by G. H. Ephron
“He’s wrong.” There was a pause. “What about Olivia?”
I pushed the hair out of my eyes and swung my feet over the edge of the bed. “I saw Olivia for such a short period of time, it’s hard to …”
“Peter, think who you’re talking to. I know all the disclaimers.”
“Sorry. Habit.” My mouth tasted foul. I got up and headed for the bathroom. “Well,” I started, “based on a minimal amount of data and a very cursory inspection, she seems like a normal, disaffected teenage girl. For the most part.”
“And the rest?” Channing asked, picking up immediately on the hedge.
I squeezed a taste of toothpaste onto a finger and licked it off. “She seemed edgy, overly moody. Could just be that she’s not getting enough sleep.”
“That, too.”
“I saw Olivia taking a pill. Is Daphne prescribing anything?”
“She had her on Prozac a while ago. But nothing now.”
“Well, it would be a good thing to find out what Olivia’s medicating herself with. It could be contributing to the moodiness,” I said, leaning heavily against the bathroom door. “And she’s attracted to the photographs of Annie Brigman.”
“Who’s that?”
“A photographer from early this century. Beautiful images of young women, yearning to merge with nature. There’s a mysterious eroticism in them. That alone wouldn’t concern me. But she also had some material about suicide.”
“She knows her grandmother killed herself.”
I went back and sat on the bed, resisting the impulse to lie down again. “Channing, she has this sheet about how to commit suicide, with sections highlighted.”
“Oh,” Channing said. It was like the sound of the air going out of a balloon. She knew as well as I did that for an adolescent, an obsession with suicide is a danger signal.
I said gently, “Some of the literature suggests that, for whatever reason, suicidal behavior runs in families.”
“Don’t you think I know that?”
“I could easily be wrong. I talked with her for less than ten minutes, and—”
She cut me off. “Will you do a more formal evaluation? Please.”
“Wouldn’t you rather take her to someone who isn’t a friend? Someone who can be completely objective?”
“I need someone I trust.”
“Why not Daphne?”
There was a pause. “I’m not asking you to be her therapist. I just want someone who can give me hard information. Besides, Daphne …” She broke off the thought. “I want another opinion. I can’t send her to someone I don’t know. I wouldn’t trust them. You, I trust. Please, Peter,” she went on, “do this for me. Take care of Olivia. Say you have some time to squeeze her in this week when she’s on spring break.”
I found myself thinking about what kinds of tests would help me understand Olivia. Those long, dysfunctional lists of to-do’s on her wall suggested a processing problem. Cognitive tests would help me understand how she was making sense of the world. I tried not to think about the conflict I might have to face, dealing with Daphne, who, like most analysts, saw things in terms of drives and emotions. Especially if my take on Olivia didn’t square with hers.
My datebook was on my dresser. I opened it. There was a time slot free late Monday morning. “How about you and Olivia meet me tomorrow in the cafeteria, around eleven? We can talk, then I’ll take her for a few hours.”
“Great. Thanks, Peter. I really appreciate this.”
When I arrived at work Monday, I detoured to the closet behind the nurses’ station and gouged the clot of mail out of my mailbox. Most of it was glossy advertising and pamphlets from the drug companies, plus an embossed invitation to an all-you-can-drink dinner at the Ritz—all I had to do was endure a thirty-minute “analysis” of current treatments for anxiety.
I turned the card over. No stamp, no address. Just a handwritten “Dr. Zak, hope to see you there.” Had to have been hand delivered by one of the sales reps. It annoyed the hell out of me, the carte blanche access these guys had to the unit.
I threw it all away. I continued down the hall to our conference room. I barely registered my colleagues already assembled inside. All I saw were the holes that had been punched in the walls and the dangling wires left behind by a small army of workers who’d commandeered the room a few weeks ago and then vanished without a trace. I’d called maintenance four times. Each time, someone different had promised to send the workers back right away to finish the job. Well, right away had come and gone. Didn’t they realize we had to work in this room?
“Peter, you’re looking tense already,” Gloria said, putting her hand on my arm and peering into my face. She looked relaxed and rested, despite having worked all Saturday night. Her khaki pants and white shirt were crisp, her short dark hair damp, the comb lines still showing.
I still hadn’t recovered from Saturday’s all-nighter. “You need a cup of coffee,” Gloria observed. She already had her own oversize mug.
She was right. It felt like a tension wire was pulling my eyebrows together. I took off my glasses and massaged the bridge of my nose. I’d had a cup—or was it two?—a few hours earlier. Since then I’d gone for a run, showered, shaved, and sanded a couple of rust spots off my car.
I left my briefcase at the head of the table and made a quick trip to the coffeemaker. When I returned, Gloria, our social worker, and our music therapist were ready to get started. Our psychology fellow and a senior aide joined us. Kwan strolled in on a wave of aftershave. He was carrying a cup of tea and a glazed doughnut. He was impeccably turned out, as always, in a dark three-piece suit.
I sat down and pulled out the rounds book. Conversation quieted and then turned off. All eyes focused on the white board listing the eighteen beds on the unit.
Before we could get started, there was a tentative knock at the door, and Jess Dyer poked her head in. Catching my eye, she pinked up. When she saw everyone else, she blushed more.
“Dr. Dyer, please come in,” I said, my voice formal. “We were just starting rounds.”
She slipped into the room. Today, in her dark suit with her blond hair pinned up, briefcase in hand, she looked older and more substantial than she had at Channing’s party. In fact, she looked like a psychiatrist.
“This is Dr. Jess Dyer, our new resident,” I announced.
Kwan sprang up, pulled over a battered Windsor chair, and gave a courtly bow. It was the same respectful way he treated patients. Jess nodded thanks, took a seat, and hurriedly pulled out a pad of paper and a pen.
I turned my attention back to the white board. “Let’s start with Mr. Fleegle. A seventy-five-year-old alcoholic.” Jess was writing. “Mr. Fleegle had a reaction to a new antipsychotic drug Dr. Liu is conducting trials on, late Saturday night—”
“Sunday morning,” Gloria corrected.
“Right. Very early Sunday morning. Seems like the Zerenidine interacted with some whiskey someone snuck in to him.”
“He shouldn’t have been drinking,” Kwan groused as he slumped in his chair, chin sunk into his chest. He’d have to report the adverse event—that’s what they call it when a drug being tested does something unexpected. This one could be a major setback for the Zerenidine trials, and Kwan would be the unfortunate messenger.
“How’s Mr. Fleegle doing?” I asked. “Any more hallucinations?”
“No. He seems pretty normal,” Gloria said. “Normal for Mr. Fleegle, at any rate.”
“Poor Pharmacom,” Kwan said. “They have such high hopes for Zerenidine.”
“Poor Gloria!” I said. “She was in here for hours trying to calm him down.” As for me, there were several things I’d rather have done than catch Mr. Fleegle’s lounge act. “I thought the Zerenidine trial was almost finished.”
“I need to enroll five more subjects in the next two weeks. So I’d appreciate any help any of you”—he nailed me with a hard look—“can give me.” Two weeks wasn’t much time.
“I
can help,” Jess offered. “I coordinated research for Dr. Temple while I was on the Drug and Alcohol Unit.”
“Really?” Kwan seemed impressed. He dug around in his pocket and passed Jess his business card. “Let’s talk later today, Dr.—” He hesitated.
“Dyer. D-Y-E-R,” Jess said as Kwan wrote.
It was a small thing but definitely an indication of how preoccupied he was. A young, attractive resident shows up and Kwan hasn’t got her name written at the top of his meeting notes. All he’d written on the blank sheet was the numeral 5 large and underlined.
“We had some more excitement on Sunday night,” Gloria said. “Patients partying in the tunnels.”
“Our patients?” Kwan asked.
“No. A bunch from the Drug and Alcohol Rehabilitation Unit. They broke into one of the decommissioned buildings. Must have felt pretty safe because they had a boom box, a couple of bottles of cranberry juice they’d helped themselves to, popcorn, marijuana, and some vodka.”
I tried not to laugh, but I had a vision of Mr. Fleegle nursing a sea breeze, waving a cigar, and crooning “Melancholy Baby” to a group of rapt patients in hospital johnnies.
“Dr. Destler is not amused,” Gloria said. “You’ve got a manifesto in your e-mail this morning.”
That news made everyone quiet for a few moments. Arnold Destler was chief bean counter at the Pearce. He’d been bustling around for the last four years, “bringing the Pearce into the twenty-first century,” as he put it. Not surprisingly, you mentioned his name and the reaction was never lukewarm. People saw him as either our savior or as the Angel of Death, who was turning the Pearce into an institution not worth saving.
Gloria took a dim view. Whenever Destler’s name came up in private conversation, she’d start muttering. “The man’s a psychopath. Someone ought to put him out of his misery.” In morning meeting, though, she just sat there tight-lipped. She was convinced Destler had spies everywhere reporting back to him.
“Looks like we had a few discharges over the weekend,” I said, noting the erasures on the white board.
“Four patients discharged, one admitted,” Gloria said.
That gave us three empty beds—a welcome breather, as long as it didn’t last. Though even a few days below capacity made me anxious. With our razor-thin financial margins, we were under constant pressure to maintain a census of at least 95 percent.
I glanced at the list on the board. “Lydia Small.”
“Admitted Sunday,” Gloria said.
“A new patient?” Kwan asked, his voices prickling with interest.
I reached behind me for the chart and scanned the admitting record. “Seventy-eight years old. Police picked her up chasing her sister down the street with a carving knife. No clothes on. They brought her to the ER, delirious. No history of violence. They had her in restraints but couldn’t get her calmed down. They did a rapid neuroleptization.”
“Must have knocked the hell out of her,” Kwan said.
“A rapid what?” Jess asked.
“Neuroleptization,” Kwan and I chorused.
Kwan went on, “Means they gave her a half milligram of Ativan and a half milligram of Haldol. Then after an hour, doubled it. After that, doubled it again. Standard operating procedure with a violent patient.”
“Then they throw up their hands and ship her to us,” I added.
“She’s completely out of it this morning,” Gloria said.
“No surprise there,” I said. “Is her blood work back?”
“Not yet,” Gloria answered.
Kwan sat at attention. “Sounds like a perfect candidate for the Zerenidine trial.”
Now I was sure he was preoccupied. Leaping from symptom to treatment wasn’t his style. He was the one who held off treating a patient who’d kidnapped and threatened to kill his mother-in-law. The guy kept insisting she was an alien. He held the police at bay for eight hours before they were able to capture him, book him, and deliver him to us. Knee-jerk response would have been to dose him with antipsychotics, but Kwan waited and evaluated. Turned out he was right to wait. The guy had been forgetting to take his thyroid medicine. Severe hypothyroidism made him delirious, not demented. We restarted his medication, and three weeks later, he was as normal as the rest of us.
I was relieved when he added, “Let’s wait until her blood work comes back before we decide. She’ll need to be off the benzos for at least twenty-four hours anyway.” He turned to Jess. “Dr. Dyer, please call the lab as soon as we’re done here and make sure they get her test results to us, ASAP.” Jess took notes. “Then, if she’s coherent, talk to her about the study and get her consent. In the meantime, find out who can give permission if she turns out not to be competent.”
Next, we discussed Matthew Farrell. Kwan said, “We’ve just started him on Adderall.” Jess looked up. “A-D-D-E-R-A-L-L. It’s a fairly new psycho-stimulant. Supposed to be a more effective treatment for patients with Asperger’s syndrome.”
I added, “Helps with concentration, anger control.”
Kwan doodled on his paper. “I wonder how he’d do on Zerenidine … .”
I snapped the file shut. “He’s only eighteen years old! And he doesn’t fit the profile.”
Kwan raised one finger. “Bursts of anger.” Two fingers. “Out of touch with reality.”
“He’s not out of touch with reality. You’re the one who’s—”
“Can we get on with rounds?” Gloria asked pointedly. “I thought we were supposed to be talking about patient care. You two are going at it like a pair of bull elephants.”
That brought the meeting to a full stop. “O-kay,” I said. “Point well taken.”
We resumed and got through the remaining patients on the unit without further acrimony. But the tension was still there. I knew it would be, until Kwan’s Zerenidine trial ended and he could stop sizing up each new patient as a potential research subject.
Research had become a fact of life at the institute. The money, the prestige that came from being in the forefront in the fight against mental illness—it was all intoxicating. Individual doctors profited. The institute profited. We used to worry about the danger of finding ourselves in bed with our patients. Now we had an entirely different bed partner to worry about—the drug companies.
5
IT WAS after eleven by the time I got to the cafeteria to meet Channing and Olivia. The place smelled like Fridays at P.S. 181—baked haddock and canned corn. I scanned the cavernous room. A squadron of Formica tables was arrayed on a field of putty-colored linoleum. I’d expected to see Channing sitting there tapping her fingers on the tabletop to get me to move along, move along. I’d expected to see Olivia looking self-conscious as only an adolescent girl can look when she has to be seen in public with her mother. But the place was deserted.
I went through the food line, bypassing a muffin that looked as if someone had sat on it. I got a cup of coffee and took it to a table near the entrance. I sat down to wait. The coffee tasted vile, but I drank it anyway.
I checked my watch. A quarter past. A little role reversal. I’d always been the late one—only one of our many incompatibilities that seemed, in retrospect, fairly trivial. For a woman with the soul of a rebel, Channing had very buttoned-down habits. Under the Indian-print bedspread in her incense-laden dorm room, the sheets had been tucked in with hospital corners, sharper than any drill sergeant’s. Shoddy research methods? Not likely. But then, it was unthinkable to me that she’d be late.
Now it was twenty past. I used the house phone in the lobby and called her office. It went directly to the automatic answering system. I hung up and called her beeper instead. I punched in my office number.
I hung up and stared out the window. It would soon be lunchtime. People were starting to drift toward the cafeteria in ones and twos, small groups, But none of them was Channing. The Drug and Alcohol Rehabilitation Unit was just across the lawn. Channing’s office was one of the windows under the ornately trimmed roof ov
erhang, just beyond the topmost branches of a magnificent, two-hundred-year-old oak.
I checked my voice mail. There was a message. But not in response to my beep. Channing left it while I was in morning meeting. I kicked myself for not checking my messages. It just hadn’t occurred to me. When it’s important, I usually get beeped.
“Peter, I’m running a bit late. Why don’t you come over and find us in my office, instead of in the caf. I might need your help to extricate myself.”
I dumped out the remaining coffee and headed over to her office. The exterior of the building that was home to the Drug and Alcohol Rehabilitation Unit resembled the one that housed our unit. The interior was another story. The lobby’s mahogany paneling glowed. The walls looked recently painted. An actual brass chandelier hung from the ceiling medallion, not the fluorescent boxes that hung from ours. No question about it, they were doing something right.
I pressed the elevator button and waited. No creaks and groans from ancient machinery heeding the call to action. I could barely hear anything. I waited. I pressed the button again. Then I punched it four times hard, as if that would make a difference. It was reassuring. With all the money they had for paint and chandeliers, the elevators still didn’t work.
I followed the EXIT sign, entered a stairwell, and started up the three flights of stairs. There were banister railings on the outer wall. On the inside, where the staircase wound around an air shaft, there was a wall of elaborately turned, closely set wooden spindles that ran from the treads to the ceiling. The spindles formed a wall preventing suicidal patients from flinging themselves off the steps and down to the basement floor. The central air shafts in our unit stairways were protected, too, but by a wall of ugly, prisonlike gray metal bars.
I took the stairs two at a time, pushed open the fourth-floor door, and tried to orient myself. Up here there were fresh carpeting and brass wall sconces as well as overhead lighting. No wonder the elevator hadn’t come. The door was propped open with a wastebasket. Someone downstairs was banging on the elevator doors. I removed the basket and watched the doors slide soundlessly shut.