“Deep breaths.”
Kate drew back. “Deep breaths?”
“You sound upset.”
“I am upset.”
Some of the patients turned to stare.
“Come over here,” he whispered, escorting her into the farthest corner of the room. “Sorry, but you need to calm down. You’re under a lot of pressure right now, and this isn’t helping.”
“I’m having a perfectly normal reaction to a very creepy encounter.”
He studied her with sympathy. “The world is full of whackos, Kate. We both know that. Maybe it wasn’t intentionally creepy? Maybe it’s more innocent than creepy? I mean, your reputation precedes you. It’s not every day one of us gets an APA award. Penny… Nelly… whatever her name is… she probably read the Globe article about you and remembered who you were from school. And now she’s got a very sick kid of her own who needs a good female psychiatrist and she’s desperate… and she thinks, okay, I’m going to take my child to see this person. Is that so far-fetched? So she drops off her mentally ill daughter at the hospital where you work because she read an article that said you get great results.”
“If that’s true, then why all the secrecy? Why not tell me?”
“Maybe she was afraid you wouldn’t treat her daughter if you knew the truth?”
Kate frowned. “I probably wouldn’t.”
“There. See? That’s why she didn’t say anything.”
Kate fell silent.
He took her hand. “You’re still wearing my ring, I see.”
“I haven’t had time to think about whether it itches or not.”
He smirked. “Maybe if we called it an engagement ring.”
“Are you trying to piss me off?”
“No, I’ve fulfilled my quota today.” There it was again— that crooked-ass grin of his, the one thing that never failed to lift her spirits. “Life has a funny way of fucking with us, Kate.”
“So I’m fucked? Is that what you’re saying?”
“No, silly. We’re both fucked.”
She cracked a smile. “Shut up.”
“Inject some irony into your veins, quick.”
“Shut up, you dork.”
“You can abuse me all you want. Go ahead. I can take it.”
“Asshole.”
“There. Better now?”
“Yes. Actually.”
“You’re welcome. Just take it in stride, okay?” He caressed her cheek. “Be my hero, Kate. I need you to be strong for me.”
“Yeah, I’m fucking Lara Croft.”
“You are Lara Croft. Which means that I’m fucking Lara Croft.”
“Ha. My boyfriend is hilarious.”
“See you tonight, babe.” He gave her a fist bump.
She paused. “I’ve got to get Maddie admitted, so I may be a little late.”
He smiled cynically at her. “A little, huh? I’ve heard that song before.”
“Okay. Maybe a lot late.” When he didn’t respond, she said, “Hey, this is what we both signed up for, isn’t it?”
He nodded. “Not to worry. Just take care of yourself, Kate.”
“I’ll call you later, babe.”
11
KATE SPENT THE REST of that afternoon and evening with Maddie Ward, who turned out to be fourteen, and not twelve, as Kate had assumed. Maddie came across as very childlike for a fourteen-year-old, which alarmed Kate and sent up a red flag. Delayed puberty was fairly common, with plenty of causes: genetic, hormonal, environmental. Sometimes a child’s growth spurts occurred on the outer edges of her teenage years, but Maddie was small for her age, without any of the precociousness of a typical teenager; she hadn’t even begun menstruating, and her immaturity could be a symptom of serious abuse.
They’d taken away Maddie’s pink blouse and jeans, her backpack and goose down jacket, and now she wore the pajamas her mother had dropped off in the rumpled grocery bag, along with a pair of grippy hospital socks from her “welcome” bag. The nurses let her choose the color, and Maddie had picked bubblegum pink.
She sat in an adult-sized wheelchair, looking orphaned, while various hospital personnel came and went, wheeling her from one department to another, monitoring her vitals, scanning her insides and running a bunch of tests to see if there was anything physically wrong with her.
Once in a while, Kate would step out into the hallway and try reaching the Wards on their landline, but they weren’t picking up. They must’ve unplugged their answering machine, too, because she couldn’t even leave a message.
The hospital’s forensic psychiatrist photographed all the scars and scabs on Maddie’s body and went away to make a professional assessment, while Kate called up the electronic medical records on her laptop and read through the doctors’ notes and diagnoses in order to piece together a medical history—childhood illnesses, physical injuries, drug interactions. She was looking for a pattern of abuse and neglect.
She didn’t find much. There was a broken finger at age five, when Maddie “accidentally” caught her hand in a car door. There were two fractured ribs and a concussion at age eight, when she “fell out of a tree” in her backyard. There were minor sprains and injuries at school, but no history of cigarette burns or choke marks, no signs of malnutrition. The most troubling aspect for Kate was the lack of regular doctor’s visits, just a handful of emergency room visits and a string of psychiatric consultations. This wouldn’t have been unusual if the parents didn’t have health insurance, but the Wards were adequately covered. Most parents rushed their kids to the doctor at the first signs of a sniffle. Not the Wards. That alone was highly suspicious. Maddie was generally healthy, but she was definitely not okay.
After a hearty meal in the cafeteria, Kate’s patient was looking better. Her eyes were clear. Her cheeks were rosy. She’d perked up a little. Kate wheeled her over to Radiology to have X-rays taken of her bones, since any fractures, fresh or healed over, could provide evidence of abuse in the home. Abused children had a tendency to protect their parents—sometimes out of love, sometimes out of fear.
In between each intrusive medical procedure, Kate plied her patient with questions in order to get past her built-in apprehension. While they waited for the X-ray tech to arrive, Kate said, “I had a favorite tree I used to climb in our backyard. This huge old oak. I’d always climb as high as I could, because… from way up there, life didn’t seem as daunting.”
Maddie smiled. “I fell out of a tree once. It really hurt.”
Kate nodded. Such a childlike way of speaking.
“I had to go to the emergency room.”
“When was this?”
“I was eight. I hit a branch on the way down and broke my ribs.”
Kate winced. “Ouch.”
“I had to stay in the hospital overnight.”
“Do you know why you’re in the hospital now?”
Maddie shrugged. “Because I’m sick in the head?”
“We’re trying to figure out what’s going on.” Kate reached for the girl’s forehead to brush away a few stray hairs, and Maddie flinched. That flinch told her a lot. “Sorry. I didn’t mean to startle you.”
“You didn’t,” she said defensively, playing with her ponytail.
“What does your father do, Maddie?”
“He drives a truck. He’s gone a lot.”
Maddie’s demeanor was that of a ten-year-old, both emotionally and mentally, and Kate was deeply concerned. “But he’s home now, right?” she asked.
“Not for a few more days.”
“Oh. Really?” Nelly had told her that Mr. Ward was resting at home. “Are you sure about that?”
Maddie nodded.
Kate decided to drop it for now. “So it’s just you and your mom and dad at home? Any brothers or sisters?”
“Nope. Just me.”
“Do you have any pets? A dog maybe?”
She shook her head. “We had a hamster at school once.”
“Yeah?” Kate smiled. “I had
a hamster. I called him Felipe.”
Maddie giggled. “Ours was called Snark.”
“Snark the Snarky School Hamster?”
Maddie had a ticklish laugh.
“Did you ever wish you had any brothers or sisters?”
“Uh huh. But Mommy says I’m a handful.”
“I see.”
Mommy? Most fourteen-year-olds called their parents Mom and Dad.
“My best friend has two brothers and three sisters.”
“Wow, that’s a full house. Who’s your best friend?”
“Melissa.”
“What’s the one thing you like most about Melissa?”
Maddie thought for a moment. “Her family.”
“What about them?”
“They’re nice.”
“Nice as in… what exactly?”
Maddie bit her lip before elaborating. “They don’t fight. They laugh a lot. They play practical jokes all the time, and it’s funny. And they have fried chicken for dinner and chocolate ice cream for dessert.”
“Wow, that’s cool.”
Maddie giggled. “It’s really cool.”
Kate seized the opportunity to wade into forbidden territory. “Do your parents fight a lot?”
“Sort of.”
“Does it make you uncomfortable when they fight?”
Maddie nodded, eyes downcast.
“Do they scream? Shout? What?”
“There’s lots of shouting.”
“Anything else?”
Maddie didn’t answer.
“Pushing and shoving?”
“Sometimes.” She peered at Kate through her long eyelashes. “Daddy pushes Mommy sometimes. Especially when she calls him a loser.”
“Does he ever hurt her?”
“No.” Denial.
“Are you sure?”
“I don’t know.” Hesitation.
“Does he ever shove you? Shout at you?”
“Maybe.” Semi-confession.
Next came the big question. It was like crossing a psychological landmine. “Does your father ever hit you, Maddie?”
She paused for a few seconds. “I have to go to the bathroom,” she said finally.
“Okay. I’ll get the nurses’ aide.”
Susie Potts was on duty tonight, a twenty-five-year-old so perky and sweet her personality oozed out of her like raspberry pie filling. She reached for Maddie’s hand and said, “Hey, bunny. Escort time. Gotta pee? Let’s go.”
Maddie wasn’t allowed to use the restroom without a chaperone, since she was on suicide watch. Susie, although often distracted, was a natural, entertaining the children with shadow-puppets and telling funny stories. Whereas Kate had the burden of getting to the truth.
When Maddie returned from the restroom, she was much less responsive to Kate’s questions. It must’ve been the last one that shut her down. Does he hit you? Perhaps a bridge too far.
Maddie squirmed and complained about the hospital wheelchair being uncomfortable. Kate cancelled the final test, sent Susie back to the break room and wheeled Maddie past the nurses’ station, where the night staff sat gossiping, their whispered conversations sprinkled with juicy exclamation points.
Maddie’s assigned room was at the end of the corridor, where another young patient was sound asleep. It was eleven o’clock, and after such a long day of being poked and probed, Maddie finally lost it and became inconsolable. “I want to go home,” she sobbed. “Where’s Mommy? I want to go home!”
Kate tried to comfort her as best she could, but the girl had reached her breaking point. Maddie’s roommate woke up and complained about the noise. Kate authorized a sedative, and one of the night nurses came into the room with a loaded needle and plunged the syringe into Maddie’s backside. Meanwhile, Kate gave Maddie a running commentary, explaining what was going on every step of the way: why she’d decided to give Maddie a sedative; what her mother had said about Maddie needing help; why Kate was so concerned about her self-inflicted injuries; and what they were attempting to do, the entire hospital staff—trying to help her.
Maddie grew lethargic as the meds took effect. She could barely speak or move. At least she was no longer upset—the poor kid didn’t have any energy left for that. Her pupils were the size of pinpricks. It bothered Kate a great deal, but after years of experience, she knew that it was for the best. Finally, Maddie closed her eyes and drifted off to sleep.
Out in the hallway, Kate tried to reach Nelly again, but the phone rang and rang into a non-compliant void.
She monitored Maddie for the rest of the night and consulted with various specialists on her test results. There were some old callus-formation fractures on Maddie’s ribs that corresponded with the report that she’d fallen out of a tree—however, it didn’t rule out physical abuse. The bite marks on the child’s forearms were determined to be her own, when measured against the dental imprints of her teeth. The scabs and scars on her arms, thighs and calves were superficial and probably self-inflicted, since there were no injuries anywhere on her body that the patient couldn’t reach on her own. That didn’t preclude abuse, but it went a long way towards discounting it. Most significant of all, there was no evidence of vaginal trauma or sexual abuse. Thank God for that, Kate thought.
Exhausted but satisfied she’d gotten Maddie safely admitted, Kate put Susie in charge of keeping an eye on the girl and went upstairs to her office to type up her notes. As dawn approached, she went back downstairs, dismissed the tired-looking aide, and watched the horizon turn from pink to ruby red in a few spectacular minutes.
She returned to Maddie’s room to check on her patient. Kate studied the swollen veins on the girl’s forehead and wondered what could have driven the child to cut and bite herself. Given Penny Ward’s troubled history, perhaps it wasn’t such a leap. Besides hearing a single voice inside her head, there were no overt signs of schizophrenia—no visual hallucinations, no flat affect, no odd or eccentric behavior, no grooming issues. But schizophrenia wasn’t the only option. A self-harmer could be diagnosed with personality disorder, bipolar disorder, anxiety disorder, or any other number of syndromes. Kate would have to search for a deeper meaning other than disease or chemical imbalance. She wanted to know why Maddie Ward was here and what her parents might’ve done to her.
Around 6 AM, Maddie woke up.
“How are you feeling?” Kate asked. She’d been answering her emails on her iPhone, and her head was buzzing from overwork and lack of sleep.
The girl snuggled deeper into her blankets. “Semi-weird.”
“Hm. That’s a good one.” Kate smiled. “I’m feeling semi-weird myself. Any numbness? Tingling?”
“No.”
“Sorry about the tests. And the shot.”
Maddie scrunched her nose. “You say you’re sorry a lot.”
“I do?” Kate made a face. “Gee, I’m sorry about that.”
Maddie giggled. “So sorry for being so sorry all the time.”
“Awfully sorry for all my sorries.”
They both laughed.
Then Maddie asked, “What’s wrong with me?”
“That’s what we’re trying to figure out.”
“Will I be okay?”
“I believe so, yes,” Kate said confidently.
The girl closed her eyes and was asleep within minutes.
Soon the morning aide, Claire, was back, looking fresh as a daisy, and Kate had a craving for nicotine that she wisely ignored. She decided to get a cup of coffee instead and bumped into Ira in the break room.
“Jeez Louise,” he exclaimed. “You look terrible.”
“Thanks a lot.”
“Come into my office for a second.”
A wash of morning light poured in through the hermetically sealed windows. Ira took a seat behind his desk, while outside a snowplow dragged its blade across the courtyard with a scraping sound.
“What’s going on? I thought you were taking a few days off?”
“I’ve been up a
ll night with a new patient, Maddie Ward. Her mother dropped her off yesterday and abandoned her, literally draping her in crucifixes and rosaries. She’s fourteen years old, but she acts much younger, more like a ten-year-old. She’s been having aural hallucinations, and her mother thinks she’s possessed.”
“No kidding?” His eyes widened with interest. “Are they religious fanatics?”
“I don’t know. Possibly. Anyway, her mother refused to come into the hospital. She signed the paperwork in the parking garage yesterday and drove away.” Kate decided not to mention her personal connection to Nelly, not just yet. It would only complicate things, and besides, she wanted to do a little more digging into the matter on her own.
“I’ve got news for you, Kate,” Ira said. “You can’t be a doctor twenty-four-seven. You just lost a good night’s sleep, right when you needed it the most. So what gives?”
“I couldn’t bear the thought of her spending last night in the hospital alone,” Kate confessed. “I suspect there’s abuse in the home. Maddie’s father. No conclusive proof yet. Just a gut feeling.”
“Since when are you a mother substitute? You can’t blur the lines, Kate. This isn’t about you. It’s not about appeasing your guilt for something you may or may not have done sixteen years ago.”
Kate lowered her gaze and stared at her hands. “Wow, Ira. Don’t hold back.”
“You know me, Kate. I tell it like it is.”
Her cheeks flushed. She looked at him. “This has nothing to do with sixteen years ago. Okay? And you’re right, I am a poor mother substitute. But at least I was there for Maddie when she woke up this morning. If she trusts me, maybe she’ll open up and tell me what the hell is going on.”
He grinned. “I like it when you defend yourself.”
“Was that a test?”
“Maybe.”
Kate scowled. “I’m not in the mood to be your guinea pig, Ira.”
He shrugged.
“Anyway, so far, it looks as if most of her wounds are self-inflicted, including the bite marks on her arms—they match her dental impressions.”
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