“What was her mental state before her death?”
“She was doing very well, like I said. She wasn’t acting out or skipping school. She hadn’t reported any suicidal urges for months. She wasn’t giving away any of her personal possessions, except… well, that’s not important.” Kate caught Russell’s wince in her peripheral vision. Don’t volunteer unnecessary information.
“Let me be the judge of that,” Felicia said.
“She gave me a few things she’d found at the beach,” Kate explained. “I had to remind her, we can’t accept gifts from our patients. Hospital policy.”
“I see. What sort of things?”
“Just a…” How did you explain a skirt weight? “A few seashells,” Kate lied.
“And how was her family situation?”
“She and her mother were still arguing quite a bit,” Kate said. “Nikki thought her stepfather was too controlling. However, she was learning to communicate her needs and concerns to them.”
“Were there any other suicide attempts in her past?”
“Just the one that brought her to us to begin with.”
“I see. And what was the method?”
“She overdosed on aspirin.”
“And more recently, was she drinking alcohol or taking drugs?”
“I’m confident she was no longer doing drugs. However, it’s possible she wasn’t entirely forthcoming about her alcohol intake.”
“Okay. But did she display any of the symptoms of addiction?”
“None whatsoever.”
“Any history of mental illness in the family?”
“Not according to her mother.”
“Did she have any phobias?”
“Just that she was afraid of people’s tongues.”
“People’s tongues?”
Kate nodded. “The tips of people’s tongues bothered her. Also, she was afraid of the plumbing… old pipes in the house, the noises they made at night.”
“In your opinion, did this constitute cause for concern?”
“No. A lot of people have strange phobias. Those were separate issues from her main illness, which was bipolar disorder.”
They talked about medication and discussed Nikki’s state of mind during her last session with Kate. Felicia spoke in a monotone, conferring little emotion one way or another. Finally, she concluded the interview by saying, “Is there anything else you’d like to add?”
“Only that I consulted with my supervisor on the case. Dr. Ira Lippencott.”
Felicia nodded politely. “Thanks for your cooperation, Dr. Wolfe.” She packed up her briefcase and stood up. “You’ll be hearing from us in a few weeks. In the meantime, here’s my card.”
“We’ll call you if we have any questions, Miss Hamilton,” Russell said. As soon as the door closed behind her, he turned to Kate. “You handled that very well.”
She excused herself and rushed to the bathroom. She fought off a wave of disorientation as she studied her face in the mirror. She could feel the strain accumulating behind her eyes. She splashed cold water on her face and grabbed a paper towel. She hated her own vulnerability.
In psychiatry, a person’s core vulnerability was the emotional state that was most terrifying for them—fear of harm, fear of shame, fear of isolation. Kate’s was her sense of failure at not being able to help her sister, and by proxy, her young patients. It kept her working long hours. It made her struggle to become a better doctor. She had failed to protect Nikki. She would not fail again.
14
KATE FOUND MADDIE WARD alone in her room.
“Good morning,” she said. “How are you feeling?”
The girl rubbed her tired eyes. “Okay, I guess.”
“Your tests all came back negative. Which is a good thing.”
“Why is negative good?”
“It means we can rule out brain injury or other neurological causes.” She didn’t add that they still had to find out where the aural hallucinations were coming from, why Maddie was cutting and biting herself, and what combination of family dysfunction, psychological factors and chemical imbalance was causing her depression. “How do you feel in general?”
Maddie shrugged listlessly. “I don’t know.”
“Been a rough couple of days, huh?”
This morning, she looked different—older. More like a fourteen-year-old, and less like a twelve-year-old. The nurses had confiscated her gold stud earrings, leaving little holes in her earlobes. Her long blond hair was out of its ponytail and fell across her shoulders in swirly loops. She sat cross-legged on the hospital bed and gazed forlornly out the window. Her eyes had grown-up sorrows in them. Usually, when you walked through a psych ward during visiting hours, the rooms would be packed with family members bearing gifts. But Maddie Ward had been alone for forty-eight hours. No cards. No flowers. No phone calls. No visitors. That in itself constituted neglect, in Kate’s mind.
“Have you been getting along with your roommate?”
“Yeah.”
The roommate’s bed was made. She was probably in the day room. A sixteen-year-old anorexic—one of their frequent fliers.
“Is everything else okay?” Kate asked, nudging her into the conversation.
Maddie’s eyes grew soft and fragile, and suddenly the little girl re-emerged. “Is she a suicide risk like me?”
“Who? Your roommate?”
“Is that why they keep checking on us?”
“The nurses just want to make sure you’re safe.”
Maddie’s mood shifted. “They don’t know what they’re dealing with,” she said darkly.
Red flags popped up all over the place. It was such an adult thing to say. “What do you mean? What are they dealing with?”
“They’re having a fight over my soul,” Maddie whispered conspiratorially.
“Who?”
“My parents.”
“Are you talking about the Devil? Possession?”
Maddie gazed out the window and didn’t answer.
Kate pulled up a chair and took a seat. “Maddie, does your father have a work number where he can be reached?”
A head shake. “We’re not supposed to call him at work.”
“I see. Then how do you contact him in case of an emergency?”
Maddie shrugged. “I don’t know.”
Taking a different tack, Kate took a pack of chewing gum out of her pocket. “Would you like a piece? It’s spearmint.”
Maddie grinned. “Thanks.”
Kate handed her a stick of gum and watched as she unwrapped it and folded it into her mouth. Maddie drew her knees toward her chest and chewed contentedly, the smell of spearmint wafting Kate’s way.
She tried again. “If there was an emergency at school, and your mother wasn’t available, who would the principal call? Do you have any relatives nearby? Any aunts or uncles? Cousins or grandparents?”
“Nope.”
“Nobody?”
She shook her head.
“What if the school had to reach your dad in case of an emergency?”
“Calling him wouldn’t stop me,” Maddie said harshly.
Kate paused. “What do you mean?”
“When I say I want to kill myself, I mean it.”
Most fourteen-year-olds couldn’t articulate their alienation like this, let alone admit to suicidal tendencies. “Why would you want to kill yourself?”
“I don’t know.”
“Does the voice inside your head tell you to kill yourself?”
Maddie stopped chewing.
“When your father gets angry, does he ever hurt you or your mom?”
“Why do you keep asking me that?”
“Because you haven’t answered the question yet.”
The girl’s face reddened. She studied Kate as if she were the enemy—and perhaps she was. “Once, when I wouldn’t stop bugging him, he pushed me.”
“What were you bugging him about?” Kate asked.
“Stuff.”
“What kind of stuff?”
Maddie shrugged noncommittally. “Sometimes I feel like bugging him.”
“And he shoves you away?”
“Only because I annoy him. Like this.” She nudged Kate gently.
“No harder than that?”
“No.”
“More than once?”
“I told you!” Maddie’s face darkened. Her eyes watered.
“Are you sure?”
“Why do you keep asking me that?” Bright tears spilled down her cheeks.
“Sorry,” Kate backtracked. “I didn’t mean to upset you.”
Maddie wiped her wet face.
“Is he religious?” Kate pressed.
The girl sighed. “I dunno.”
“Is your mother religious?”
She sniffled, and Kate handed her a box of Kleenex. “She’s Catholic. She believes in God. She believes in Jesus and the Holy Ghost and the Devil and hell and curses. Daddy doesn’t.”
“What do you believe in, Maddie? Do you believe in the Devil?”
Maddie’s eyes widened. She stared at Kate with growing anguish. “Mommy says she went to school with you, a long time ago, and one day your sister disappeared, and the whole town went looking for her, but then when they finally found her, she was dead. Buried alive.”
Kate’s heart skipped a beat.
“Mommy says that’s what happens to bad little girls. They get killed.”
Kate sat in troubled silence, leaping back in time. She had been sixteen when Savannah disappeared, and Penny had been eighteen, a senior in high school. Kate barely remembered the shy, awkward, blond-haired girl who kept mostly to herself. A shrinking violet nobody thought much about, truth be told, until her uncle’s trial, when she was suddenly everywhere—on TV, on the Internet, in the newspapers. Penny was the state’s star witness and had put Blackwood in prison, but you could tell she hated the limelight. When the cameras were on her, Penny would duck her head and raise her hands in front of her face.
“What else did your mother tell you?”
Kate asked. Maddie frowned. “She says you can fix me.”
“Is that all?”
A shrug.
“You just said you didn’t have any relatives. Did you forget about your mother’s uncle? Henry Blackwood?”
Maddie flinched. “He’s in prison.”
“Do you know why?”
“No.”
“Are you sure?”
The girl was becoming evasive—probably trying to protect her mother from Kate’s scrutiny.
“What else did she say about me?” Kate persisted. “Besides the fact that my sister was killed, and we went to the same school together?”
Maddie gave her a worried look. “Are you mad at me?”
“No.”
“But your face is red.”
Kate drew a breath. “I’m just surprised, that’s all. I was heartbroken when I lost my sister, and it’s still very painful for me.”
Maddie nodded solemnly. An empathetic warmth suffused her cheeks.
Kate experienced a creeping paranoia, but she would have to check her anger and confusion at the door and deal with it later. “Okay,” she said. “Let’s back up a minute. I have a few more questions about the voice. When did you start hearing it?”
Maddie sighed. “I don’t remember. A long time ago.”
“What’s the worst thing it ever said to you?”
“Jump out a window.”
“It told you to jump out a window?”
“I was upstairs in the attic, and it said, Do it. And I knew what it meant, because I jumped out the window.”
Bad news. This was a clear sign of psychosis, a voice demanding that its host do something terrible and the host complying. “When was this?”
“I was eight years old.”
Kate cocked her head. “But weren’t you eight when you fell out of a tree?”
“No. I jumped out a window and hit the tree on the way down.”
“So you didn’t really fall out of a tree?”
“No.”
“Did anybody push you out of that window?”
Maddie made a face. “The voice said do it. So I did it.”
“Can you hear the voice now?”
She paused for a moment, then shook her head.
“How would you describe your relationship with your mother and father?”
The girl eyed her suspiciously.
“Just say whatever pops into your head.”
“They’re afraid of me.”
“Why?”
“They don’t understand me.”
“And how does that fear manifest itself? What do they do?” Besides—Kate thought sarcastically—drape you in rosaries and drop you off at some faraway hospital, and then scurry home.
“Mommy prays all the time.”
“What does she pray for?”
“For me to get better.”
“Does she believe in possession?”
“That’s sort of an understatement.”
Another oddly adult response from a child-like teenager.
“Does she think you’re possessed?” Kate asked.
“She doesn’t talk about it much.”
“Why not?”
“My dad told her not to.”
“So your father doesn’t want her saying you’re possessed?”
“Once, she said there was a demon inside me, and he hit her.”
At last. “He did?”
“He slapped her across the face.”
“Just once? Or more than once?”
“Like this.” She demonstrated by slapping the air.
“And what about you, Maddie? Has your father ever slapped you?”
“No.” Defensive posture.
“Are you sure?”
“I probably deserved it,” she blurted out.
“But you just said he didn’t hit you.”
“Sometimes I make stuff up,” Maddie admitted.
Uh-oh. That put a new wrinkle into the mix. But psychosis and lying weren’t mutually exclusive. Abused children sometimes lied to cover up their parents’ sins, making it difficult to untangle the truth from delusion and flat-out falsehoods.
“He hit you? Why? What happened? What were the circumstances?”
“I told him something he didn’t want to hear.”
“What was that?”
“I can’t remember.”
“Try.”
“Stop asking! They love me.”
“I’m sure they do,” Kate acceded.
“They’re just messed up.” The girl’s voice grew high and tight. “They love me.”
“Does your father—”
“My stepfather,” Maddie snapped.
“Oh. He’s your stepfather?”
Maddie nodded, her gaze fixed on the view beyond the window.
“I didn’t realize…”
“My real father’s dead.”
“Sorry.”
“Don’t be.”
Kate frowned. “I’m going to ask your parents to come visit you today.”
“Good luck with that.”
Another strange response.
“Why do you say that?” When Maddie didn’t answer, Kate said, “I haven’t been able to reach them at home. Is there another number where they can be contacted?”
Maddie shook her head wildly. “Mommy doesn’t like cell phones. She says the government could be listening in.”
“Listening in?”
“I’m tired of talking.”
“Okay. Well, hopefully they’ll come visit you today.”
Kate knew that her questions were becoming increasingly intrusive, and it was obvious that Maddie needed some space. She walked out of the room and stood in the hallway, while keeping one eye on her troubled patient through the open doorway. She called the Wards at home again. This time their machine picked up and Kate left a brief message.
She had only looked away for a second, but
when she glanced back into the room, Maddie was banging her fists on the window, attempting to break the glass.
Kate hurried back in and grasped Maddie by the arms. “Shh, it’s okay.” This was a setback. Clearly Maddie could no longer be left alone. Not even for an instant.
15
KATE WENT UPSTAIRS TO the Adult Psychiatric Intensive Care Unit to talk to James. He was finishing off a group therapy session, sitting in a circle with twelve patients in the day room. James’s most difficult charge, Agatha, stood in the center of the group, making the thin, depleted wail of a cat in heat. Her arms shimmied in a sort of dance. She tried to explain herself, but only seemed capable of producing streaky, mascara-laced tears.
Kate hung back and waited. Rumpled, out-of-date magazines were strewn around the lounge. Every inch of upholstery was coffee-stained, and the ugly wallpaper looked like a Rorschach test.
A few minutes later, group was over, the participants gazing at one another with cloudy, abnormal eyes before shuffling away. James came over to Kate and said, “I have a mega-headache. Let’s go.”
They went downstairs to the cafeteria, which smelled of fried onion rings and warmed-over meatloaf. Attending physicians, residents, visiting scholars and other hospital staff rotated through, loading up their trays with additive-laden pre-packaged food, while smokers got their fix out on the terrace.
James popped a couple of Excedrins and swiped two trays for them. He handed Kate one and ordered a cheeseburger, fries and an iced tea. She got a cup of coffee and a sorry-looking slice of apple pie, and they found a table in back next to the recycling bins. A pungent smell wafted toward them, turning her stomach. She watched James bite into his cheeseburger and sop up the grease with a bunch of napkins, undeterred by the funky odor.
“How’s it going with your new patient?” James asked.
“I’m very concerned about her environment. Maddie gave me conflicting stories, but I’m leaning toward a potentially abusive stepfather, which would explain her mother’s demeanor the other day. I’ve been trying to reach her—Nelly, I mean—but she’s not returning my phone calls. She doesn’t have a cell phone, apparently, so I’m thinking of driving up there this afternoon. Get to the bottom of things.”
“Right, like why she picked you, of all people, to treat her child.”
“And why she didn’t mention the fact we went to school together. Or who her damn uncle is.”
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