“It hasn’t been fun, that’s for sure. But the worst of it falls on Cindy. To be honest, we’ve got your basic, traditional, sex role-stereotyped marriage— I work; she takes care of things at home. It’s by mutual choice— what Cindy really wanted. I’m involved at home to some extent— probably not as much as I should be— but child rearing’s really Cindy’s domain. God knows she’s a hell of a lot better at it than I am. So when something goes wrong in that sphere, she takes all the responsibility on her shoulders.”
He stroked his beard and shook his head. “Now, that was an impressive bit of defensive pedantry, wasn’t it? Yes, sure, it’s been damned rough on me. Seeing someone you love . . . I assume you know about Chad— our first baby?”
I nodded.
“We hit bottom with that, Dr. Delaware. There’s just no way to . . .” Closing his eyes, he shook his head again. Hard, as if trying to dislodge mental burrs.
“Let’s just say it wasn’t anything I’d wish on my worst enemy.”
He jabbed the elevator button, glanced at his watch. “Looks like we caught the local, Doctor. Anyway, we were just coming out of it— Cindy and I. Pulling ourselves together and starting to enjoy Cassie when this mess hit the fan . . . Unbelievable.”
The elevator arrived. Two candy-stripers and a doctor exited, and we stepped in. Chip pushed the ground-floor button and settled with his back against the compartment’s rear wall.
“You just never know what life’s going to throw you,” he said. “I’ve always been stubborn. Probably to a fault— an obnoxious individualist. Probably because a lot of conformity was shoved down my throat at an early age. But I’ve come to realize I’m pretty conservative. Buying into the basic values: Live your life according to the rules and things will eventually work out. Hopelessly naïve, of course. But you get into a certain mode of thinking and it feels right, so you keep doing it. That’s as good a definition of faith as any, I guess. But I’m fast losing mine.”
The elevator stopped at four. A Hispanic woman in her fifties and a boy of around ten got on. The boy was short, stocky, bespectacled. His blunt face bore the unmistakable cast of Down’s syndrome. Chip smiled at them. The boy didn’t appear to notice him. The woman looked very tired. No one talked. The two of them got off at three.
When the door closed, Chip kept staring at it. As we resumed our descent he said, “Take that poor woman. She didn’t expect that— child of her old age and now she has to take care of him forever. Something like that’ll shake up your entire worldview. That’s what’s happened to me— the whole child-rearing thing. No more assumptions about happy endings.”
He turned to me. The slate eyes were fierce. “I really hope you can help Cassandra. As long as she has to go through this shit, let her be spared some of the pain.”
The elevator landed. The moment the door opened, he was out and gone.
• • •
When I got back to the General Peds clinic, Stephanie was in one of the exam rooms. I waited outside until she came out a few minutes later, followed by a huge black woman and a girl of around five. The girl wore a red polka-dot dress and had coal-black skin, cornrows, and beautiful African features. One of her hands gripped Stephanie’s; the other held a lollipop. A tear stream striped her cheek, lacquer on ebony. A round pink Band-Aid dotted the crook of one arm.
Stephanie was saying, “You did great, Tonya.” She saw me and mouthed, “My office,” before returning her attention to the girl.
I went to her consult room. The Byron book was back on the shelf, its gilded spine conspicuous among the texts.
I thumbed through a recent copy of Pediatrics. Not long after, Stephanie came in, closed the door, and sank into her desk chair.
“So,” she said, “how’d it go?”
“Fine, outside of Ms. Bottomley’s continuing antagonism.”
“She get in the way?”
“No, just more of the same.” I told her about the scene with the nurse and Chip. “Trying to get on his good side but it probably backfired. He sees her as a shameless ass-kisser, though he does think she takes good care of Cassie. And his analysis of why she resents me is probably right-on: competing for the attentions of the VIP patient.”
“Attention seeking, huh? There’s a bit of Munchausen symptomology.”
“Yup. In addition, she did visit the home. But only a couple of times, a while back. So it still doesn’t seem likely she could have caused anything. But let’s keep our eyes on her.”
“I already started, Alex. Asked around about her. The nursing office thinks she’s tops. She gets consistently good ratings, no complaints. And as far as I can tell there’s been no unusual pattern of illness in any of her patients. But my offer’s still open— she causes too much hassle, she’s transferred.”
“Let me see if I can work things out with her. Cindy and Chip like her.”
“Even though she’s an ass-kisser.”
“Even though. Incidentally, he feels that way about the entire hospital. Doesn’t like getting special treatment.”
“In what way?”
“No specific complaints, and he made a point of saying he likes you. He’s just got a general concern that something could be missed because of who his father is. More than anything, he looks weary. They both do.”
“Aren’t we all,” she said. “So what’s your initial take on mama?”
“She wasn’t what I expected— neither of them was. They seem more health-food restaurant than country club. And they’re also different from each other. She’s very . . . I guess the best word for it is basic. Unsophisticated. Especially for a honcho’s daughter-in-law. I can see Chip growing up rich, but he’s not exactly corporate son.”
“The earring?”
“The earring, his choice of profession, his general demeanor. He talked about getting conformity shoved at him throughout childhood and rebelling. Maybe marrying Cindy was part of it. There’s a twelve-year difference between them. Was she his student?”
“Could be, I don’t know. Is that relevant in terms of Munchausen?”
“Not really. I’m just getting my feet wet. In terms of a Munchausen profile, it’s too early to tell much about her. She does toss some jargon into her speech and she’s highly identified with Cassie— feels the two of them have an almost telepathic link. The physical resemblance between them is strong— Cassie’s like a miniature of her. That could enhance the identification, I suppose.”
“Meaning if Cindy hates herself she could be projecting it on to Cassie?”
“It’s possible,” I said. “But I’m a long way off from interpretation. Did Chad also resemble her?”
“I saw him dead, Alex.” She covered her face, rubbed her eyes, looked up. “All I remember was that he was a pretty little boy. Gray, like one of those cherub statues you put in a garden. Tell the truth, I tried not to look at him.”
She picked up a demitasse cup, looked ready to throw it.
“God, what a nightmare. Carrying him down to the morgue. The staff elevator was jammed. I was just standing around, holding this bundle. Waiting. People passing right by me, gabbing— I wanted to scream. Finally I walked over to the public elevators, rode down with a bunch of other people. Patients, parents. Trying not to look at them. So they wouldn’t know what I was carrying.”
We sat for a while. Then she said, “Espresso,” leaned over toward the little black machine and turned it on. A red light glowed. “Loaded and ready to go. Let’s caffeine our troubles away. Oh, let me give you those references.”
She took a piece of paper from the desk and handed it to me. List of ten articles.
“Thanks.”
“Notice anything else,” she said, “about Cindy?”
“No belle indifférence or dramatic attention seeking, so far. On the contrary, she seemed very low-key. Chip did mention that the aunt who raised her was a nurse, so we’ve got a possible early exposure to health-related issues, on top of her being a respiratory tech. But that’s real
ly pretty thin, by itself. Her child-rearing skills seem good— exemplary, even.”
“What about the relationship with her husband? Pick up any stress there?”
“No. Have you?”
She shook her head. Smiled. “But I thought you guys had tricks.”
“Didn’t bring my bag this morning. Actually, they seem to get along pretty well.”
“One big happy family,” she said. “Have you ever seen a case like this before?”
“Never,” I said. “Munchausens avoid psychologists and psychiatrists like the plague because we’re proof no one’s taking their diseases seriously. The closest I’ve come are doctor-hoppers— parents convinced something’s wrong with their kids, running from specialist to specialist even though no one can find any real symptoms. When I was in practice I used to get referrals from doctors driven crazy by them. But I never treated them for long. When they showed up at all, they tended to be pretty hostile and almost always dropped out quickly.”
“Doctor-hoppers,” she said. “Never thought of them as mini-Munchausens.”
“Could be the same dynamic at a milder level. Obsession with health, seeking attention from authority figures while dancing around with them.”
“The waltz,” she said. “What about Cassie? How’s she functioning?”
“Exactly as you described— she freaked out when she saw me, but calmed down eventually.”
“Then you’re doing better than I am.”
“I don’t stick her with needles, Steph.”
She gave a sour smile. “Maybe I went into the wrong field. Anything else you can tell me about her?”
“No major pathology, maybe some minor language delay. If her speech doesn’t get better in the next six months, I’d have it checked out with a full psych battery, including neuropsych testing.”
She began ordering the piles on her desk. Swiveled and faced me.
“Six months,” she said. “If she’s still alive by then.”
6
The waiting room was hot with bodies and impatience. Several of the mothers flashed hopeful looks at Stephanie as she walked me out. She smiled, said, “Soon,” and ushered me into the hall.
A group of men— three white-coated doctors and one business suit in gray flannel— was heading our way. The lead white-coat noticed us and called out, “Dr. Eves!”
Stephanie grimaced. “Wonderful.”
She stopped and the men came abreast. The white-coats were all in their fifties and had the well-fed, well-shaven look of senior attending physicians with established practices.
Business-suit was younger— mid-thirties— and hefty. Six feet, 230 or so, big round shoulders padded with fat under a broad columnar head. He had short dishwater hair and bland features, except for a nose that had been broken and reset imperfectly. A wispy narrow mustache failed to give the face any depth. He looked like an ex-jock playing the corporate game. He stood behind the others, too far away for me to read his badge.
The lead doctor was also thickset, and very tall. He had wide razor-edge lips and thinning curly hair the color of silver plate that he wore longish and winged at the sides. A heavy, outthrusting chin gave his face the illusion of forward movement. His eyes were quick and brown, his skin pinkish and gleaming as if fresh from the sauna. The two doctors flanking him were medium-sized, gray-haired, and bespectacled. In one case, the hair was a toupee.
Chin said, “How’re things in the trenches, Dr. Eves?” in a deep, adenoidal voice.
Stephanie said, “Trenchlike.”
He turned to me and did some eyebrow calisthenics.
Stephanie said, “This is Dr. Delaware, a member of our staff.”
He shot his hand out. “Don’t believe it’s been my pleasure. George Plumb.”
“Pleased to meet you, Dr. Plumb.”
Vise-grip handshake. “Delaware,” he said. “What division are you with, Doctor?”
“I’m a psychologist.”
“Ah.”
The two gray-haired men looked at me but didn’t talk or move. Suit seemed to be counting the holes in the acoustical ceiling.
“He’s with pediatrics,” said Stephanie. “Serving as a consultant on the Cassie Jones case— helping the family cope with the stress.”
Plumb swung his eyes back to her. “Ah. Very good.” He touched her arm lightly. She endured it for a moment, then backed away.
He renewed his smile. “You and I need to confer, Stephanie. I’ll have my girl call yours and set it up.”
“I don’t have a girl, George. The five of us share one woman secretary.”
The gray twins looked at her as if she were floating in a jar. Suit was somewhere else.
Plumb kept smiling. “Yes, the ever-changing nomenclature. Well, then my girl will call your woman. Be well, Stephanie.”
He led his entourage away, stopped several yards down the hall, and ran his eyes up and down a wall, as if measuring.
“What are you going to dismantle now, boys?” said Stephanie under her breath.
Plumb resumed walking and the group disappeared around a corner.
I said, “What was that all about?”
“That was about Doctor Plumb, our new chief administrator and CEO. Papa Jones’s boy— Mr. Bottom Line.”
“M.D. administrator?”
She laughed. “What, the coat? No, he’s no doc. Just some kind of asinine Ph.D. or something—” She stopped, colored. “Jeez, I’m sorry.”
I had to laugh. “Don’t worry about it.”
“I’m really sorry, Alex. You know how I feel about psychologists—”
“Forget it.” I put my arm over her shoulder. She slipped hers around my waist.
“My mind is going,” she said softly. “I am definitely falling apart.”
“What’s Plumb’s degree in?”
“Business or management, something like that. He uses it to the hilt— insists on being called Doctor, wears a white coat. Most of his lackeys have doctorates, too— like Frick and Frack over there: Roberts and Novak, his numbers crunchers. They all love to traipse into the doctors’ dining room and take over a table. Show up at medical meetings and rounds for no apparent reason, walking around staring and measuring and taking notes. Like the way Plumb just stopped and sized up that wall. I wouldn’t be surprised if the carpenters show up soon. Dividing three offices into six, turning clinical space into administrative offices. And now he wants to confer with me— there’s something to look forward to.”
“Are you vulnerable?”
“Everyone is, but General Peds is at the bottom of the barrel. We’ve got no fancy technology or heroics to make headlines. Most of what we do’s outpatient, so our reimbursement level’s the lowest in the hospital. Since Psych’s gone.” She smiled.
“Even technology doesn’t seem immune,” I said. “This morning, when I was looking for an elevator, I went by where Nuclear Medicine used to be and the suite had been given over to something called Community Services.”
“Another of Plumb’s coups. But don’t worry about the Nukers— they’re okay. Moved upstairs to Two, same square footage, though patients have trouble finding them. But some of the other divisions have had real problems— Nephrology, Rheumatology, your buddies in Oncology. They’re stuck in trailers across the street.”
“Trailers?”
“As in Winnebago.”
“Those are major divisions, Steph. Why do they put up with it?”
“No choice, Alex. They signed away their rights. They were supposed to be housed in the old Hollywood Lutheran Tower— Western Peds bought it a couple of years ago, after Lutheran had to divest because of their budget problems. The board promised to build fantastic suites for anyone who moved over there. Construction was supposed to start last year. The divisions that agreed were moved to the trailers and their old space was given to someone else. Then they discovered—Plumb discovered— that even though enough money had been raised to make a down payment on the tower and do some of the remod
eling, insufficient funds had been allocated to do the rest and to maintain it. Trifling matter of thirteen million dollars. Try raising that in this climate— heroes are already in short supply because we’ve got a charity hospital image and no one wants their name on a bunch of doctors’ offices.”
“Trailers,” I said. “Melendez-Lynch must be over-joyed.”
“Melendez-Lynch went adios, last year.”
“You’re kidding. Raoul lived here.”
“Not anymore. Miami. Some hospital offered him chief of staff, and he took it. I hear he’s getting triple the salary and half the headaches.”
Devil's Waltz Page 7