“Yeah, sure. But you had time to get your Dunkin’s, I see.”
“Are you kidding me? I can’t start my day without coffee and a doughnut.”
“We have coffee here.”
“That crap? No way.” Yvette had dark pink lips and a bad frost job. There was always a pencil or an unlit cigarette stuck in her mouth, and she would rush outside for a smoke during her break. “What are you all of a sudden? My mother?”
“That’s right,” Tamara said sarcastically. “I’m spying on you.”
“Feels like I’m being watched. Like the walls are breathing.”
“Did you just say the walls are watching you?”
“Can you prove they aren’t?”
Tamara burst out laughing. All was forgiven. “Anyway. Doc’s over there waiting for you.”
“Who?” Yvette spun around. “Oh hi, Dr. Wolfe. My goodness. Nikki McCormack. Bless her poor soul.”
“I’m still in shock,” Kate admitted, coming over.
“Such a sad day.”
“Can we talk for a minute? I have a few questions about her admission.”
“Of course. Let me take off my coat, and I’ll be right with you.”
Kate leaned against the admitting desk, while Yvette stashed her belongings away. “Who’s the girl in the corner?” she asked.
Yvette glanced over. “I don’t know. Tamara?”
“Hm? Oh. Her mother brought her in.” Tamara shrugged. “She was here a minute ago.”
“I’ve been sitting here for ten minutes, and I haven’t seen anyone.”
“Maybe one of the other staff knows? I’ll go find out.” Tamara disappeared into the nurses’ coffee room.
The elevator dinged just then and the doors whooshed open, and James strode into Psych Admissions, all business. He took Kate aside. “We’re going to see that attorney Ira recommended,” he said. “I made an appointment for eleven-thirty. Let’s go.”
“Wait.” Kate balked. “There’s no need to overreact.”
“I’m not overreacting. I just want to make sure nobody messes with you.”
“Nobody’s going to mess with me,” she said, scowling.
“I’m just looking out for you, sweetie. Let’s go. I don’t want to be late.”
5
ON THE RIDE INTO Boston, Kate tried to suppress the panicky, floppy little breaths that threatened to grow into something worse. The snow-laced city blurred past the windshield like a scratchy black-and-white movie. She’d done her very best to present herself professionally to the world this morning—her greasy hair was pulled into a chignon and her makeup had been carefully applied—but her nerves were raw and ugly. She felt frazzled and exhausted.
They took the GPS-prescribed route to the law firm, situated on the top floor of a monolithic high-rise in the heart of downtown Boston. They pulled into the underground garage and let the valet park their car. Kate couldn’t stop shivering as they waited for the elevators.
James squeezed her hand. “You okay?”
“Do I have a choice?”
“I’m going to help you through this, every step of the way,” he reassured her.
They took the elevator up to the twenty-fourth floor. The law firm’s lobby was a fortress of rose marble. The walls were covered with expensive artwork that echoed the corporate logo. The receptionist wore Dolce & Gabbana. “Good morning. Can I help you?”
“We’re here to see Russell Cooper,” Kate said.
“One moment please.” The receptionist picked up the phone and punched in a number. “Russ? Your eleven-thirty’s here.” She placed the receiver down. “Go right in. It’s the last door on your left.”
Russell Cooper was a middle-aged man with studious gray eyes behind a pair of wire-rim glasses. He wore a conservative suit and a blue silk tie. “Call me Russell. Have a seat.” He gestured toward the pair of overstuffed leather chairs facing his desk.
Kate took a moment to admire the panoramic view of downtown. She could see the Prudential from here, glimmering in the distance, brilliant sunshine bouncing off its highly reflective surfaces.
“James gave me the broad strokes over the phone,” Russell told Kate. “Why don’t you tell me what happened in your own words?”
She cleared her throat and smoothed her skirt across her knees. “Nikki was admitted to Child Psych about eight months ago. She was suicidal. She was on drugs. She was acting out. She met the nine criteria for a major depressive episode. She stayed with us for four weeks, before being discharged and scheduled for outpatient treatment. Since that time, I’ve been seeing her once a week for behavioral therapy. We also meet with her family periodically. We’ve adjusted her meds several times, and the latest dosage appeared to be working. We were making good progress when… when it happened.”
“All right. I have a few questions.” He glanced down at the checklist on his desk. “Did you explain the potential side effects of her meds to Nikki and her parents?”
“Yes.”
“Ignore any pleas for help?”
“No. Well, there is one thing…”
He glanced up. “Yes?”
“I was about to go on vacation for two weeks, which seemed to upset her.”
“Did she threaten to kill herself if you left?”
“No.”
“Did you provide her with an alternative practitioner?”
“Yes. I encouraged her to see Dr. Lippencott while I was away, but she refused. I also gave her my private contact information and told her to call me any time, day or night.”
“Good. Did she call you?”
“Not that I know of.” It made Kate wonder about the Unavailable caller ID, but Nikki’s cell phone number always displayed on caller ID, and Kate would’ve recognized the Newton area code if Nikki’s parents had tried to reach her. Besides, she’d received the call ten minutes before Ira had given her the bad news.
“Was there any mention of suicide in her recent therapy sessions?”
“Not for the past two or three months at least. But we were in the middle of therapy, so it’s reasonable to assume that she wasn’t entirely out of the woods.”
“Was she stable?”
“Relatively stable, in my judgment.”
“If that’s true, then basically that’s all I need to know.”
Kate could detect deep lines of cynicism on the man’s face. As far as she understood it, Russell Cooper had been Ira’s friend since their undergraduate days at Yale, and he’d successfully handled two of Ira’s lawsuits.
“We’ll argue you met the standard of care,” Russell said, “if it comes to that.”
“I doubt her family would sue me,” Kate muttered.
“You never know. Once the dust settles, after the funeral— that’s the danger zone. The family can commence a wrongful-death action against you and the hospital any time they feel like it, right up until the statute runs out. So the question is: did you depart from the accepted ‘standard of care’ by failing to evaluate Nikki’s mental state?”
She shook her head, while James cleared his throat and said, “Kate’s one of the best child psychiatrists they have. She won an APF award, which is a big deal in our line of work. She’s compassionate and caring and does everything by the book.”
“I’m sure she does.” Russell smiled and slid his glasses back up the bridge of his nose. “Ira speaks very highly of you, Dr. Wolfe. But the hospital will want to make sure it hasn’t breached the standard of care by failing to keep the patient safe from harm. They’ll want to make sure she was properly diagnosed, that an adequate history was taken, and that her medication was appropriate.”
James leaned forward. “Kate would do anything for her patients.”
“James,” she said reproachfully, blushing.
Russell Cooper smiled. “I’m sure that’s true. And the courts have found that a medical provider can’t be held liable for mere errors in judgment. But we need to cover all the bases. Unfortunately, malpractice suits are be
coming more commonplace, especially when a patient commits suicide.”
James glanced at her with concern in his eyes.
“What about the funeral?” Kate asked.
“As far as attending the funeral, that’s just fine,” he said. “As a matter of fact, I’d encourage as many staffers as possible to attend. It’s an excellent way to demonstrate the hospital’s concern. However, if you’re going to help out with funeral arrangements, Kate, I’d advise you to keep the meetings short. You can be open to people’s grief, but if they ask about Nikki’s treatment, you need to remind them it’s confidential.”
“Of course.”
“The family may not even think about suing you, but there are plenty of attorneys out there who are on a mission to hold psychiatrists accountable. So by all means, set up a meeting with the family to discuss eulogies, donations, cards, whatever you like. Honor their requests, but don’t volunteer. Let them call the shots. Basically, you want to be supportive without opening yourself up to a lawsuit,” he said. “Any questions?”
Kate frowned. “What happens next?”
“First, the hospital will carry out an internal investigation, sometimes called a psychological autopsy. It will be thorough, but quick. They don’t want to open a can of worms for discovery by the plaintiff’s attorney. However, Risk Management is going to have the hospital’s best interests at heart, Kate. Not yours. So my advice to you would be to cooperate fully, but be cautious. Choose your words carefully. I’d like to be there for the interview. Just a precaution.”
“When will this happen?” James asked.
The attorney shrugged. “Usually right away.”
Kate brushed away a distracting strand of hair and said, “I’ve been trying to figure out how I might’ve handled things differently…”
“Please don’t do that.” Russell shook his head. “Keep those thoughts to yourself. I have one thing I tell every doctor who comes through my door: the family is saddled with the burden of guilt. Nobody needs a psychiatrist who’s saddled with it too.” He checked his watch and tucked in his chin. “Any other questions?”
“I don’t think so.” Kate glanced over at James, who shook his head.
“Good.” His smile was more of a wince. “Let me know when Risk Management gets in touch, and we’ll set up a meeting.”
They all stood up at once.
“Appreciate your help.” James gave him a hearty handshake.
“Nice to meet you both,” Russell said warmly, shaking Kate’s hand.
She smiled gratefully at him. “I feel much better now.”
“No worries. I got your back.”
6
THE ELEVATOR RIDE DOWN to the garage seemed to take forever. They waited an eternity for the valet to get their car.
“Where do you want to eat?” James asked.
“There’s stuff in the fridge,” Kate said, putting on her gloves.
“Okay, listen. After lunch, I’d like to do some role-playing for the Risk Management interview.”
“Seriously? Role-playing?”
“You can’t just wing it. Remember what Russell said. You have to choose your words carefully.”
She shrugged indifferently. “I’d rather go back to work.”
“There’s no more work today. You’re exhausted. I’m exhausted. We were supposed to be in Sedona right now, remember? We’re going home.”
“I’m just saying… it would be nice to keep busy,” Kate objected weakly.
“Nobody’s putting any pressure on you to go back to work but you.”
“Okay, but don’t expect me to be happy about it.”
“I get that. But I’m in charge today. For your own good.”
The car’s heater blew hot air around their ankles as they headed back into Cambridge. It was snowing again. The windshield wipers swept away fat white flakes that landed with stunning clarity on the glass. They drove past the frozen river, while flurries blurred the road ahead. She shivered, cold as marble beneath her winter coat.
All of a sudden, a dark blue sedan in the passing lane veered in front of them and decelerated rapidly. James hit the brakes in order to avoid a collision, and the Lexus skidded across the road, sliding toward the guardrail before coming to an abrupt halt in the emergency lane. “Fuck!” he cried, as their heads jerked forward and their seatbelts took the strain. Kate bit her tongue and could taste warm blood in her mouth.
“Did you see that asshole?” James said through gritted teeth, flashing his emergency blinkers. The blue sedan took the next exit and disappeared into the flurries ahead. “That idiot cut me off. He could’ve killed us! I’m amazed the airbags didn’t deploy.” He looked at her and blinked, climbing down from the dizzying heights of his outrage. “Kate? Your lip is bleeding. Kate?”
She heard a flapping sound and realized it was her wildly beating heart. She saw something strange move toward them through the snow, something odd and whimsical, like a seahorse bobbing around inside an aquarium. It was a little girl. This shocked her so much, she unfastened her seatbelt and got out of the car.
“Where are you going?” James cried out. “Get back in the car!”
Kate stood by the side of the road, staring into the snowstorm, clumpy flakes sticking to her face and hair. She gazed at the falling snow and whispered, “Savannah?” Snow swirled in the wind, creating new shapes, and Kate had the sensation that she was being warned. Danger ahead.
“Kate?” James shouted.
Her head was spinning. Her skull throbbed. Was she having a stroke? In the blink of an eye, the illusion was gone.
He got out of the Lexus and strode through the driving snow. “This is dangerous. What are you doing?”
“I just saw something.”
“What?”
She balked. She could tell by the set of his jaw that he was beginning to lose confidence in her. That he was becoming afraid for her.
“What did you see?” He gestured wildly into the snowstorm. “There’s nothing out there.”
“My head is pounding.”
“We’ve both had an incredibly stressful day. Let’s go home.” He tried to take her by the elbow, but she brushed him away. “Kate… please.”
Back in the Lexus, he watched for oncoming traffic as he pulled out onto the road, while Kate stared at the frozen river, little vortices of snow curling off its surface. She rubbed her temples.
He shot her a concerned look. “Are you getting a migraine?”
“I think so.”
She got them about twice a year. Sometimes the pain was so bad she had to lie down for twenty-four hours. Her stomach was doing somersaults. “Today totally sucked.”
He nodded solemnly but couldn’t help himself. In typical James fashion, he burst out laughing. Soon they were both laughing. It was the kind of sick humor that grabbed you and shook you and wouldn’t let go. She laughed so hard, her stomach hurt. Her temples were throbbing.
“Everything’s going to be okay,” he said with tears in his eyes.
“Just get us home in one piece, you jerk.”
7
THE GARGOYLES LOOKED OMINOUS in the snowstorm. They crouched in the corners of the building, as if ready to pounce on unsuspecting passersby. The lobby seemed much less elegant than it had last night. Kate and James weren’t laughing anymore. And they didn’t feel like fooling around.
Their front door stuck a little as James pushed it open. Kate entered the high-ceilinged living room and collapsed on the sofa.
“Coffee?” he asked from the kitchen.
“Is there any wine left?”
“Just Heineken. Want me to go get some?”
“No, babe. Stay with me,” she pleaded.
He came into the living room and handed her two Aleves with a bottled water. “Here, take this,” he said gently. He sat down beside her, ready to comfort her, but suddenly she couldn’t stand his sympathy anymore and got up and padded around the living room in her stockinged feet, feeling claustrophobic. Sh
e wanted to hit something.
It had stopped snowing outside. According to the weather report, the cloud cover would burn off by mid-afternoon, but Kate didn’t want the sun to come out. She preferred the blanketing gloom of winter. She wanted to curl into a hibernating ball without having to explain herself.
She stood in front of the bay windows overlooking Massachusetts Avenue and watched the traffic as it whooshed past in slow motion. Another effect of the migraine. She crawled into James’s lap and closed her eyes.
“Today was bad, but I’ll get past it… and I’ll be stronger because of it.”
“That’s my girl.” He kissed her forehead and stroked her hair, and her greasy chignon fell apart beneath his fingers.
She took a deep breath and sighed. “I’m afraid to tell you what I saw.”
“I’m not going to judge you, babe.”
“I saw my sister, coming toward me through the snow… trying to warn me.”
“A visual hallucination from the migraine.”
“That’s what I figured.”
“Combined with snow flurries playing tricks on the eyes. Combined with a near-collision on the road. Combined with a sleepless night…”
“Gotcha.”
“You haven’t had nightmares about Savannah in a long time. You’re under a lot of stress right now and Nikki’s death came as a terrible shock. It’s pretty obvious that stirred everything up.”
“So I’m not crazy?”
“No, and I should know. I’ve got an MD after my name and everything.”
She smiled through the pain.
“Hey, I have an idea. After the funeral, let’s take a few days off and head down to the Cape.”
She rolled her eyes. “I can’t go anywhere yet. There’s the Risk Management interview.”
“Okay.”
“And what if Nikki’s parents file a lawsuit?”
“Let the hospital handle that.”
“Anyway, I won’t be able to relax until everything’s settled down. I’m sorry we lost our deposit, James. But I’m going back to work. I can’t leave right now.”
He frowned. “Listen, sweetie, you’re a dedicated doctor, and I love that about you. But even superheroes have their limits, right? You’ve been up all night. You’re under an enormous amount of strain. It’s no surprise you’re seeing things, because at some point the dam is going to burst and—”
A Breath After Drowning Page 4