The two other nurses, Filipinas in their twenties, glanced at each other and moved away as if spurred by a silent’ code.
Stephanie said, “Morning, Vicki. How’s our girl doing?”
“So far so good.” Reaching over, the blond nurse pulled a chart out of the slot marked 505W and handed it to Stephanie. Her nails were stubby and gnawed. Her gaze settled on me again. The old charm was still not working.
“This is Dr. Alex Delaware,” said Stephanie, thumbing through the chart, “our consulting psychologist. Dr. Delaware, Vicki Bottomley, Cassie’s primary care nurse.”
“Cindy said you’d be coming by,” said the nurse, making it sound like bad news. Stephanie kept reading.
“Pleased to meet you,” I said.
“Pleased to meet you.” A challenging sullenness in her voice made Stephanie look up.
“Everything okay, Vicki?”
“Peachy,” said the nurse, flashing a smile as jovial as a slap across the face. “Everything’s fine. She held down most of her breakfast, fluids and P/O meds—”
“What meds?”
“Just Tylenol. An hour ago. Cindy said she had a headache—”
“Tylenol One?”
“Yes, Dr. Eves, just the kid stuff, liquid, one teaspoon— it’s all in there.” She pointed to the chart.
“Yes, I see,” said Stephanie, reading. “Well, that’s all right for today, Vicki, but next time no meds— not even OTC stuff— without my approval. I need to authorize everything, other than food and beverage, that passes between this child’s lips. Okay?”
“Sure,” said Bottomley, smiling again. “No problem. I just thought—”
“No harm done, Vicki,” said Stephanie, reaching over and patting the nurse’s shoulder. “I’m sure I would have okayed Tylenol. It’s just that with this kid’s history we’ve got to be super-careful to tease out drug reactions.”
“Yes, Dr. Eves. Is there anything else?”
Stephanie read more of the chart, then closed it and handed it back. “No, not at the moment, unless there’s something you want to report.”
Bottomley shook her head.
“Okay, then. I’m going to go in and introduce Dr. Delaware. Anything about Cassie you want to share?”
Bottomley removed a bobby pin from her hair and stuck it back in, fastening blond strands to the cap. Her eyes were wide-set and long-lashed, a soft, pretty blue in the tense, gritty terrain of her face.
She said, “Like what?”
“Anything Dr. Delaware should know, to help Cassie and her parents, Vicki.”
Bottomley stared at Stephanie for a moment, then turned to me, glaring. “There’s nothing wrong with them. They’re just regular people.”
I said, “I hear Cassie gets pretty anxious about medical procedures.”
Bottomley put her hands on her hips. “Wouldn’t you, if you got stuck as much as she does?”
Stephanie said, “Vicki—”
“Sure,” I said, smiling. “It’s a perfectly normal reaction, but sometimes normal anxiety can be helped by behavioral treatment.”
Bottomley gave a small, tight laugh. “Maybe so. Good luck.”
Stephanie started to say something. I touched her arm and said, “Why don’t we get going?”
“Sure.” To Bottomley: “Remember, nothing P/O except food and drink.”
Bottomley held on to her smile. “Yes, Doctor. Now, if it’s all right with you, I’d like to leave the floor for a few minutes.”
Stephanie looked at her watch. “Break time?”
“No. Just wanted to go down to the gift shop and get Cassie a LuvBunny— you know those stuffed bunnies, the cartoons on TV? She’s crazy about them. I figure with you people in there, she should be fine for a few minutes.”
Stephanie looked at me. Bottomley followed her glance with what seemed to be satisfaction, gave another tight laugh, and left. Her walk was a brisk waddle. The starched cap floated along the empty corridor like a kite caught in a tailwind.
Stephanie took my arm and steered me away from the station.
“Sorry, Alex. I’ve never seen her like that.”
“Has she been Cassie’s nurse before?”
“Several times— almost from the beginning. She and Cindy have developed a good rapport and Cassie seems to like her too. When Cassie comes in, they ask for her.”
“She seems to have gotten pretty possessive.”
“She does have a tendency to get involved, but I’ve always looked at that as a positive thing. Families love her— she’s one of the most committed nurses I’ve ever worked with. With morale the way it is, commitment’s hard to find.”
“Does her commitment extend to home visits?”
“Not as far as I know. The only home things were a couple I did, with one of the residents, at the very beginning, to set up the sleep monitor—” She touched her mouth. “You’re not suggesting she had something to do with—”
“I’m not suggesting anything,” I said, wondering if I was, because Bottomley had chapped my hide. “Just throwing out ideas.”
“Hmm . . . well, that’s some idea. Munchausen nurse? I guess the medical background fits.”
“There’ve been cases,” I said. “Nurses and doctors looking for attention, and usually they’re the really possessive ones. But if Cassie’s problems have always started at home and resolved in the hospital, that would rule her out, unless Vicki’s a permanent resident at the Jones household.”
“She isn’t. At least not as far as I know. No, of course she isn’t— I’d know if she was.”
She looked unsure. Beaten down. I realized what a toll the case was taking.
“I would like to know why she was so hostile to me,” I said. “Not for personal reasons but in terms of the dynamics of this family. If Vicki and the mother are tight and Vicki doesn’t like me, that could sour my consult.”
“Good point . . . I don’t know what’s eating at her.”
“I assume you haven’t discussed your suspicion of Cindy with her?”
“No. You’re really the first person I’ve talked to about it. That’s why I phrased my no-meds instructions in terms of drug reactions. Cindy’s also been asked not to bring food from home for the same reason. Vicki and the nurses on the other shifts are supposed to log everything Cassie eats.” She frowned. “Of course if Vicki’s overstepping her bounds, she might not be following through. Want me to have her transferred? Nursing Ad would give me hell, but I suppose I could swing it pretty quickly.”
“Not on my account. Let’s keep things stable for the time being.”
We walked behind the station. Stephanie retrieved the chart and studied it again.
“Everything looks okay,” she said finally. “But I’ll have a talk with her anyway.”
I said, “Let me have a look.”
She gave me the chart. Her usual neat handwriting and detailed notes. They included a family-structure chart that I spent some time on.
“No grandparents on the mother’s side?”
She shook her head. “Cindy lost her parents young. Chip lost his mom, too, when he was a teenager. Old Chuck’s the only grandparent left.”
“Does he get up here much to visit?”
“From time to time. He’s a busy man.”
I continued reading. “Cindy’s only twenty-six . . . maybe Vicki’s a mother figure for her.”
“Maybe,” she said. “Whatever it is, I’ll keep a tight leash on her.”
“Don’t come down too hard right now, Steph. I don’t want to be seen by Vicki— or Cindy— as someone who makes anyone’s life harder. Give me a chance to get to know Vicki. She could turn out to be an ally.”
“Okay,” she said. “This human relations stuff is your area. But let me know if she continues to be difficult. I don’t want anything getting in the way of solving this thing.”
• • •
The room was inundated with LuvBunnies— on the windowsill, nightstand, the bed tray, atop the
TV. A bucktoothed, rainbow-hued welcoming party.
The rails of the bed were lowered. A beautiful child lay sleeping— a tiny bundle barely swelling the covers.
Her heart-face was turned to one side; her rosebud mouth, pink and parted. Buttermilk skin, chubby cheeks, nubbin nose. Her hair was sleek, straight, and black and trickled onto her shoulders. The bangs were moist and they stuck to her forehead. A ring of lace collar was visible above the blanket hem. One hand was concealed; the other, dimpled and clenched, gathered the fabric. Its thumb was the size of a lima bean.
The sleeper sofa by the window was unfolded to a single bed that had been made up. Military corners, pillow smooth as eggshell. A flowered vinyl overnight bag sat on the floor next to an empty food tray.
A young woman sat cross-legged on the edge of the mattress, reading TV Guide. As soon as she saw us she put down the magazine and got up.
Five five, firm figure, slightly long-waisted. Same shiny dark hair as her daughter’s, parted in the middle, tied back loosely and gathered in a thick braid that nearly reached her waist. Same facial cast as Cassie’s, too, stretched by maturity to something just barely longer than the perfect oval. Fine nose; straight, wide, unpainted mouth with naturally dark lips. Big brown eyes. Bloodshot.
No makeup, scrubbed complexion. A girlish woman. Twenty-six but she could easily have passed for a college student.
From the bed came a soft, breathy sound. Cassie sighing. All of us looked over at her. Her eyelids remained closed but they fluttered. Threads of lavender vein were visible beneath the skin. She rolled over, facing away from us.
I thought of a bisque doll.
All around us, the LuvBunnies leered.
Cindy Jones looked down at her daughter, reached over and smoothed hair out of the child’s eyes.
Turning back to us, she ran her hands over her clothes, hurriedly, as if searching for unfastened buttons. The clothes were simple— plaid cotton shirt over faded jeans and medium-heeled sandals. A pink plastic Swatch watch. Not the post-deb, VIP daughter-in-law I’d expected.
“Well,” whispered Stephanie, “looks like someone’s snoozing away. Get any sleep yourself, Cindy?”
“A little.” Soft voice, pleasant. She didn’t have to whisper.
“Our mattresses have a way to go, don’t they?”
“I’m fine, Dr. Eves.” Her smile was tired. “Actually, Cassie slept great. She woke once, around five, and needed a cuddle. I held her and sang to her for a while and finally she fell back around seven. Guess that’s why she’s still out.”
“Vicki said she had a headache.”
“Yes, when she woke. Vicki gave her some liquid Tylenol and that seemed to work.”
“Tylenol was the right thing to give her, Cindy. But in the future all medications— even over-the-counter stuff— will have to be approved by me. Just to play it safe.”
The brown eyes opened wide. “Oh. Sure. I’m sorry.”
Stephanie smiled. “No big deal. I just want to be careful. Cindy, this is Dr. Delaware, the psychologist we spoke about.”
“Hello, Dr. Delaware.”
“Hello, Mrs. Jones.”
“Cindy.” She extended a narrow hand and smiled shyly. Likable. I knew my job wasn’t going to be easy.
Stephanie said, “As I told you, Dr. Delaware’s an expert on anxiety in children. If anyone can help Cassie cope, he can. He’d like to talk with you right now, if this is a good time.”
“Oh . . . sure. This is fine.” Cindy touched her braid and looked worried.
“Terrific,” said Stephanie. “If there’s nothing you need from me, I’ll be going.”
“Nothing I can think of right now, Dr. Eves. I was just wondering if you’d . . . come up with anything?”
“Not yet, Cindy. Yesterday’s EEG was totally normal. But, as we’ve discussed, with children this age that’s not always conclusive. The nurses haven’t charted any seizurelike behavior. Have you noticed anything?”
“No . . . not really.”
“Not really?” Stephanie took a step closer. She was only an inch taller than the other woman but seemed much larger.
Cindy Jones passed her upper lip under her top teeth, then released it. “Nothing— it’s probably not important.”
“It’s okay, Cindy. Tell me anything, even if you think it’s irrelevant.”
“Well, I’m sure it’s nothing, but sometimes I wonder if she’s tuning out— not listening when I talk to her? Kind of staring off into space— like a petit mal? I’m sure it’s nothing and I’m just seeing it because I’m looking for things now.”
“When did you start noticing this?”
“Yesterday, after we were admitted.”
“You never saw it at home?”
“I . . . no. But it could have been happening and I just didn’t notice. Or maybe it’s nothing. It probably is nothing— I don’t know.”
The pretty face began to buckle.
Stephanie patted her and Cindy moved toward the gesture, almost imperceptibly, as if to gain more comfort from it.
Stephanie stepped back, breaking contact. “How often have these staring episodes been occurring?”
“Maybe a couple of times a day. It’s probably nothing— just her concentrating. She’s always been good at concentrating— when she plays at home she concentrates really well.”
“Well, that’s good— the fact that she’s got a good attention span.”
Cindy nodded but she didn’t look reassured.
Stephanie drew an appointment book out of a coat pocket, ripped out a back page and handed it to Cindy. “Tell you what, next time you see this staring, make a record of the exact time and call in Vicki or whoever’s on duty to have a look, okay?”
“Okay. But it doesn’t last long, Dr. Eves. Just a few seconds.”
“Just do the best you can,” said Stephanie. “In the meantime, I’ll leave you and Dr. Delaware to get acquainted.”
Pausing for a moment to look at the sleeping child, she smiled at both of us and left.
When the door closed, Cindy looked down at the bed. “I’ll fold this up so you’ll have somewhere to sit.” There were delicate lavender veins under her skin, too. At the temples, throbbing.
“Let’s do it together,” I said.
That seemed to startle her. “No, that’s okay.”
Bending, she took hold of the mattress and lifted. I did likewise and the two of us turned the bed back into a sofa.
She smoothed the cushions, stood back, and said, “Please.”
Feeling as if I were in a geisha house, I complied.
She walked over to the green chair and removed the LuvBunnies. Placing them on the nightstand, she pulled the chair opposite the couch and sat, feet flat on the floor, a hand on each slender thigh.
I reached over, took one of the stuffed animals from the window ledge, and stroked it. Through the glass the treetops of Griffith Park were green-black and cloudlike.
“Cute,” I said. “Gifts?”
“Some of them are. Some we brought from home. We wanted Cassie to feel at home here.”
“The hospital’s become a second home, hasn’t it?”
She stared at me. Tears filled the brown eyes, magnifying them. A look of shame spread across her face.
Shame? Or guilt?
Her hands shot up quickly to conceal it.
She cried silently for a while.
I got a tissue from the box on the bed table and waited.
4
She uncovered her face. “Sorry.”
“No need to be,” I said. “There aren’t too many things more stressful than having a sick child.”
She nodded. “The worst thing is not knowing— watching her suffer and not knowing . . . If only someone could figure it out.”
“The other symptoms resolved. Maybe this will too.”
Looping her braid over one shoulder, she fingered the ends. “I sure hope so. But . . .”
I smiled but said nothing.
She said, “The other things were more . . . typical. Normal— if that makes any sense.”
“Normal childhood diseases,” I said.
“Yes— croup, diarrhea. Other kids have them. Maybe not as severe, but they have them, so you can understand those kinds of things. But seizures . . . that’s just not normal.”
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