by Nate Kenyon
Soft and full lips, her best attribute. Her nose held the slightest bump on its ridge, the result of a childhood injury and the one thing about her face she’d always wanted to fix.
“Gives you character, girl,” her friend Charlie would say.
She scooped the cat up in her arms and breathed in his fine, soft hair. He purred, stretched, and jumped down. “So much for cuddling,” she said. “You just want me for my can opener anyway.”
Otto meowed accusingly at her. She had come home late; how dare she? Jess fixed a can of food for him and waited for her water to boil.
Her mind drifted back to Sarah. Something was not making sense. What she was supposedly dealing with here was a fragmentation of the thought process, where so many unrelated topics intruded on directed attention that the patient became overwhelmed and simply withdrew. Delusions of grandeur and auditory hallucinations were common.
But was that really what she had seen today? Sarah was immobile, seemingly unresponsive, but in the end she had moved, she had responded.
Jess crossed the room and removed Sarah’s file from her briefcase. She set it next to her cup on the little kitchen table, poured steaming water over her tea bag, added milk and sugar. Then she opened to the first photocopied page.
Height and weight had remained within normal range, if closer to the small end of the scale. No distinguishing marks except for a slight scar, approximately three centimeters, near the temple.
She was being examined on the recommendation of Dr. Jean Shelley. The specific reasons for the recommendation were not given. Jess was surprised to see Shelley also listed as court-appointed guardian.
This was followed by a battery of tests, many of them medical and focusing on brain function and brain wave activity. Each opinion was backed by a second and sometimes a third. But the physicians’ notes were lacking any real insight, and the entire section seemed fragmented. She flipped further, into psychological testing. They had tested Sarah at various age levels for motor skills and language and found her ahead of developmental stages. Detachment and marked withdrawal were noted, which indicated an absence of a familiar caregiver. Sarah showed unusual cognitive abilities for her age. The phrase “unusual cognitive abilities” was not defined.
What little schooling she had received was largely on a one-on-one basis. Still, Sarah had learned her alphabet quickly and read at a third grade level by the time she was seven. But almost from the beginning she had shown a lack of contact with reality, delusions of grandeur. These went beyond normal developmental stages. When she was just four years old she became convinced she could force open locked doors, simply by thinking about it. It was noted that, in fact, she did become quite proficient at breaking and entering. Several times they found her wandering around areas of the facility when she should have been confined to her room.
A year or two later she got suddenly worse. She believed she could read people’s thoughts. Sarah became violent with those who tried to restrain her during these fugues.
Bender, Children’s Depression Inventory, CMMS, Goodenough-Harris, all were given as the girl grew older. Apparently she had cooperated well enough for the tests. Wasserman’s notes (at least she assumed they were his) were scribbled in a hand so slanted and confused they were all but illegible. At least his handwriting is a mess. Perhaps his impeccably neat office was an attempt to hide a cluttered psyche. Jess felt as if she had just caught him with his pants down, and she smiled a secret smile.
And that was about all of it. She went back and looked for anything physically abnormal. Blood pressure was high, especially during morning and evening hours. Sarah’s CAT scan had shown some accelerated activity in the parietal lobe, but this did not seem to be substantiated on further trials.
Studying the file further, Jess was convinced there were missing sections. Where were the initial indications, problems, developmental abnormalities? Where were the extensive physical follow-ups, blood work, chemical screens? Where was the family history, the events of early infancy? Months were missing, whole blocks of time. Had nothing of interest happened, or had someone removed the record?
Feeling energized, Jess picked up the phone and dialed information. But when she obtained the number for the Wasserman Facility and finally got through, she was told Dr. Wasserman was not available.
She dialed information again. There were no listings for a Dr. Evan Wasserman in the immediate area.
Her tea was cold. Frustrated, she went to the window, and found herself beginning to drift. Outside, it had begun to drizzle, the streets stained dark, water reflecting the ripple of passing headlights.
She had been left hanging. She did not like to wait for anything. When she was little she was always grabbing things off the supermarket shelves, running off alone, driving her mother crazy. But then had come Michael, to draw the attention off her. When her brother was born they all knew something was wrong right away. He did not respond to them properly, did not play, did not cry, did not sleep at night. She became free to do what she wanted; Michael required constant supervision. Like her, he could and would do anything. But for him it was not a matter of choice.
Jess fought against the images from the past, and finally succumbed to them, images of pain and fear, and most of all, guilt. She listened to the soft patter on the roof and let them wash over her like rain.
Later Otto wandered over from his hiding place under the bed and curled up in her lap. She sat with him by the window and watched the trains go by.
—6—
At the Wasserman Facility, all of the rooms were dark, except one.
Evan Wasserman sat at his desk, listening to the sounds of his charges settling in for the night. These were familiar to him now. He often worked late, and sometimes stayed over on the army cot he kept in his closet. On these nights he left strict instructions for the overnight nurses that he was not to be disturbed unless it was an emergency.
His apartment was all the way in Newton and the traffic was murder. If it weren’t for the rumors among the staff, he might sleep here more often. It was easier that way; he didn’t have to make the drive in the morning, and there was no one to keep him at home.
Night sounds. Someone shuffling somewhere, an occasional shout, an incoherent cry. He swung around in his chair and looked out the window. Darkness outside, swarming at the glass. Beyond a certain length of manicured backyard stretched acres of wild, abandoned land. A series of crumbling brick buildings, part of the old Boston State Hospital, sat about half a mile away through the brush. All this unused acreage in the middle of the city, some would say it was a shame. But right now it gave him space to breathe. That space was under attack. There were two development proposals currently with the city, and if he wasn’t careful they would mean the end of his business.
He could not think clearly tonight. The uneasy feeling threatened to explode within him, and it kept him from his usual lists. Dr. Wasserman was a list man, everything neatly in its place, he would cross his tasks off with a freshly sharpened pencil when he had completed them, one by one. If something was not done on time he became very agitated. His grandfather had been like that too; during his early years he had often come across fragments of Grandfather’s paper that had been scratched and rewritten and worn clean through.
After his grandfather had passed away, his father had taken over the family business, but he was hopeless at it. Wasserman had spent many nights slipping through these very floors as a child, his father locked away in an office downstairs, diddling one of the nurses. When the sounds of their union grew to be too much to bear Evan would ride up the creaking elevator to these vast and then empty rooms, crumbling paint and chipped linoleum, footsteps echoing like the whispers of a ghostly companion. There were always interesting games to play, closets and more hidden spaces to explore. Every once in a while he would discover one of his grandfather’s lists, tucked away in the back of a drawer or cabinet like some sort of treasure map in code.
How he had loved
this place, even then. How he had hated his father for letting it fall to pieces. His father was not fit for the job; his grandfather’s death had forced the issue.
He wondered what his grandfather would think of all this now. The children’s welfare had been the most important thing to him. He was a much better man than me, Wasserman thought. I am putting them all at risk.
He wondered why he was so restless tonight. Perhaps it was the girl Jean had sent him. She was attractive, certainly, more attractive than most with her high cheekbones, raven-black hair, and determined mouth; a glow about her, a focused strength. She seemed very bright and capable. All this worried him very much. He picked up the phone and hit a number on his speed dial.
The phone was picked up on the fifth ring. There was a long moment of silence. “I’m sorry to bother you,” Wasserman said. “You weren’t sleeping? I didn’t wake you?”
“As a matter of fact, you did.”
“That girl, Jess Chambers. I don’t know that she’s right for this.”
“We’ve talked it to death, Evan. We’ve gone over it a thousand times. You know the odds, they’re worse than winning the lottery.”
“She’s headstrong, very pushy. She has a problem with authority. I don’t like her.”
“You don’t have to like her. It’s Sarah we’re concerned with. The bond will form, take my word for it. I think the first session went well.”
“She was agitated afterward. We had to sedate her again.”
“That’s a good sign. Look, you’ve been with this from the beginning. But if you want to throw in the towel, by all means, let me know. We can pull the plug right now. Just never mind what it would mean for your funding. I hate to be selfish, but you know what that will mean for me. It’s a death sentence, Evan.”
Wasserman clenched the phone. He fought his instant panic at the thought, and hated the way his voice sounded afterward. “Don’t say that. We’ll go on, of course we will. We’ll get things up and running again. I’m just concerned about introducing a new element into all this. I don’t want Chambers…testing me. And she’d better not talk to anyone.”
“It doesn’t matter. Nobody’s going to believe her.”
That was right, of course. He was a respected member of the APA, and no matter how unconventional his treatment, there would be nobody who would get through security to see it.
But there were countless other things to consider. The late-night hours invited so many insecurities. He worried about money-hungry developers trying to yank the land out from under him, or worse, putting a strip mall in his backyard. He worried about what he might have to do if their plans backfired. They were sitting on a time bomb, for God’s sake.
But most of all, he worried about losing the only person other than his grandfather who had ever meant anything to him.
He sighed. “I don’t have to tell you what could happen here if she loses control again.”
“We don’t have a choice. That’s a risk we have to take. Now stop worrying and get some sleep, please. You need to be fresh when Helix comes in for the next site visit. Impress them, or we’re both in trouble. You know what I mean, Evan.”
There was a long pause on both ends. need you, he thought, but didn’t say anything. Damn it, he was never able to say it.
Don’t even think about dying on me.
“Good night,” he said softly.
He hung up the phone and stared out at the murky night sky.
It was all true, of course; he needed to get his head together and prepare, or things would get bad very fast. He had worked very hard to regain the upper hand in this case, and he did not want to lose it now. The possibilities were far too frightening.
He thought about the Room upstairs, and his mind seemed to stretch and threaten to get away from him.
He set about making a list of the things they wanted to accomplish. The list was long. He scratched things out and started again, working silently in his office until it was far too late to go home. Began to imagine the girl housed somewhere below his feet. Just below his feet. Then he unfolded his bed from the closet and went to sleep with the lights still burning as a talisman against a deeper darkness.
—7—
In classes Jess felt as if she had been set adrift, awash in the steady drone of flat voices, the words in her textbooks failing to hold her interest. She was anxious to be doing something. The gaps in Sarah’s file bothered her terribly. Through all the reports there had been precious little psychiatric opinion. She had to have some more information before she met with Wasserman. She was determined never to allow him to have the same advantage over her again.
In her class on personality disorders, Professor Thomas singled her out to be his latest target. The little auditorium was filled with the rustling of papers as everyone tried desperately to look busy. They were trying to avoid “the stick,” a nickname students had for the wooden yardstick the professor used to point out offending members of his class. As far as anyone knew, he had yet to make physical contact with it; but nobody wanted to be the first.
Thomas was a very large black man in his sixties with a full head of gray hair, which most of his students assumed was a wig. He was also an expert on personality development, and he often traveled across the country to speak on the subject.
“Self-control,” Thomas said. “Is acting-out behavior ‘outgrown’?” He tapped the stick lightly on the back of an empty seat. “Miss Chambers? Do you feel that aggression is an inherent trait, or something that can be unlearned?”
“Kohn shows us a definite link between defiant behavior in preschoolers and subsequent aggression during adolescence. But not all of his subjects remained aggressive throughout their lives.”
“What is your personal opinion?”
“It’s a matter of degree. If we looked at the severity of the aggressive behavior, I think the data would hold up. The behavior has to fit into the parameters of the subject’s stage of development.”
“Example.”
“If a three-year-old is throwing temper tantrums, that’s normal for his age. If the tantrums involve beating another child senseless with a yardstick, that’s cause for concern.”
Snickers from several people in class. “All of you should stop laughing long enough to clear your ears,” Thomas said, pointing. The yardstick quivered in the air as if it were eager to strike. “Miss Chambers’s logic may seem obvious to you all, but she has just given us an excellent example of using what we have learned to form an opinion. A diagnosis and eventual treatment follows the same line of thought. Now, what would you do to diagnose the disorder in such a hypothetical?”
“It’s difficult to say without more information. Is the problem chemical? Biological? Environmental? I’d investigate a number of factors: abuse in the home, previous patterns of behavior, any relatives with overaggressive tendencies. Is he learning by example? Or are there other indicators of a chemical imbalance, previous head trauma, even possible brain damage?”
Thomas nodded. “Each case is unique,” he said. He let the yardstick touch to the floor, and it thumped. “It’s vital not to have any biases when you begin. You must weigh the evidence and eliminate possibilities, one by one.”
After class they stood below the semicircle of seats as students slowly filed out, a few of them staring curiously back like drivers past the scene of an accident.
“I want you to know that the yardstick comment did not go unnoticed,” Thomas said. “By the way, I never beat my students unless they truly deserve it.”
Jess hoped her small smile was properly apologetic. “Of course not, Professor. I did wonder if you could help me, though. I’m writing a paper on the symptoms and treatments of schizophrenia—mainly younger patients, préadolescents.”
“Then you won’t have much data. The adolescent transition tends to trigger a schizophrenic type.”
“But there are cases as young as, say, six years old?”
“Extremely rare. Where before a chil
d might be hyperactive, or moody, or even aggressive, the hormonal changes during puberty wreak havoc in the brain and you see personality fragmentation, psychosis. I’d be surprised to see a confirmed diagnosis as young as six.”
“If a diagnosis were in doubt—say a child has been labeled as schizophrenic by an expert, but others had reason to question it—what would you look for?”
“Organization of any kind, Miss Chambers. In schizophrenics the thinking process has been interrupted, scrambled, if you will. Without medication a patient is often unable to focus on a particular line of thought and carry it through. Autism is often mistaken for schizophrenia, and vice versa.”
“Would a child in this situation be sedated, restrained? Would neuroleptics be an effective treatment?”
Thomas frowned. “I would emphasize family therapy and behavioral modification techniques. You want to reward a patient’s good behavior while controlling his environment to the utmost degree.”
“So you would not isolate a child in these circumstances?”
“Absolutely not. Now if you’ll excuse me, I’ve got another class to teach. Unless you’d like me to write your paper for you?”
When Jess arrived back at her apartment, there was a message on the machine from Professor Shelley.
“Have you had time to take a look at her file?” Shelley asked, when Jess had reached her at home.
“I read through it, yes.”
“Any questions?”
“Something struck me. It said that you were the one who recommended her admittance. It also said that you’re her court-appointed guardian.”
There was a long pause on the other end. Jess imagined Shelley sitting in a wing chair by the light of a lamp. Did she have an apartment or a house? Did the professor live alone? She realized how little she knew about Shelley’s personal life. At the same time she wondered why it mattered.
“I did recommend her, yes,” Shelley said. “I kept close track of Sarah after she was born. She had family who raised her for a year or so. Sarah’s mother was not entirely stable, her parents were taking care of both of them. It was difficult. Sarah’s grandparents had my number, and when she got to be too much to handle, they called me. I agreed to watch over her treatment.”