He closed his eyes briefly, his heart going out to Quentin and all of the rest of the kids who were going through the same thing. Off of the medications that would help balance out their brains, instead being controlled by punishing electric shocks. What was it Margaret had just been saying?
Do you have any idea what it feels like to be punished for who you are? For the way your brain was formed? Something you have absolutely no control over?
He knew; he’d spent his whole childhood living it, but at least the punishments he had faced for his incorrigible behavior hadn’t included electrical shocks. Prescriptions weren’t the full solution, but the right ones made things a little easier to handle.
Zachary looked down at the list the receptionist had made.
“So who is left? There’s someone I can talk to?”
“The unit supervisor for Quentin’s unit. Her name is Nancy Whitmore. She can come out and see you. I’m afraid the rest… you’ll have to make appointments with them.” She slid the paper across the desk to him. She had filled in the names and numbers where appropriate.
“So where do I find Nancy Whitmore?”
“She will be out to get you when she’s free. She said it wouldn’t be too long.”
Zachary wondered whether, like Dr. Abato, Nancy Whitmore was making a point to him. She had more important things to do than talk to an interfering private detective. She was a busy person. But at least she had agreed to talk to him. He was sure she could have told the receptionist the same thing the others had, that they were too busy and couldn’t meet with Zachary, no matter how far he had come.
So he smiled and nodded politely, and went and sat down on the modern, flat, uncomfortable couch where he had spent the last forty-five minutes. Sooner or later, she would be out to see him, and he could get some of his questions answered.
Chapter Eleven
E
ventually, Nancy Whitmore came to fetch Zachary. She was a redhead, her hair short and frizzy, her clothing a size too large so that it was sloppy and didn’t fit to her form properly.
“Zachary Goldman?”
Since he was the only one sitting there, it was a good bet. Zachary pushed himself to his feet. “Hi. I guess you’re Ms. Whitmore.”
“Just Nancy, love. Why don’t you come with me, then? You were here just a few days ago, weren’t you? With Dr. Abato.”
“Yes. But I didn’t manage to talk to you. I appreciate you taking the time today, with no appointment. You must be busy.”
She made a sweeping-away motion with one hand. She led the way to the other side of the reception area to an unimpressive unmarked door.
“Things are pretty quiet for most of the day. Until the kids start getting finished their sessions. Then we have a few hours of barely-controlled chaos before bed.”
Zachary nodded, smiling. He appreciated her good humor. The supper hour through bedtime was always difficult in institutional settings. Tired, cooped-up, and frustrated kids in a less-controlled environment. Kids coming off their meds and rebounding. Dealing with low blood sugar, meals, and trying to keep things peaceful until night meds and lights out. “The arsenic hour,” he’d heard one of them refer to it as. Except that it was more than just an hour.
“So you’re the head supervisor for the unit Quentin was in.”
“That’s right. Here most of their waking hours. Someone takes over at night, but of course things are pretty quiet then.”
“How was Quentin that last day before he died?”
She ran her fingers through her already-frizzed-up hair. “Quentin was Quentin. He wasn’t one of the easiest children.”
“What does that mean? In terms of his usual behavior?”
“Parents often wait until their children are completely out of control and they can no longer manage them before putting them into a program like Summit. That puts a lot of pressure on us, trying to get a child from intractable to manageable. If they get them in early on, it’s much easier to train them.”
“That makes sense.”
“When Quentin started out at Summit, he was on strong antipsychotics and still couldn’t be controlled. He was violent and there were other children in the home, which made it an emergency situation. He would be held in the municipal jail until a placement could be found for him. And the municipal jail doesn’t have the training or resources to deal with a violent teen with autism.”
Zachary had seen the inside of a couple himself. Sitting by himself in a barred cell, while the adults in the other cells, the real criminals, catcalled and mocked him, uttering threats and sordid remarks when the guards were out of hearing. Feeling like he’d been dumped there like a bag of trash. No one to turn to. No one who wanted to deal with one more minute of his crap.
“Mr. Goldman?”
“Zachary,” he corrected automatically. “Sorry. Just thinking.”
She motioned him through the big door, which turned out to be the security door for Quentin’s unit.
“So he came here,” Nancy said simply. “Home sweet home.” She made a twirling motion to include everything in the unit.
“Can we sit down and talk somewhere? Do you have logs of what happened that day and night that we could look at?”
“We log everything.” Nancy considered for an instant. “I suppose the response room would be the best. Just let me grab some books.”
Zachary waited while she got together what she thought she would need. The unit was quiet, just a few supervisors around, no residents in sight. They were in therapy for long hours every day. They probably wouldn’t be found in the unit during the day unless they were sick.
“Had Quentin been sick recently?”
“Sick? No, who told you that?”
“Just wondering. Sometimes an illness can lead to depression…”
“No. He hadn’t been sick.”
Zachary sat down and glanced over the books that Nancy had collected. “So what do we have?”
“This is Quentin’s personal file.” She nudged a black binder toward him. “That should contain everything you need. His therapy logs, any observations made during the morning and evening, outside of his therapy. Any… negative behaviors and consequences. Anything that is applicable to him should be in there.”
Zachary opened it up. “By consequences, do you mean punishments? Aversives like electric shocks?”
She studied him for a minute, uncertainty written on her face. “That is part of the program here,” she agreed. “That’s one of the keys that helps us to reach kids like Quentin. Just saying ‘no’ isn’t effective at all on a child like that. There are some children where that’s all you need to do. But kids like Quentin need a stronger aversive.”
Zachary slowly turned the pages of the binder. It appeared to all be in chronological order. Logs from various sources. Mostly from therapy and the daily log of the unit, checking off the steps to his daily routine. A few narrative lines here and there.
“Okay. And what have you got there?”
“These are the unit logs. Everything that is written in the unit logs should have been transcribed to the personal files. But if you want to double-check…”
Zachary nodded. He looked at the last couple of therapy logs. A brief entry as to what behavior was being taught, followed by long rows and columns of checkmarks and X’s. Mostly X’s.
“So the checkmarks mean that he showed the right behavior, and the X’s mean he showed the wrong behavior,” he suppositioned.
Nancy nodded. “Right.”
“And when he got a checkmark, he got a reward?”
She smiled at him. “You know the way the program works. Very small rewards, so that we can stretch them out over the length of the therapy. Obviously, you can’t give a child a candy for every right behavior, when you’re going to have them repeated hundreds of times throughout the day.”
“One lick of a lollipop.”
“The favorite reward for many of our children. Children with autism can be very m
otivated by food. You wouldn’t believe the number of lollipops and gummy bears we go through here. I go home, and I can’t stand anything that smells like a gummy bear!”
“And when he got an X, he didn’t get a lick or a gummy bear.”
“Right again.” She nodded.
“Did he get an aversive?”
“Yes. More than likely.”
“So can I interpret this log to mean that every X represents an electrical shock?”
“No, no. You’d have to talk to the therapist or his aide. He might have gotten any aversive. A stern word. Planned ignoring. Taking something away from him. There was a court ruling…” she trailed off, looking hopeful that he already knew about it and would jump in with the details.
But Zachary shook his head, indicating he didn’t know about it.
“There were threats that they were going to shut the program down. Some video that got out there on the internet and was being shown out of context. What did people ever do before they could upload to the internet? But our parents are very strong supporters of the program. So they argued in the court to keep the program going. Eventually, the judge agreed, but with some specific guidelines. One of them was that skin shocks were only to be used if a child was being violent or could not physically be controlled without it. So they wouldn’t have used shocks for the aversive during therapy. Unless he was being violent.”
“Can you tell from the log?”
She turned the binder around so she could look at it right-side-up. Her eyes went over the various headings and comments on the page.
“Well… yes, his therapist does note that he wouldn’t cooperate without physical intervention. And Quentin… I know the boy. If he didn’t like something, he would hit, bite, spit…”
“So they would have used shocks as the aversive.”
“Yes.”
“For every one of these X’s.”
“Maybe not all of them… but probably.”
Zachary ran his eye down the column, tallying up the X’s. He turned the page and kept going.
“So the day before he died, he had around sixty shocks during therapy.”
Nancy swallowed. “If you say so. I wasn’t there. You’ll have to talk to one of the people who was.”
Zachary looked down the evening and night log. It was strange not to see a section for night meds to be checked off. The logs that he’d seen kept at other institutions had always included morning and night meds.
“It looks like there was an incident before lights out.” He rested his finger under the brief words in the log. “What is ‘Loss of Privilege Food’?”
“Well, as I said, a lot of the residents are very motivated by food.”
“Yes.”
“One of the negative reinforcers that is used is the Contingent Food Program.”
“What does that mean?”
“It means that food is withheld until the desired behavior is demonstrated.”
“During his therapy.”
“For as long as necessary to reliably demonstrate the desired behavior.”
“You starve him until he does what he’s told.”
“They don’t starve. That’s why Loss of Privilege Food is provided. At the end of the day, if their nutritional intake has not been adequate during the Contingent Food Program, they receive Loss of Privilege Food.”
Zachary breathed out long and slow. He knew what was coming. Prisons sometimes provided meal replacement foods. Foods that were designed to be unpalatable, but to meet dietary requirements. They had the appropriate levels of calories and macronutrients that were needed, and they were given a vitamin supplement, but the bricks of food replacer were like eating sawdust held together with beef fat. Not pleasant. Not something the prisoners eventually acquired a taste for.
“What was the Loss of Privilege Food?”
“I told you, the food that they received at the end of the day if—”
“No, what is it made of? What form is it in?”
She sucked in her cheeks, looking at the stack of binders. There wasn’t any point in avoiding the question. If Nancy refused to answer, he would get it from someone else.
“It’s like a meatloaf,” she explained. “Ground meat mixed with potato flakes. Spinach and liver powder for additional nutrients. It meets all of the RDAs.”
“Would you eat it? Have you tasted it?”
“Uh… it’s not meant to be appetizing. They’re supposed to be motivated to earn their regular food.”
“I don’t suppose it’s served with gravy and biscuits.”
“No… just served cold.”
Zachary’s stomach turned over. “How long was Quentin on the Contingent Food Program?”
“I’m not sure. It had been a while.”
Zachary flipped backward through the daily logs, looking for the notation on each day’s chart. It had been more than a while. He returned to the evening before Quentin’s death.
“What does this say?”
Nancy leaned closer to the page.
“Uh…” She was reluctant to read what Zachary had already clearly understood. “It says that he refused his Loss of Privilege Food.”
“So he went to bed hungry? He didn’t get his RDA that day?”
“We can’t starve them,” Nancy protested. “He could go one day refusing the Loss of Privilege Food, but after that we had to take positive action.”
“And…?”
“Force feed it to ensure that he’d had adequate nutrition.”
“How?”
“What do you mean?”
“I mean, was he tubed? Fed by mouth? How was he force fed?”
“Uh…” She shifted uncomfortably. “By mouth.”
Zachary shook his head in disgust. They wouldn’t give him regular food because he liked it and they wanted to use it as a reinforcer. But he still had to get calories and he refused the crap food they tried to give him, so they had held him down and forced it down his throat.
Nancy cleared her throat a few times. He looked at her face and saw that she was struggling with emotion, holding back tears.
“It’s not right,” she whispered. “I’ve never agreed with the Contingent Food Program. It’s cruel. Food is the only pleasure some of these kids get. To use it against them is… inhumane.”
And there was more on the log sheet. They both knew it.
“Were you here or had you gone home?”
“I was still here. I go home right after supper.”
“So you saw them doing it. Forcing him to eat the alternative food.”
“Yes.” She dabbed at the corners of her eyes. “I was here… I saw. It was my job to make sure he got the food he was supposed to.”
“Were you the one who did it?”
“No. I couldn’t. The security staff and a couple of aides…”
“And he gagged.”
“Yes. Some kids are very sensitive to certain textures. Quentin often gagged on the Loss of Privilege Food. It’s sort of a lumpy paste…”
“So what happened?” Zachary was looking at the log sheet. He didn’t need her to tell him what happened, because it was right there on the log sheet in front of him. But he wanted to hear it from her. To understand just how far the institution was willing to go to break the children they had charge of.
“He threw up. That made them angry. But it wasn’t like he did it on purpose! He wasn’t just being willful. They shocked him for throwing up. Kept shocking him for struggling. Eventually… they got it down. And it stayed down.”
“And what happened after that?”
“By then, it was lights out. I stayed until they had gotten it all down him, a couple of hours past my usual shift change. And then I went home. They were getting him ready for bed.”
“What had to be done to get him ready for bed?”
“Changing his clothes. They were soiled. Showering him off. Giving him night clothes and returning him to his room.”
Zachary felt like he needed a
shower himself. He had done nothing to Quentin; he hadn’t participated in his torture. But he felt like he had, just by living his life in ignorance that such barbarism was being practiced right there in his own country. He went on eating what he wanted and sleeping when he could, oblivious to the practices that Margaret Beacher was protesting.
“I expect that after all that, his door was locked.”
“No.” Nancy shook her head. “Not while I was there. Quentin didn’t wander at night. He preferred to stay in his room. We didn’t need to lock his door.”
“Dr. Abato said that if there had been an incident during the day, his door would be locked at night.”
She rolled her eyes. “Dr. Abato isn’t here at night and there are no policies that say Quentin’s door should be locked if he refuses food. If he’d been violent with one of the staff or the other kids, that would be different. But he hadn’t been. He’d just had trouble with therapy.”
“He came here because he was violent, didn’t he? You didn’t have trouble with him with other residents? Or just not that day?”
“Kids are violent in different ways for different reasons. Quentin was pretty typical. He would get angry and violent when he was frustrated. If someone was in his space or took a toy away from him. He couldn’t communicate what he wanted. But he didn’t wander at night and he didn’t attack people at random.”
She was silent then, but the tilt of her head and the way that she was leaning toward him suggested that she wasn’t finished talking, so he waited.
“If he did get upset or threatening, seeing this is usually all it took to back him off.” She tapped one of the little boxes on her belt. The ones with pictures of the children.
“What’s that?” Zachary asked. “I thought they were pill boxes, but if you don’t give them meds…”
His Hands were Quiet Page 9