It was the answer he'd expected, and the lipless smile reappeared.
'It's clear,' he said, 'that we're operating from very different theoretical backgrounds. Since we'll be working together, it's best that I lay my cards on the table. You're suggesting a classical psychodynamic approach: People's problems are caused by unconscious conflicts. Interpret the content of their ramblings in order to bring the unconscious to consciousness, and everything works itself out.' Puff, puff. 'Which is all very fine, I suppose, in cases of minor adjustment disorders. But not at all relevant to schizophrenia. The psychoses, Dr. Delaware, are essentially physiologic phenomena - chemical imbalances within the brain. What the patient has to say while in the throes of that imbalance has very little, if any, clinical significance.'
'I'm not suggesting we psychoanalyze every nuance,' 1 said, 'and I respect the data on the biology of schizophrenia. But despite the fact that they sink into patterns, psychotics are as individual as anyone else. They have feelings. And conflicts. It can't hurt to learn as much as we can about Jamey as an individual.'
'A holistic approach?' 'Just a thorough one.'
'Very well,' he said somewhat testily, 'let's get on with it. What was it that you wanted to know? Ah, yes, visual and auditory hallucinations, do I think that's unusual? Statistically, yes. Clinically, no. An atypical pattern has been the hallmark of this case from the beginning. Are you suggesting hallucinogenic abuse?'
'It's the obvious differential.'
'Of course it is, but it's been ruled out. I admit that when he was brought in, my first impression was that of a PCP user. The uncle and aunt were unaware of drug use, but that didn't impress me; one could hardly expect the boy to have told them about that kind of thing. However, the tests were clearly negative.'
The pipe had gone out. He used the miniature spoon on his pipe tool to scoop out the top layer of ashes, tamped, and relit.
'No,' he said, 'I'm afraid this isn't a case of drug abuse. The diagnosis of schizophrenia is firm. While visual hallucinations are unusual in psychosis, they're not unheard of, especially in combination with auditory disturbances. Which leads me to an important point. The boy was typically incoherent and difficult to understand. He appeared to be hearing and seeing things, but I couldn't state with certainty that such was the case. All of it may very well have been auditory.'
'What did he appear to be seeing and hearing?'
'Back to content, eh?' He removed the pipe from his mouth and played with it long enough for me to wonder if he was stalling. Finally he frowned and spoke. 'To be frank, I don't recall precisely what he said.'
'Souza told me he appeared quite sharp in the beginning, claiming the commitment was a mistake and being pretty convincing about it.'
'Yes, of course,' he said hastily. 'At first there was the usual paranoid ideation: Someone was out to kill him; he was no crazier than anyone else. Then it deteriorated to wild accusations and vague mutterings about poisons and
wounds - the earth bleeding, that kind of rubbish. Considering the diagnosis, nothing extraordinary. And not at all relevant to treatment.'
'And the visual problems?'
'The visual part of it had to do with color. He seemed to be seeing bright colors, with special emphasis on red.' He smiled faintly. 'I suppose one could interpret that as sanguinary imagery - that his perceptual field was awash with blood. In light of what's evolved, that would hardly be surprising.'
'The lucid periods,' I repeated. 'What did he talk about?'
He shook his head.
'Excepting the period immediately following hospitalization, lucid is an exaggeration. Minimally responsive would be more accurate. If I used the term conversation, it was in a very limited sense. The vast majority of the time he was unreachable - autistically withdrawn. When the medication took hold, he was able to answer simple yes or no questions. But he was never able to chat.'
I thought back to Jamey's crisis call. He'd taken the initiative to reach me and, once we'd connected, had been able to report his location. While most of his speech had been jumbled, he'd maintained coherence for several isolated sentences. Far from normality but a lot more than answering yes or no. I raised the issue with Mainwaring, but he remained unmoved.
'During the last remission he began to grow more verbal. It renewed my hope that the latest medication would be the right one.'
'Are you treating him with it now?
He scowled.
'In a manner of speaking. There's no one at the jail qualified to monitor his response, so 1 have to be extremely conservative about dosage. It's not treatment in the true sense, merely patchwork, and the pattern of uneven response has reappeared.'
'That could explain what I saw when I visited him. The first time he was barely awake and showing signs of tardive dyskinesia. The second time he seemed a bit more alert and less neurologically impaired.'
The psychiatrist cleared his throat.
'I'd like to suggest,' he said mildly, 'that you steer clear of terms like alertness and relative lucidity and that you don't even suggest the notion of voluntary drug abuse. That kind of thing can only play right into the prosecution's hands and dilute the picture we're trying to paint.'
'Diminished capacity caused by paranoid schizophrenia. '
'Precisely. It's a difficult enough proposition for the layman to understand, without injecting needless complications.'
For good reason, I thought and refrained from responding. He stared at me, then began sifting through the papers on his desk.
'Is there anything else, Doctor?' he asked.
'Yes. Ms. Surtees's notes seemed more positive than anyone else's. Do you see her as an accurate reporter?'
He leaned back and put his feet up on the desk. There was a hole in the sole of one of his wing tips.
'Ms. Surtees is one of those well-meaning, maternal types who attempt to make up for what they lack in intelligence and education by becoming personally involved with their patients. The other nurses viewed her with bemusement, but she posed no problem for them. I wasn't pleased at her employment, but the family was distressed and felt one-on-one care was important, and I couldn't see her doing much harm. In retrospect, perhaps I was too permissive.'
Or impressed by dollar signs.
His jaws bunched as he chomped down on the pipe. He looked at me searchingly, requesting confirmation that he hadn't mishandled the case.
'So you don't have much faith in her credibility.'
'She's a baby-sitter,' he said brusquely, 'not a professional. Now, if that's all - '
'Just one more thing. I'd like to talk with Mrs. Vann.'
'Mrs. Vann is no longer with us.'
'Was she dismissed because of the escape?'
'Not at all. She left of her own accord, just a few days ago.'
'Did she say why?'
'Only that she'd been here for five years and wanted a change of scenery. I was disappointed but not surprised. It's difficult work, and very few last that long. She's a fine nurse, and I'm sorry to have lost her.'
'So you don't blame her for what happened.'
His eyebrows merged and created a mesh of creases in his forehead.
'Dr. Delaware, this is beginning to sound like an interrogation. My impression was that you came here to be educated, not to cross-examine me.'
I apologized for coming on too strongly. It didn't appear to mollify him. Pulling the pipe out of his mouth, he turned it upside down and knocked it angrily against the rim of an ashtray. A small cloud of grey dust rose, then sank, leaving a film of soot on the paper disarray.
'Perhaps you're not aware of the enormousness of our task,' he said. 'Convincing twelve untrained individuals that the boy wasn't responsible for his behavior will be no mean feat. The issue of blame is yet another irrelevancy that will impede us. We're expert witnesses, not judges. Why persist in digressing?'
'From where I sit, what's relevant and what's digression aren't all that clear.'
'Believe me,' he
said with visible exasperation, 'the issues aren't all that complex. The boy developed schizophrenia because of poor genetics. The disease disabled his brain and hence destroyed his so-called free will. He was programd for disaster from birth, every bit as much a victim as the people he murdered. That's not speculation; it's based on medical data - the facts speak for themselves. However, because of the ignorance of the layman, it would be helpful to augment the argument with sociological and psychological theories. That is where, I strongly suggest, you should be directing your energies.'
'Thanks for the suggestion.'
'Not at all,' he said airily. 'I'll have that chart for you within a few days. Now let me see you out.'
We rose and left the office. The corridors of the hospital were silent and empty. In the front reception room a well-dressed couple sat holding hands and staring at the floor. In the woman's lap was an unopened copy of Vogue. A cigarette dangled from the man's lips. They looked up at the sound of our footsteps and, when they saw Mainwaring, gazed up hopefully, as if at a deity.
The psychiatrist waved, said, 'One moment,' and walked over to greet them. The couple stood, and he shook each of their hands energetically. I waited several moments for the conversation to end, but when it became clear that my presence had been forgotten, I slipped through the door unnoticed.
Chapter 15
I HAD lunch at a cafe in Sherman Oaks and mentally replayed the interview with Mainwaring. For all his pharmacologic expertise, he'd given me no insight into Jamey, the person. That no doubt wouldn't have troubled him at all had it been called to his attention. He was a self-proclaimed biochemical engineer with scant interest in any organism above the cellular level. Years ago he would have been viewed as an extremist, but now he was au courant well in step with the new wave in psychiatry - a love affair with biological determinism at the expense of insight. Part of the motivation behind the shift was valid; psychotherapy, by itself, had proved minimally useful in the treatment of psychosis, and drugs had wrought remarkable, if unpredictable, symptomatic control.
But some of it was also political - through reasserting themselves as physicians, psychiatrists could distance themselves from psychologists and other nonmedical therapists - as well as economic, for insurance companies were reluctant to pay for something as ambiguous as talking
therapy but had no problem reimbursing for blood tests, brain scans, injections, and other medical procedures.
Psychology had its share of engineers, too - behavioral technologists, like Sarita Flowers, who steered clear of disorderly annoyances like feelings and thoughts and viewed the human condition as a set of bad habits in need of Skinnerian salvation.
Either perspective was a kind of tunnel vision, ad extremum, the blind worship of anything that could be quantified, combined with premature self-congratulation and a black/white view of the world. But there was a lot of grey space in the middle, and a patient could get lost there.
I wondered if that had happened to Jamey.
Arriving home at two, I called Souza and asked him to set up an appointment with Marthe Surtees.
'Ah, Marthe, a kind woman. I'll call the registry that employs her and see if I can reach her. Do you have anything to report, Doctor? I'm not asking for conclusions, only a feel for where you're going.'
'Nothing yet. I'm still asking questions.'
'I see. When do you envision yourself sufficiently prepared to write a report?"
'That's hard to say. Perhaps in a week or so.'
'Good, good. We'll be going to court for preliminaries at the end of the month. I'd like my armory well stocked by then.'
'I'll do what I can.'
"Yes, I'm sure you will. By the way, we spoke previously about the possibility of some kind of drug intoxication. Have you reached any conclusions about that?'
'Dr Mainwaring was adamant that drugs had nothing to do with Jamey's condition, and he thought even raising the possibility would damage a dim cap defense.'
'Mainwaring's not an attorney. If I can show that Chancellor pushed drugs on the boy, not only wouldn't it hurt, but it would help."
'Be that as it may. there's no evidence of drug abuse. The symptoms I noticed were probably tardive dyskinesia -
a reaction to the medications. He'd started to show them at Canyon Oaks. It's an atypical reaction after short-term treatment, but Mainwaring feels he's an atypical schizophrenic.'
'Atypical.' He thought out loud. 'Framed properly, that could work in our favor, make us less dependent upon precedent. Very well, keep probing, and let me know if anything else comes up. By the way, do you have anything scheduled later on today?'
'No.'
'Excellent. Heather arrived last night from Montecito, took a helicopter down at midnight in order to avoid the press. The children stayed behind, so if you want to speak to her, it would be a good time.'
'Sure.'
'Shall we say five o'clock then?'
'Five would be fine.'
'Excellent. I know you'll find her a superb young woman. Speaking of which, I greatly enjoyed speaking with your Robin.'
His words were gracious, but something in his tone betrayed an undercurrent of lechery. Nothing you could put your finger on; nevertheless, I felt my stomach tighten.
'She's terrific,' I said.
'Quite. Good for you, Doctor.'
He gave me the address of the Cadmus house and signed off cheerily.
Hancock Park reeks of old money.
In Beverly Hills, an unlimited budget in the absence of good taste has often produced freakish architectural excess: turreted castles, texture-coated pseudovillas, Technicolor postmodernistic monstrosities, and cheesy imitations of Tara, each costing millions, competing for applause on a single palm-lined block.
Four miles east, in Hancock Park, the quieter the better. There's some diversity of style - Tudor, Georgian, Regency, Mediterranean - but it fits together unobtrusively. Very hushed, very stately. For the most part the houses are larger than their noisy cousins in Beverly Hills, remnants of a time when multiple servants were the order of the day. They sit smugly behind expansive, knife-edged lawns, set far back from wide, maple-shaded streets. The landscaping is subdued: a solitary stately pine on the lawn, yew hedges, and an occasional splash of flower petal. Wood-sided station wagons, Volvos and Mercedes sedans in neutral shades fill the driveways. As is the case with most residential areas of L.A., the streets are ghost-town empty, save for isolated perambulators pushed by uniformed nannies or permapressed young matrons holding platinum-haired toddlers in tow. A few Jews and Asians have moved in, but for the most part Hancock Park is still WASP country. And though some of the city's meanest streets surround the neighborhood and crime is higher than anyone wants to admit, Hancock Park remains an enclave of understated wealth.
The Cadmus House was on June Street north of Beverly, not far from the Los Angeles Country Club, a two-storey brick Tudor whose bricks and contrasting stone and woodwork had been painted beige. A clover-laced flagstone path divided the lawn. On either side stood a security guard, wearing the same grey uniform as the men in the lobby of Cadmus Construction. But these guards were armed with pistols and billy clubs. The reason for their presence was obvious: A flock of reporters milled on the sidewalk. When one moved toward the house, a guard stepped forward. The reporters kept trying, and the guards kept reacting, a curious minuet. Off to the side, under a porte-cochere, sat Souza's Rolls, nosed up against a high wrought-iron gate. Standing next to the giant car was Tully Antrim, running a chamois over its glossy flanks while keeping one eye on the street. He saw the Seville and gestured for me to pull behind the Phantom.
The reporters had spied the exchange, and as I swung up the drive, they surged forward amoebically. The guards kicked up their legs and went right after them. Taking advantage of the diversion, one of the journalists, a young,
bespectacled man in a brown corduroy suit, made a dash for the front door.
Antrim moved fast. In three long strides
he was at the reporter's side. One more step brought him between the man and the door. He glared at the journalist and ordered him away. The reporter argued with him. Antrim shook his head. The reporter moved suddenly, and the chauffeur's right hand shot out and caught him in the solar plexus. The young man went pale, formed a tortured O with his mouth, and clutched his gut in agony. Antrim shoved him hard, and he tripped backward. By this time one of the security guards had reached the scene, and he pulled the still-gasping journalist off the property.
I'd watched the whole thing from the car, with a flood of shouting faces pressed against the windows and hand-held tape recorders brandished across my line of vision. As the man in the brown suit stumbled toward his car, he shouted something at his colleagues that caused them to howl in outrage at Antrim and the guards. But at the same time they stepped away from the Seville, and I used the opportunity to get out of the car and dash behind the Rolls. Antrim saw me and bounded over. By the time the reporters had stopped shouting and realized what was happening, he'd taken me by the arm, whipped out a set of keys, and unlocked the wrought-iron gate.
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