“Careful, you’ll…”
“Ouch!”
“…burn yourself.”
James sucked on his finger and gave her a contrite look, while steam hissed into the room and the copper pipes clanged in the walls.
“Poor baby.” Kate walked over to him. “So overheated and everything.” She reached for his belt buckle, looped her finger through it and pulled him close. She rubbed her pelvis against his and kissed him passionately.
He scooped her up in his arms, swung her around, and she laughed from deep in her throat as he carried her into their bedroom, nearly scuffing the walls with her winter boots. “Watch it!” she giggled. He dropped her on the bed and removed her boots one at a time. He pinched off her thick socks and unzipped her jeans.
“God, you’re gorgeous.” He unbuttoned her blouse and bent to kiss the tiny, nearly invisible scars that peppered her skin. Kate had been a cutter once. Razor blades, paperclips, thumbtacks, scissors. What had begun as an extreme response to her sister’s death had devolved into a crippling anxiety disorder. She had left little dimple-like scars on her stomach, thighs, and arms, and wore long sleeves to hide them from the world, mostly so her father wouldn’t catch on. Cutting herself felt like payback for his neglect. It also relieved some of the pressure she felt as a high school honors student trying to get into a prestigious college. It had lasted for several years, until she got into therapy and learned how to cope. Her mentor, Ira Lippencott, had saved her life. He’d stopped the self-destructive behavior in its tracks and put her on the path to wellness.
The phone rang again.
“Oh God,” she groaned. “We need to set some guidelines for your mother. Like no calling before noon or after eight o’clock.”
“Just ignore her,” James said, sliding his hands under her blouse, an urgency to his breathing. “I always do.”
“Oh please.” She stopped him. “The last thing I want to hear is Vanessa’s voice in the background while we’re making love.” She could picture his mother tapping her long polished nails on her marble kitchen island, gazing at the clock, and wondering why they weren’t picking up. At least she was a good hour’s drive away on the other side of the city.
He collapsed on top of her.
“Answer it, James,” she pleaded.
The machine picked up. They both turned their heads to listen.
“Kate?” Ira Lippencott’s voice came floating through the doorway. “I’ve got bad news. Nikki McCormack is dead. Call me as soon as you get this.”
3
NIKKI MCCORMACK WAS FOUND hanging from the center beam of her parents’ living room. A chair had been kicked out from under her. She’d hanged herself with an old clothesline from the garage, although how she’d gotten it up there, nobody knew. Her parents had discovered the body after attending a charity reception at the Isabella Stewart Gardner Museum. Her stepfather grabbed her around the middle, while her mother called 911. Together they lifted the body onto the floor. Ten minutes later, the paramedics pronounced her dead. Nikki was clad in full Goth regalia. Her skin had swelled around her neck and face, and her eyes were black and shiny as olives.
Dealing with the family—their sorrow, their vulnerability— as well as her own shock and grief all night long and into the following morning had given Kate a raging headache no amount of Tylenol could alleviate. The police were polite but thorough. The interview was mercifully short. The rest of the hospital staff was saddened but too busy to talk about it for very long. Nikki had been admitted into Acute Care eight months ago, and some of them remembered her and spoke well of her, and that was about it. Suicides weren’t terribly uncommon, but it had never happened to Kate before.
She moved from meeting to meeting all morning until around 10:30 AM, when Ira Lippencott cornered her in the break room. By then Kate was shaking so badly she couldn’t keep the coffee pot steady.
“Sheesh. You look like a ghost,” he said. “Where’s James?”
“Dealing with his own crisis. Agatha’s in full meltdown-mode.”
He nodded. The reputation of James’s most troubled patient was well known in the hospital. “Come with me.” He ushered her into his office and made her sit down, while he poured her a cup of coffee from his Breville espresso machine.
Ira’s office was full of modular furniture, decorated in a neutral palette. The plants had long outgrown their pots, and now they jammed their leaves against the glass as if they were clamoring to escape.
Ira had been her senior attending and knew all about the tragedies that had shaped her life. As an undergraduate, she’d undergone psychoanalysis with him as her therapist. It was a prerequisite. “You need to know what it’s like to sit in the other chair, before you can sit in my chair,” he’d explained. This man knew everything about her.
“Here,” he said, handing her an espresso. “Now talk.”
Kate’s shaky hands threatened to spill her coffee all over her lap, so she took a sip and set it aside. “What’s there to talk about,” she said flatly. “I failed her.”
“You did your very best, Kate. You realize that, don’t you?”
“I’m her psychiatrist, and I didn’t see it coming. And so… I failed her.”
“Now’s not the time to feel sorry for yourself.”
“Sorry for…?” she repeated.
“Self-pity doesn’t suit you.” Her mentor didn’t suffer fools gladly. “Listen to me, Kate. You aren’t alone in this. I wake up every day with a few more gray hairs.”
“I know, but…”
“But nothing.”
That did the trick. All morning long she’d managed to hold it together, but now she was flattened by Nikki’s suicide. She plucked a tissue out of the floral-patterned box, pressed it to her eyes, and let herself cry.
“I know, I know,” Ira said soothingly. “Look, it happens. We’ve all had patients commit suicide. It’s devastating. But believe it or not, you’ll learn to live with it.”
She nodded. She pulled herself together.
“So. Let’s review what you could’ve done differently,” he said. “Tell me, how was Nikki’s therapy going?”
“We were making good progress. She was responding well to the new meds.”
“And what about the family sessions?”
“Her parents were opening up to the possibility they may have contributed to some of Nikki’s issues.”
“And her addictive behaviors?”
“She’d stopped drinking and taking drugs, as far as I know. She was slowly pulling her life together.”
“Excellent. So? What more could you have done? Canceled your vacation? These things happen, Kate. It comes with the territory.”
“Well, I’m canceling my vacation now.” Last night, her dreams had crackled with tension—monsters chasing little girls who snapped in half like twigs. “Elizabeth McCormack wants me to come to the funeral.”
“Good. It’s advisable to stay in close contact with the family, at least through the funeral, certainly until the autopsy results are available.”
Autopsy. That cold word brought it home to her.
“I’ve been wracking my brains trying to figure out how this could’ve happened.”
“Kate. Please.” Ira sighed and pinched the bridge of his nose. “You know better than that. None of this was your fault. Sometimes the darkness takes over.”
She gave him a skeptical look. They’d known each other for a very long time. “Seriously? Sometimes the darkness takes over? That’s supposed to reassure me?”
“I’m not in the business of reassuring anyone.”
“Right, we aren’t supposed to comfort and reassure our patients, we’re supposed to redirect them toward the path of self-recovery… blah blah blah.”
“Exactly.”
“I was being sarcastic.”
“I know you were.”
She felt the old reproach like the hum of an oncoming electrical storm. The events that had shaped her life would never go awa
y, but at least she’d managed to set them aside for a period of time… to place them in a box and mentally tape the lid shut, put the box inside a closet and lock the door. But Nikki McCormack’s death had just blown the closet door off its hinges.
“Look, you can handle this, Kate. You’ve suffered more hardships than most people encounter in a lifetime.” He folded his hands on the desktop. “But here’s the deal. Nikki’s death reflects on me as well. It reflects on the entire department. And I know what you’re thinking. So I want you to know: what happened last night had absolutely nothing to do with your sister. Do you accept that?”
“Intellectually, yes.”
“Well, I need you to accept it here.” Ira tapped his chest. “Completely.”
Savannah Wolfe, with her wavy golden hair, her delicate sea-green eyes and excitable laugh had been such a happy, trusting twelve-year-old, that any predator in the neighborhood could have taken advantage of her. She was the kind of enterprising kid who rescued ants from the driveway and raised baby birds with broken wings. Even the smarmiest dog food commercials made her cry. She was willing to help anyone—friends, neighbors, strangers—even a grown man with bloodshot eyes. All he had to do was ask. “Hey, little girl… couldja help me out a second?”
Kate felt a painful throbbing behind her eyes. “Look, I understand these shaky old feelings about my sister don’t apply, but…”
“Push aside your emotions.” Ira crossed his arms. “I need you to handle this like a professional.”
“Of course I can handle it,” she said defensively.
“The only thing that counts is that you provided standard care for her symptoms. That’s all the hospital wants to know. Did you provide standard care?”
There was a lull before the impact struck. “Standard care?”
“Legally, that’s all the hospital requires. Did you use the proper quantifiers to make an accurate diagnosis?”
She nodded with dull recognition.
“The hospital doesn’t want to hear what you could’ve done differently, Kate. You have to quit second-guessing yourself. It doesn’t help anyone. You’re a brilliant psychiatrist, extremely well qualified, with excellent references. You were treating Nikki for bipolar disorder. You were monitoring her medication and redirecting her behavior in talk therapy. The patient appeared to be stabilized and you were documenting her improvement. Nothing else matters. Now,” he said, leaning forward, “can you handle it?”
“Yes,” Kate responded, not entirely sure. She’d never lost a patient before. It was brand new territory for her. And Ira wasn’t acting like himself. She’d never seen this Ira before. This covering-his-ass Ira.
“When you talk to Risk Management, I want you to give them your clinical observations—period. Don’t get emotional. Do you need an attorney?”
“An attorney?” Kate repeated, her heart beginning to race. Getting sued for malpractice was every doctor’s worst nightmare.
“The hospital is going to have the hospital’s best interests at heart. Just in case a tort action should arise. It’s only natural. You need to take care of yourself.”
Tort action? Lawsuit?
“Here. I’ll give you the name of my attorney. I’d highly recommend him.” He opened his desk drawer and handed her a business card. “Tell him I referred you.”
“Thanks.”
“And don’t worry. Everything’s going to be fine. We’ve all been through it before. Now if you’ll excuse me, I’ve had a rough night and I’ve still got a mountain of paperwork to do. Sorry to kvetch. I’m going to file my progress reports and head home. I’d advise you to do the same.”
Kate noticed the shift of light in his eyes. “Ira,” she said. “Did you leave those peanuts in my office?”
He gave her a quizzical look. “What peanuts?”
“There’s a jar of Planters Peanuts on my bookshelf.”
“No. Maybe James?”
“I already asked. He didn’t do it.”
“Well, I wouldn’t give it too much significance. Probably someone’s playing a little joke. Anyway, let’s talk again in the morning, shall we?”
She stood up and clasped his hand. “Thanks, Ira.”
“Don’t worry. You’ll get through it. Just think of this as a rite of passage.”
Kate hurried down the corridor, ducked into her office, grabbed her coat, knotted her scarf and put on her winter gloves. She took the elevator down to the first floor, where she crossed the busy hospital lobby and pushed on the automatic glass doors like they were two giant pillows. She went outside and bummed a cigarette from one of the residents. She breathed nicotine deep into her lungs and recalled her sister’s final words to her.
“How long do I have to wait?”
“Just a few minutes. I’ll be right back,” Kate promised.
“Where are you going?”
“Right over there. See those trees? Don’t be scared.”
“I’m not scared.”
“I know, you’re my brave little bud.”
“I’m not scared of anything, Katie.”
She suppressed a hiccupy sob, and the other smokers turned to stare at her. She coughed a few times, masking her anguish, and they politely looked away. She stood there coughing and smoking and watching her breath fogging the winter air.
4
KATE DIDN’T WANT TO go home, not when there was so much work to be done. She took the elevator back up to Admissions to talk to Yvette Rosales about Nikki McCormack’s state of mind eight months ago, since Yvette was the nurse who’d admitted her. The Psych Unit staff was always busy. The phones were constantly ringing. A nurse’s job was never done.
Kate walked past the orderlies and RNs in their colorful scrubs on her way to the nurses’ station, a sort of bureaucratic port in a brain-chemical storm. Tamara Johnson was a beefy middle-aged woman who knew where all the bodies were buried. Head nurse and chief bottle-washer.
“Morning, Tamara. Have you seen Yvette around?”
Tamara wagged her heavy head. “She’s due any minute. Probably wanted her Dunkin’s and missed her bus again. I swear she takes that bus as an excuse to be late all the time. How’re you holding up, Doc?”
“Not great.”
“Yeah, I know. I remember when we admitted Nikki. Scrawny little thing. Bold as could be. She took one look around the place and pronounced everybody else insane.” Tamara laughed. “Not her. Just ‘every other crazy-assed mofo’ in the room.”
“That’s our Nikki,” Kate said with a pained smile.
“Would you like coffee? I just made a pot.”
“No, thanks. I’ll wait over there.”
Kate had brought some paperwork with her and found a seat. The admitting room was an ode to mediocrity— corduroy sofas, imitation-leather chairs, watercolor prints on the exposed brick walls. There were glossy brochures on display at every table.
She opened a manila folder and reviewed her notes. At the time of her admission last June, Nikki was becoming uncontrollable at home. She fought constantly with her parents, took drugs, and drank alcohol. Her stepfather was a strict disciplinarian, and the rebellious teenager missed her dad. The divorce had been especially hard on her.
Somebody shouted, “Get your hands off me, you stinky motherfucker!”
Kate glanced up. Several dozen people were waiting to be evaluated, and she knew most of them from a brief stint of training on the adult ward. She suspected from the way they angled their baseball caps at the security camera that two men she hadn’t seen before were drug addicts faking symptoms in order to get a shot of Demerol. There were also a couple of mood disorders; an anorexic; a young mother with postpartum depression; an elderly male who kept cleaning his hands with alcohol wipes; and a pre-teen girl she didn’t know sitting prim and apart from the others.
Kate honed in on the central conflict—a cadaverous male schizophrenic who’d veered off his meds was yelling at an elderly female depressive, shouting obscenities at her, and waving h
is skinny arms. The woman sat twisted in her seat like a wet washcloth, her rheumy eyes full of doubt, as the man loomed over her—if a stick could loom.
An orderly with his keys jangling from his belt loop hurried over and tended to the dispute. Clive Block was famous for his negotiating skills. He got things calmed down and separated the two quickly. Nobody messed with Clive. The nurses didn’t even bother calling security. Scuffles were commonplace in the Psych Unit. At all hours of the day or night, you could hear doors slamming and voices raised in anger.
Now Kate turned her attention to the pre-teen in the corner. The girl had a pale blond ponytail, sleepy green eyes, and a calm, relaxed demeanor. For an instant, Kate was reminded of Savannah. The similarity was striking. She wore neatly pressed denim jeans and a pink blouse buttoned all the way up to her throat. Her goose-down parka was folded in half and placed carefully beside her. There was a primness about her, a guarded stiffness. Kate guessed she was around twelve, and she appeared to be alone in the waiting room. Where were her parents?
Kate wasn’t able to “spot the crazy,” as some of her friends indelicately put it, until she focused on the child’s jewelry. Draped around her neck were dozens of silver crosses on slender silver chains, and beaded rosaries were wrapped around both wrists. Kate got an impression of a child who’d been isolated from the world—there was a striking sadness about her. A heart-sinking loneliness. Kate’s young patients typically would slouch in their chairs, lean against walls, or curl their shoulders forward in a permanent shrug. But this child sat with practiced poise. She seemed to contain a perfect solitude within her small body. She exhibited an elegant self-discipline that was highly unusual for somebody that age. But again—where were the parents? Perhaps her mother had gone to use the restroom?
Kate was just about to go find out when Yvette Rosales came breezing into the unit, apologizing to everyone within earshot. “Sorry! Sorry! My stupid bus was late again.”
Tamara planted her hands on her hips. “Your bus was late? Or you were late?”
“I waited and waited and waited.”
A Breath After Drowning Page 3