Sometimes Dutchy brought her to the office, but increasingly it was Hernandez, who still regarded me with a jaundiced eye. Then other chaperons began to appear: a series of dark, lean youths young men who smelled of work-sweat and looked so alike that, in my mind, they became interchangeable. I learned from Melissa they were Hernandez's five sons.
Alternating with them was a big, doughy woman about Dutchy's age with tightly braided hair and cheeks like wind-bellows.
The owner of the deep Gallic voice. Madeleine, the cook/maid.
Invariably, she arrived sweating and looking fatigued.
All of them slipped away the moment Melissa stepped over the threshold, returning to pick her up precisely at session's end. Their punctuality and avoidance of eye contact-smacked of Dutchy's tutelage. Dutchy, the few times he showed up, was the most adroit at escape, not even stepping into the waiting room. No follow-up on my request to collect data. I should have been resentful.
But as time went on, it bothered me less and less.
Because Melissa seemed to be getting better. Without him.
Without any of them. Ten weeks since therapy had started and she was a different child, unburdened, conspicuously calm, no more kneading, no more pacing. Allowing herself to smile. Loosening up as she played.
Laughing at my repertoire of grade-school jokes. Acting like a kid.
And though she continued to resist talking about her fears about anything substantive her drawings had become less frantic, the sack-men were vanishing. Windows and doors sprouted like buds on the stone faces of houses that now stood plumb-straight.
Drawings that she preserved and presented to me with pride.
Progress? Or just a seven-year-old putting on a happy face for her therapist's sake?
Knowing what she was like outside the office would have helped my assessment. But those who could tell me shunned me as if I were a virus.
Even Eileen Wagner was out of the picture. I'd phoned her office several times and gotten her answering service, despite being careful to call during business hours. Slow practice, I supposed. She was probably moonlighting to make ends meet.
I called the Medical Staff Office at Western Pediatrics to find out if she had another job. They had nothing else listed. I phoned her office again, left messages that went unanswered.
Strange, considering the dedication she'd shown in arranging the referral, but everything related to this case smacked of strange, and I'd gotten used to it.
Remembering what Eileen had told me about Melissa's fulminating school phobia, I asked Melissa the name of her school, looked up the number, and called it. Presenting myself as her doctor and not clarifying when the clerk assumed pediatrician, I asked to speak with Melissa's teacher a Mrs. Vera Adler, who confirmed that Melissa had missed a good deal of school early in the semester but since then her attendance had been perfect and her "social life" seemed better.
"Was she having social problems, Mrs. Adler?"
"I wouldn't say that, no. I mean, she was never a problem of any sort, Doctor. But she wasn't the most outgoing child kind of shy.
Off in her own world. Now she mixes more. Was she ill before, Doctor?"
"Just the usual stuff," I said. "Just following up.
"Well, she's doing fine. We were starting to worry, she was absent so much, but she's fine now. A very nice, extremely bright little girl she tests out on the Iowa at the ninety-ninth percentile.
We're so glad she's gotten adjusted I thanked her and hung up, heartened. Said to hell with the grown-ups and continued to do my job.
By the fourth month of treatment, Melissa was treating the office as if it were a second home. Sauntering in smiling, making a beeline for the drawing table. She knew every cranny, could tell when a book had been moved from its usual place, was quick to put it back.
Restoring. Showing an unusual eye for derail that jibed with the perceptual sensitivity Dutchy had described.
A child whose senses ran on full throttle. For her, life would never be boring. Could it ever be tranquil?
As the fifth month began she announced she was ready to talk again.
Informing me that she wanted to be a team just like I'd said at the beginning. - I "Sure. What would you like to work on?"
"The dark."
I rolled up my sleeves, ready to muster every kernel of wisdom I'd gathered since grad school. First I taught her to recognize the physical warning signs of anxiety how she ftlt when the fear came on.
Then I trained her in deep relaxation that evolved into full-blown hypnosis because of her ease at drifting into imagery. She learned selfhypnosis in a single session, could sink into trance within seconds. I supplied her with finger signals she could use to communicate while under, and finally began the desensitization process.
Seating her in a chair, I told her to close her eyes and imagine herself sitting in the dark. A dark room. Watching as her body grew taut and her index finger popped up, I warded off the tension with suggestions of deep calm and well-being. When she'd relaxed once more, I had her return to the dark room. On/off, over and over again, until she could tolerate the image. After a week or so, she'd mastered the imaginary darkness and was ready to tackle the real enemy.
I drew the outer office drapes and manipulated the light-switch rheostat, getting her accustomed to gradually increasing dimness.
Stretching the time that she sat in partial darkness and reacting to evidence of tension with instructions for deeper and deeper relaxation.
Eleven sessions into the treatment, I was able to pull the blackout drapes closed, plunging both of us into total darkness.
Counting the seconds out loud and homing in on the sound of her breathing. Ready to move in at the merest catch or quickening, determined she'd never experience prolonged anxiety.
Rewarding each success with high praise and low art cheap plastic toys that I bought in bulk at the five-and-dime. They thrilled her.
By the end of the month, she could sit in blackness which sometimes made me lose my balance for an entire session, free of tension, chatting about school.
Soon, she was as nocturnal as a bat. I suggested it might be a good time to work on her sleep. She smiled and agreed.
I was especially eager, because this was my bailiwick. During my internship I'd been presented with several cases of children with chronic night terrors and had been impressed with the level of disruption the episodes caused in kids and their families. But none of the psychologists or psychiatrists at the hospital knew how to treat the disorder. Officially, there was no treatment other than tranquilizers and sedatives whose effects were unpredictable in children.
I went to the hospital library, chased down references, found plenty of theory but nothing about treatment. Frustrated, I sat for a long time thinking and decided to try something outlandish: operant conditioning.
Bald behavior therapy. Reward the children for not having terrors and see what happened.
Simple-minded-almost crude. Theoretically, it made no sense. As the senior staff was quick to inform me over their fuming pipes. How could unconscious behavior-arousal from profoundly deep sleep-be consciously manipulated? What could voluntary conditioning accomplish in the face of hard-wired deviance?
But research had emerged recently that suggested greater voluntary control over body function than had ever been imagined: patients learning how to raise and lower skin temperature and blood pressure, even mask severe pain. At Psychiatric Case Conference, I asked for permission to try to decondition night terrors, arguing that there was nothing to lose. A lot of head-shaking and words of discouragement, but consent was granted.
It worked. All my patients got better and stayed better. The senior staff started implementing my plan with their patients and achieved similar results. The chief psychologist told me to write it up for a scientific journal, listing him as co-author. I sent the article in, overcame skeptical reviewers with columns of numbers and statistical rests, and got published. Within a year other th
erapists had begun to replicate my findings. I received requests for reprints and phone calls from all over the world, was asked to give lectures.
Had been doing just that the day Eileen Wagner had approached. It was the lecture that had led me to Melissa.
And now Melissa was ready to be treated by the expert. But there was a problem: The technique-my technique-depended upon family cooperation.
Someone needed to monitor the patient's sleep pattern precisely.
I buttonholed Dutchy on a Friday afternoon, before he had a chance to dash away. He gave a resigned look and said, "What is it, Doctor?"
I handed him a pad of graph paper and two sharpened pencils and, adopting the demeanor of a full professor, gave him his orders: Before bedtime, Melissa was to practice relaxation. He wasn't to badger or remind her; it would be her responsibility I His job was to record the occurrence and frequency of night terrors. Nights without terrors were to be rewarded the following morning with one of the trinkets she seemed to love so much. Nights following terrors were not to be commented on.
"But, Doctor," he said, "she's not having them."
"Not having what?"
"The terrors. Her sleep's been perfectly calm for weeks. The bed-wetting's also ceased."
I looked over at Melissa. She'd stepped behind him. Half a small face peeked out. Enough for me to see the smile.
Pure joy. Reveling in her secret, as if it were confection.
That made sense. The way she'd been brought up, secrets were the coin of the realm.
"The change has really been quite remarkable," Dutchy was saying.
"That's why I didn't feel it was necessary to-" I said, "I'm really proud of you, Melissa."
"I'm proud of you, Dr. Delaware," she said, starting to giggle.
"We're an excellent team."
She continued to get better more rapidly than science could explain.
Leapfrogging over my clinical games plans.
Healing herself Magic, one of my wiser supervisors had once said.
Sometimes they Yl get better and you won't know why Befrre you've even started doing what you think is so goddam clever and hotshot scientific. Don't fight it. Just put it down to magic. It's as good an explanation as any.
She made me feel magical.
We never got into the topics I'd thought essential to explore: death, injury, loneliness. A Mikoksi with acid.
Despite the frequency of sessions, her chart was thin I had very little to record. I began to wonder if I was functioning as anything more than a high-priced babysitter, told myself there were worse things to be. And, faced with the onslaught of difficult cases that seemed to grow each month as my practice burgeoned, I was thankful for the chance to be passive and magical for forty-five minutes a day, three times a week.
After eight months she informed me that all her fears were gone.
Risking her wrath, I suggested reducing our time together to two sessions a week. She agreed so readily that I knew she'd been thinking the same thing.
Nevertheless, I expected a few backward steps as the loss sank in and she attempted to buy herself time and attention. It never happened, and at year's end she was down to one session per week. The quality of the sessions changed, too. More casual. Lots of gameplaying, no drama.
Therapy winding itself down. Triumph. I thought Eileen Wagner would like to know, made one more attempt to reach her, got a disconnected-number recording. Called the hospital and learned she'd closed her practice, resigned from the staff, left no forwarding address.
Puzzling. But she wasn't my concern. And one less report to write wasn't something I'd mourn.
For such a complicated case, it had turned out surprisingly simple.
Patient and doctor, slaying demons.
What could be purer?
The checks from Fiduciary First Trust kept coming, three figures at a shot.
The week of her ninth birthday, she arrived with a gift. I had none for her had decided long ago never to buy patients anything.
But she didn't seem to mind and glowed from the act of giving.
A gift too big for her to carry. Sabino brought it into my office.
Massive basket of crepe-paper-wrapped fruit, cheeses, wine samples, tins of caviar, smoked oysters and trout, chestnut paste, jars of preserves and compotes, from a gourmet shop in Pasadena.
Inside was a card.
TO DOCTOR DELAWARE, LOVE, MELISSA D.
On the reverse side was a drawing of a house. The best she'd ever done-carefully shaded, lots of windows and doors.
"This is beautiful, Melissa. Thank you very much."
"Welcome." Smiling, but her eyes had filled with tears.
"What's the matter, lion?"
"I want.
She turned around and faced one of the bookcases, hugging herself.
"What is it, Melissa?"
"I want... It's time maybe. to for no more.
She trailed off into silence. Shrugged. Kneaded her hands.
"Are you saying you want to stop coming for sessions?"
Multiple rapid nods.
"There's nothing wrong with that, Melissa. You've done great.
I'm really proud of you. So if you want to try it on your own, I understand and I think it's terrific. And you don't have to worry-I'll always be here if you need me."
She whipped around and faced me.
"I'm nine years old, Dr. Delaware. I think I'm ready to handle things on my own.
"I think you are, too. And don't worry about hurting my feelings."
She started to cry.
I went to her, hugged her. She put her head against my chest and sobbed.
"I know it's hard," I said. "You're worried about hurting my feelings.
Probably been worried about that for a long time."
Wet nods.
"That's very kind of you, Melissa. I appreciate your caring about my feelings. But don't worry I'm fine. Sure, I'll miss seeing you, but I'll always keep you in my mind. And just because you stop coming for regular sessions doesn't mean we can't stay in touch. Over the phone.
Or by writing letters. You can even come in to see me when there's nothing bothering you. Just to say hi."
"Do other patients do that?"
"Sure."
"What're their names?"
Smiling mischievously.
We both laughed.
I said, "The thing that's most important to me, Melissa, is how well you've done. How you've taken charge over your fears. I'm really impressed."
"I really feel I can handle things," she said, drying her eyes.
"I'm sure you can.
"I can," she repeated, looking over at the big basket. "Have you ever had chestnut paste? It's kind of weird doesn't taste like roasted chestnuts at all.
The following week, I phoned her. Dutchy answered. I asked how she was doing. He said, "Very welt indeed, Doctor. Let me get her for you." I couldn't be sure, but I thought he sounded friendly.
Melissa came on the line, polite but distant. Letting me know she was okay, would call me if she needed to come in. She never did.
I called a couple of more times. She sounded distracted and eager to get off the phone.
A few weeks later I was doing my books, reached her ledger sheet, and realized I'd been paid in advance for ten sessions I hadn't conducted.
I wrote out a check and mailed it to San Labrador. The next day a manila envelope arrived at the office by messenger. Inside was my check, in three neatly torn pieces, along with a sheet of scented stationery.
Dear Dr. Delaware, l I 'ith much gratitude I FaithAill) ) I urs, Gina Dickinson Same fine graceful hand she'd used to promise me, two years ago, that she'd be in touch.
I wrote another check for exactly the same amount, made it out to Western Pediatrics Toy Fund, went down to the lobby, and posted it.
Knowing I was doing it for myself as much as for the kids who'd get the toys, and telling myself I had no damn right to feel noble.
Then I
took the elevator back up to my office and got ready for my next patient.
It was one in the morning when I put the file away. Reminiscing was strenuous exercise, and fatigue had enveloped me. I hobbled to bed, slept fitfully, did a good impression of waking at seven, and marched into the shower. A few minutes after I'd dressed, the bell rang. I went to the door and opened it.
Jonathan Kellerman - Alex 06 - Private Eyes Page 7