A Mother's Trial

by Wright, Nancy

  It was Priscilla who now brought up the topic she really wanted to explore. What had Carte really been driving at in the earlier meeting? And this time, he confronted the issue more squarely.

  Mindy’s sodium level, he said, indicated that she was receiving an external source of sodium that was causing her diarrhea, and it was the sort of thing you could get over the counter at any drugstore.

  “What do you mean?” Priscilla asked.

  “Something with a laxative effect, that all of us are familiar with,” he answered.

  “I’m not familiar with that,” she said. “There are no laxatives in our house.”

  “Well, it’s common knowledge. You can buy it anywhere.”

  “I don’t know anything about that,” she said again. And Carte did not answer her and did not look at her.

  “It’s obvious to me that I can sit here and tell you over and over again, till I’m blue in the face, that I don’t know what you’re talking about,” she burst out. “But you’re obviously not going to believe me.”

  And again, he looked away and didn’t answer.

  Later, Priscilla swore she made the next suggestion. Carte would swear it was his own.

  “The Child Protective Services has to be called.”

  They would both agree, however, that Priscilla then said, “I’ve worked there and I know the procedure. You shouldn’t just call the social worker on duty. Call Annie Jameson. She’s the head. I’ve got her home number in my car. I’ll get it for you.”

  Startled, Carte replied, “Yes. All right.”

  Afterward, Priscilla claimed that at this point in the conversation, she demanded that there be a criminal investigation. Carte was to deny that she said it. Instead—and she always denied this in her turn—his recollection was that she made a very damaging admission.

  “That makes me a prime suspect,” he swore that she said.

  Priscilla half ran to her car in the parking lot behind the Medical Office Building. She found and opened her briefcase, dug in it briefly till she came upon Annie’s number. Then she hurried back to Carte and handed him the number she had written down.

  “Thank you,” he said. Then he turned and without another word walked away from her. She stood, rigid and alone, and watched until he turned the corner and was gone. Later, returning home—and as though in preparation for coping with what was to come—she began a journal.

  16

  The Emergency Room had emptied out by five-thirty that afternoon. There were no more pediatric patients to be seen in the outpatient clinic. Evelyn could go home.

  She had never spent a harder day. She hadn’t had that kind of pressure since joining Kaiser. Most of her work here—for all the pediatricians—was outpatient clinic work, just like a private pediatrician’s practice. The only difference was that with Kaiser she had the advantage of constant consultation, any time she wanted it. It made the job less lonely, the atmosphere more relaxed, and the pressures easier to bear.

  The drawback, Evelyn reflected, was that when something as nerve-wracking as this situation hit you, you weren’t prepared. You weren’t used to living on the emotional edge. And you weren’t twenty-five years old, either. You were Chief of Pediatrics, dealing with parents who had hair-trigger emotions, and a very sick little girl with terrible veins and a bad case of dehydration. You were dealing with a potentially serious crisis.

  Estol Carte had just left her office. He had spent a worse day than she had, but he had stayed on top of it in a way that would never cease to impress Evelyn.

  He had sat by her desk and told her that the control sample on Mindy’s new formula contained precisely the right amount of sodium. So it appeared that the source of the sodium overload in Mindy’s original formula was not contaminated factory stock. And then he had described his most recent meeting with Priscilla Phillips. Apparently Mrs. Phillips had denied all knowledge of laxatives or cathartic salts.

  “I told her I’d have to call the Child Protective Services, and she said I should call the head of it. She went down to her car and brought me back the number!” he’d told Evelyn, shaking his head.

  “What did you do?”

  “I called her. Also the San Rafael police. They’re meeting me here later.”

  “God, it never occurred to me to do that, Estol. We re going to have to write up a child abuse report.”

  “I know.”

  “I’ll do it. I’ll work on it tonight. Have you been up to see Mindy?” said Evelyn.

  “Yes, she’s doing fine. I ordered oral Cho-free for her. She hasn’t had either the IV or NG in all afternoon.”

  “What about serum electrolytes?”

  “I’ll leave an order for them to be drawn in the morning. That’ll give her body a chance to equilibrate whatever’s still in there. But I’m sure the sodium will be down.”

  “Well, I’ll check first thing when I come on the ward in the morning,” said Evelyn. “I can’t believe we’ve got another whole day of this to go through.” She felt a sudden sense of comradeship—they could be two shipwrecked survivors on a lifeboat. She hoped they wouldn’t sink in the next storm.

  Estol left, and Evelyn went back upstairs to collect her things. She shrugged out of her stiffly starched white doctor’s coat and into her warm one. She gathered up a handful of copies of the child abuse forms that Kaiser supplied in quadruplicate and stuffed them into her bulging bag, then walked back through the hospital to the parking lot. The fog had returned, she thought briefly, or perhaps it had never lifted at all.

  17

  Later Priscilla would not be able to remember how she arrived home that Saturday afternoon. She did notice that the camper was not there, so Steve and the boys had not returned yet. This was a good thing, for she did not want to be distracted now. She had to telephone Annie Jameson and warn her that Carte was going to call.

  Annie Jameson was the head of the Child Protective Services in Marin County, a branch of Health and Human Services, and Priscilla knew her quite well. They had worked together on and off for the past ten years. Annie had been Priscilla’s manager when Priscilla had returned to work on a month-to-month basis in January 1975, and she had supervised Priscilla’s work as an on-call social worker in the Child Protective Services program when it started up in the fall of that same year. Annie’s grandniece was the same age as Erik, so that gave them something to talk about, and Annie had met Steve and the boys, but Priscilla considered the short, dumpy, sixtyish woman a professional rather than a social friend.

  Annie’s line was busy, but after repeated attempts, Priscilla finally got through.

  “You’re not going to believe this, Annie,” she began.

  “I already know. The doctor just called; I’m on my way to meet him now. It will take a while. I understand he’s already called the police—you know that’s the procedure.”

  “I know, Annie. Oh, Annie—I can’t believe this is happening to me. It’s totally unreal!” She broke into tears.

  “Priscilla, I’m sure it’s a misunderstanding. We’ll straighten it all out in no time, I’m sure. The policeman and I will come over after we meet the doctor at Kaiser. Now don’t be upset—”

  “Oh, Annie, I’ve been crying all day! I don’t know if I can bear it!”

  “Priscilla, please don’t worry. Take some aspirin. Try to calm down. I’ve got to go now. But I’ll see you soon.”

  “Yes, all right.” Priscilla hung up the phone, found some aspirin, and waited for Steve to come home.

  He was furious.

  “Why the hell did you go up there, Pris!”

  “Because I had to know. And you were right. They think I did it. Carte said it was something you could buy in the drugstore, and he implied I did it. I don’t even know what he’s talking about. I gave him Annie Jameson’s number, and she’s meeting them over there—Carte and the police.”

  “I’m going to call that sonovabitch right now and get a list of the employees out of him,” Steve exploded. “Ther
e’s gotta be somebody we know working over there. Somebody with a grudge, Pris.”

  Priscilla heard Steve’s end of the phone conversation. She watched his face redden. Finally he hung up.

  “Well?” she asked.

  “He doesn’t think it’s necessary,” Steve minced in apparent imitation of the doctor. “Well, I’ll get it out of him, or some damn administrator up there, you can bet on that!”

  Somehow they got the boys to bed. Mechanically, Priscilla tidied the house, picking up clothes and toys, polishing the kitchen counters, waiting for the doorbell.

  The visit was worse than Priscilla expected; she spent most of it in tears. From the beginning it was obvious that both Annie and the young, officious police officer she had brought with her, believed that a finger was being pointed straight at Priscilla. And not just because of Mindy.

  “I understand you had another child who died,” the officer said. “We’re going to have to investigate that, too.”

  For a while, Priscilla sat wordless, the tears streaming in fine runnels down her face. Steve was yelling about their enemies and a list of Kaiser employees and kept saying that the boys were fine, that they’d be sick if Priscilla was going around poisoning the children. That she was the best mother anyone could have. That she had worked against child abuse for years, that they both had fine reputations in the community. He was shouting.

  “But what about Mindy? What will happen to Mindy?” Priscilla finally broke in over Steve.

  “I don’t know. Maybe a foster home, Priscilla, just for a little while,” Annie said.

  “Oh, no!” Priscilla was shrieking. “Annie, you know I lost one child and now they want to take another! You can’t do this to me!”

  “Well, I don’t know, Priscilla. Why don’t we talk to the doctor tomorrow. I’ll set something up. Maybe we can work something out.”

  “Annie, you’ve got to do something about the visiting. They’re only letting me visit five minutes an hour. They won’t even let it accumulate. She’s not used to being alone like that.”

  “All right, Priscilla. I’ll see what I can do. Why don’t you and Steve plan to come by the hospital tomorrow about noon? I’m sure we can work this out. Please don’t worry.”

  Priscilla sat motionless on the orange sofa as they rose and then left. She did not even move when she heard Steve slam the front door after them. She felt rooted, helpless. Because, for once, she didn’t know what to do.

  18

  Annie was there to meet them as promised. Steve felt as though he’d been treading water in a deep pond for an hour. His big, burly body was floppy with no sleep and worry and uncertainty.

  That morning he had called Jim Hutchison.

  “Someone’s trying to poison Mindy,” he said. There had been a pause before the minister replied.

  “What?”

  And Steve had repeated it, explaining what had happened. “We need you up at Kaiser, Jim. Can you come?” It was for Priscilla, really, that he was asking, he knew. Priscilla had leaned so hard on Jim when Tia had died.

  “Yes, of course, Steve.” The heavy Irish voice had been reassuring. “I’m just getting ready for the service, but I’ll be up as soon as it’s over. By one o’clock certainly. Don’t worry,” Jim had said.

  So they expected him in time for the meeting that Annie Jameson had arranged with Dr. Callas in the ICU Quiet Room.

  At noon, Steve and Priscilla drove to the hospital to visit Mindy. Steve did not go in. He couldn’t bear some nurse standing over him, watching every move. He looked through the glass door as Priscilla moved to Mindy’s bed. He knew Pris was crying.

  “How is she?” he asked when Priscilla returned five minutes later.

  “She looks okay. They’re giving her cereal and bottles. She hasn’t had any diarrhea.”

  So it was something in the bottle of formula, Steve thought. Maybe the damned doctors had done something right for once. But who? How had it happened? In a way, Steve didn’t want her to be better because now they’d surely be coming after Priscilla. Well, they weren’t going to do it. Not if he had anything to say about it.

  And now here with Annie Jameson was Dr. Callas, her face set in accusation. Steve almost flinched. Jim Hutchison wasn’t here. He had called at the last minute and said he couldn’t make it till later, that they should go on without him.

  The Quiet Room seemed smaller still, Steve thought, as though a black cloud of threat and danger had entered, seeping under the single door, filling the room. Steve could almost feel it hanging there, ready to shroud them all.

  Priscilla was crying before they went into that little room, and she cried on and off throughout the meeting. Annie said they were there to talk about the visiting. It felt good to Steve to have some support. And Annie was effective. She was an older woman with a calm voice and an air of reason.

  “I don’t see why the visiting can’t accumulate,” she said to Dr. Callas. “It is so inconvenient for the Phillipses to arrange their lives so that they can be here five minutes each hour.”

  “That’s right,” Priscilla broke in. “It’s too exhausting. Either I have to sit outside the door for the other fifty-five minutes and watch the clock, or go home, try to live a normal life, and then rush back.”

  “What I suggest—” began Miss Jameson.

  “It’s totally ridiculous—”

  “Steve—”

  “I just wanted to—” he began again.

  “Let her finish!”

  “Okay. Sorry,” he muttered.

  “Why not fifteen minutes every three hours? That’s what I propose.”

  Dr. Callas hesitated. “All right, Miss Jameson,” she finally said.

  “Now tell me more about these sodium levels,” Miss Jameson said.

  They were trying to tie it in with Tia, Steve realized as he listened to Dr. Callas, and that didn’t make sense. Now they were claiming that Mindy was getting sodium from outside. But when Tia’s sodium levels had been elevated, the doctors had always explained that this was a physiological response; Tia was experiencing too much output of fluid too quickly, causing an increased level of sodium in the blood.

  So what was going on? he wondered. Had they screwed up in Tia’s case? Was this thing with Mindy just an excuse for Tia? Pris kept saying they’d never tie Tia into this, that Tia was a whole different thing. But Steve wasn’t so sure.

  At the end of the meeting, Priscilla and Annie wanted to look in again on Mindy, and as they crossed the hall to the ICU, Steve turned to Dr. Callas.

  “Something I don’t understand here. Are you saying it has to be an additional sodium source and not a natural process? Tia always had high sodiums and you explained it away as a physical reaction to diarrhea. Couldn’t Mindy and Tia have the same thing?”

  Dr. Callas stopped and looked at him squarely.

  “Yes,” she replied. “The two cases are exactly the same.” But what she meant and what he understood were entirely different, and this conversation, much later, was to come back to haunt him.

  19

  All through the meeting, Evelyn struggled to stay detached. She was outnumbered. It would be easy to give in. It would stop the tears and the shouting and the hysteria.

  But over and over, Evelyn kept reminding herself, we know the chemistry, we know what we know, and we know no matter how loudly they scream and holler, that child was poisoned. Remember your data, Evelyn; keep your head.

  Last night, at midnight, the nurse had recorded a perfectly formed brown stool. The 9:15 A.M. electrolyte readings reported back from the lab had shown a sodium of 138 milliequivalents per liter, a potassium of 5.3, a chloride of 106, and a carbon dioxide of 26. All were completely normal. And Mindy’s appetite had returned. There was no getting around the evidence of the patient’s own body. It was irrefutable proof.

  It had taken Evelyn three tries and lots of scratch paper last night before she had been satisfied with the child abuse form she had filled out. This report was going t
o the San Rafael police, and to the Marin County Child Protective Services. It involved a family with a certain standing in the community. Both parents were county employees. Evelyn knew she had to be careful with this report. She wanted to be certain that she accused no one, yet she had to make sure that Mindy would be protected. She was proud of the finished product, which ended with the sentence, “The illness is consistent with the addition of a saline cathartic to the child’s intake by some person.” No one could ignore that report.

  But they might not know exactly how to deal with it. It was clear that Miss Jameson, for one, was confused about the implications of what had occurred. After the Quiet Room meeting with the Phillipses, Evelyn had conferred with the social worker alone.

  Didn’t Dr. Callas think that Mindy might go home with a public health nurse in attendance? Miss Jameson had asked.

  “No, it’s not safe,” Evelyn answered.

  “Well, couldn’t Mindy go home with them on some sort of basis? Mrs. Phillips has offered to have someone move in with them to keep an eye on Mindy. The most upsetting thing for her is to have Mindy taken away from her, especially after the loss of Tia,” Miss Jameson persisted.

  Evelyn looked at her in disbelief. “Look, I know you’re trying to help, but I have to disabuse you of the notion that Mindy can go home with Mrs. Phillips on any basis. Don’t you understand, she’s already killed one child and has tried to kill another!”

  “What do you mean? What other child?”

  “Tia! At this point I’m sure Tia didn’t die a natural death, either!”

  “My goodness! That’s really difficult to take in. I can’t believe it! What evidence do you have? I’m just sure she couldn’t have done that—that you’ll find you’re mistaken,” Miss Jameson said numbly.

  “Frankly, I think that’s unlikely. When we start looking through Tia’s chart—knowing what we do about Mindy—I think we’ll find medical evidence. Now we know what to look for. It is so easy to introduce a substance into a child with a naso-gastric tube in place, you know. Just mix it with a little water and inject it into the tube. With a bottle, of course, it’s even easier. And there have been some articles recently about mothers—perfectly ordinary-seeming mothers, incidentally—doing this sort of thing to their children. We were just never suspicious enough, unfortunately.”