for those times, try to read to her, talk to her. So that her speech will pick up. Any other suggestions?”
“Sounds like you’re on the right track,” I said.
“Sometimes I get the feeling she doesn’t talk because she doesn’t have to. I guess I can tell what she wants, and I give it to her before she has to talk.”
“Was that what happened with the headache?”
“Exactly. She woke up crying and tossing around. First thing I did was touch her forehead to see if she was warm. Cool as a cucumber. Which didn’t surprise me—it wasn’t a scared cry. More of a pain cry. By now I can tell the difference. So I started asking her what hurt and she finally touched her head. I know it doesn’t sound scientific, but you just kind of develop a feel for a child—almost like radar.”
Glance at the bed. “If her CAT scan hadn’t come back normal that same afternoon, I would have really been scared.”
“Because of the headache?”
“After you’re here long enough, you see things. Start thinking of the worst things that can happen. It still scares me when she cries out at night—I never know what’s going to happen.”
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