He moved down the line, skipping one or two who he’d forgotten or who he couldn’t see real well, the ones taken from far away and the people in them were just stick figures whose eyes were tiny like little raisins. He would forget about the pictures for months, and then one day he’d feel that one or two of them wanted him to look up at them and say hello. Today, he felt that more than ever. Aunt Stephanie’s and Pops’s eyes were bright in the yellowy light, and they’d looked eager to see him. Maybe they missed the pictures across from them and were getting lonely in the hallway with photographs on only one side.
The last picture was his great-aunt Middy. Middy was dressed in black, and she had a doughy face with big round cheeks and a big chin that looked like a cue ball but with little dents in it. Her eyes were dark, and to Charlie it looked like someone was pinching her when the photo was taken, because she looked like she was trying not to yell out. Daddy wouldn’t talk about her, and he’d heard Mommy yelling at him about it. It had been a month before Mommy left and they’d started arguing about a Merican Express bill, but as usual they’d ended up fighting about other things. Charlie had snuck up to their bedroom door, which they’d left cracked a bit by mistake, because they usually argued with all the doors closed. He’d only stayed for a second, because it sounded like Daddy was coming toward the door, but he’d heard his mommy say this: Take it down, John. I don’t want that thing looking at me every day.
He didn’t hear what his father said back, only the words awful thing to say . . .
Charlie stood in front of the photo now. Middy’s face gave him fluttery feelings up and down the inside of his stomach. He felt sorry for her, but he was also scared of her skin that sagged and bunched in places and made her face all crooked and that eye, the right one, that was crooked—East-West eyes, they called people like that in school. The right eye stared out like it was made of glass, but at the same time it seemed like it was looking through you at something bad on the other side, waiting for you to turn. Or something inside you maybe.
A noise buzzed in his ear. It was like a voice was talking on a staticky station on the radio.
In his brain, Charlie asked Middy why she looked so sad, but she didn’t say anything back. Middy’s face looked like the dough before you poured the chocolate chips in and made cookies: soft, mushy, like she didn’t feel well. The right eye gleamed under the ceiling light, and Charlie took a step backward. From here, the tiny black of her eyeball looked furious, like it wanted to scold Charlie, and he took back his question about why she was sad because he didn’t want to know anymore.
You don’t scare me, Middy, he thought. You chased my mommy out of here and I don’t like you one bit.
Charlie felt the wall behind him, and inched over a little with his right foot. All of a sudden, he tore his eyes away from Middy’s picture and dashed for the kitchen. When he got there, he closed the door behind him fast, pushing his bare feet on the brown tiles to keep the door tight against the door frame. He kept his back pressed against the wood until he’d counted to ten, and then he felt better and strolled over to one of the padded kitchen chairs, then dragged it over the shiny brown tiles that were gleaming in the sunlight coming in the window, dragged it over to the cereal cupboard. He put the chair up to the counter, then stepped on top and opened the cupboard and got down the Trix, his favorite. He reached all the way over and opened the dishes cupboard and got his Avengers cereal bowl out and then climbed down and found a big-boy spoon in the drawer.
His heart didn’t stop racing until the first bowl of Trix was beginning to leak its colors into the milk he’d poured into the cereal. Charlie watched the cereal balls send long curling rivers of red and yellow and blue into the white ocean around them, and he tried to think about when they’d start playing baseball in the yard beyond their yard, because sometimes a stray foul would come looping into their yard and the left fielders from Bishop Carroll would come running up and he’d go to throw the ball back to them and one of the boys this year might ask Charlie to be the boy who collected the balls at the end of practice. He didn’t think again about how Middy was a bad old woman or what her mean right eye might be staring at in the hallway out there, not until the Trix was almost done and it was time to go back to his room and get dressed.
CHAPTER TWELVE
Intake was busy. There was the droning voice saying “Ohhhhhhhh” from behind a closed door. Psychotic, Nat thought absently. It was something that most psychs did almost unconsciously, starting during their residency—trying to diagnose patients on the fewest clues available: what they said (before the intake exam), what they looked like, even how they smelled. It was like that old TV show Name That Tune, which he used to watch when he’d stayed home from school as a young boy. I can name that manic-depressive in three notes. Totally unscientific, of course. But during his second year of residency, Nat had earned an unofficial success rate of about 65 percent, the highest in his class.
And that droning, wavering chant coming from down the hall? Schizo, for sure.
Nat stuck his head in the nursing office. An unhappy-looking black woman looked up from her computer.
“Greene?” he said.
“Who’s asking?”
He smiled. “Nat Thayer. Hi.”
“Oh, I wouldn’t have known, seeing you didn’t say hello or good morning or anything mannerly like that.” The woman reached into an amber-colored glass bowl, pulled out a piece of hard candy, unwrapped it, and popped it in her mouth. She gave Nat a reproachful look.
“Forgive me. Good morning, Ms. Beth Annelisa Duncan, charge nurse of the intake unit. Now where’s Greene, please?”
Beth gave the candy a few more circuits of her mouth, staring blank-faced at Nat as if she were looking right through him. Then she pursed her lips and glanced down at a list by her left elbow. “Says here, Iso.”
Nat gave the door frame two sharp knocks. “Thanks.”
He went to Isolation, dodging fast-walking nurses and patients in wheelchairs, the tips of their bathrobes dragging along the floor. The section was around two corners and through one security door. As he swiped his security card and pushed through, a host of sounds came rushing at him: an exhausted doctor talking on his cell phone; someone struggling on a metal stretcher, which rattled under his or her weight; calls and shouts from the locked rooms where the dangerous patients—dangerous to themselves or staff—were kept until they were stabilized.
And floating above it all a high-pitched, maniacal, and completely hopeless laugh. Actually, it was a despairing shriek disguised as a laugh. Nat winced.
Saturday was a busy day in Iso, especially in the depths of January. Postholidays were always a bad time for unstable people. And Fridays were drinking nights in Northam, which meant the inconsolable often washed up in the psych wards at Mass Memorial the morning after.
Nat scanned the room and spotted a nurse manager, a burly Scandinavian type named Ivor. Iso was the riskiest unit in the hospital, which meant it got the linebacker types.
He tapped Ivor on the shoulder. “The hell’s that?” Nat asked.
Ivor made a blank face, as if to say, What do you mean? Then he heard the laughter.
“Para-phren,” Ivor said, which was short for paranoid schizophrenic. “Fresh off the am-bu-lance. They found him walking in the middle of Cherry Avenue with one sock on and nothing else.”
Nat made a face. “They going to be doing like that all day?”
Ivor bent over a chart and made a notation. “Why do you care? You don’t work down here.”
“But you do. And I care about you, Ivor.”
“Fuck you, too, Thayer. What do you need?”
“Greene.”
Ivor pointed toward the room from which the eerie laughter was emanating. “She got lucky.”
Nat frowned. “Damn. How long has she been in there?”
Ivor glanced up at the clock, calc
ulating. “Twenty.”
“When she’s done, tell her I’m looking for her, will ya?”
“Got it.”
* * *
Half an hour later, someone knocked on Nat’s office door.
He swiveled in a chair. Dr. Jennifer Greene stood leaning in, her hand still poised over the door.
“You rang?”
“Yeah, Jennifer, come on in.”
Greene was wearing a lab coat, a neat blue button-down, and khakis. Her light brown hair with blond highlights was tied back in a bun. She leaned against the back of one of Nat’s chairs.
“This isn’t about the yogurt in the fridge, is it? I told everyone I was going to return it.”
He smiled. “No, believe it or not, actual cases pass through this office. Please disguise your shock.”
“Actual cases? I thought you were here just to give the women in the office a reason to show up for work. I mean, besides me.”
“No, that I do as a public service.”
She laughed.
“Can I ask you a question, Dr. Greene?”
“Absolutely. What d’ya got?”
He tapped on a yellow legal pad he’d been doodling on. “I remember you did some of your postgrad work on Capgras delusion.”
Her broad face went thoughtful. “Yes. Fascinating stuff.”
“Did you do anything on Cotard as well?”
Greene’s brow creased. “Cotard delusion?”
“Yes.”
A look of eagerness spread across her face. “Don’t tell me you have a walker.”
“I’m not . . . Wait, a what?”
“A walker. That’s what we called them.”
“Why?”
“Cotard patients walk in a daze, obviously. And they walk out on their lives. Listen, if you truly have one, you have to let me assist. I’ve never—”
“Why don’t you just give me the basics for now? What was the gender breakdown on the cases you looked at?”
“Mostly female. Is that your patient?”
“Confidential. Please continue.”
She made a face. “Most were in their twenties or thirties. Many had deep issues of abandonment relating to their families. One had been in an automobile accident and he believed he was dead. In fact, he swore that not only was he deceased, but that he was putrefying, that he could smell himself rotting at night. Kept a bottle of Febreze by his bedside, went through six or seven of them a month. Some thought organs had been taken from their bodies while they slept. I’d say about half had that delusion.”
“What did the CAT scans show?”
“Abnormalities in the prefrontal, usually. But not always.”
“How did they relate to family?”
“Generally speaking, very badly. One believed his mother was transporting his corpse to hell, when she had really just taken him to the Virgin Islands to try to cheer him up. In a couple of cases, the background showed there was parental neglect on a scale that’s pretty hard to believe. One day they woke up—literally, these ideas came to them almost always in the morning—and they no longer recognized their loved ones. But it was part of a constellation of problems. Is your patient bipolar?” Greene said.
“All I can tell you is there are no signs as of yet. Not schizophrenic either, I don’t think.”
“Some pharmaceutical approaches have worked.”
“I’ve read the literature. I may recommend one or two, depending. The individual isn’t a patient here yet.”
“Why not bring her in? I’d be happy to sit in.”
“That works.”
Jennifer’s eyes studied Nat. “The home situation. For that kind of trauma . . . there have to be some deep pathologies in the parent. Parents?”
Nat turned in his swivel chair to look out over the town in the direction of the Shan. “There’s a lot wrong there. Can’t say much more than that.”
Out of the corner of his eye, Nat saw that Jennifer had advanced to the corner of his desk and was now leaning on it.
“You did a home visit?”
Nat laughed.
“I appreciate your curiosity, Dr. Greene. Now get out of my office. And thank you.”
She got up, walked back to the office, swinging her shoulders, lost in thought. She turned at the doorway, as he’d known she would. She put her hands across the doorway and held them there. “Have you gone back further?”
“Past the father? I hope to. I have to get the situation stabilized before I start going back in time.”
She nodded. “Very deep pathologies, Dr. Thayer. Very.”
CHAPTER THIRTEEN
that night Nat Thayer brought home the printout he’d made at the hospital library. It was an article from the May 2002 issue of Neurology. He popped open a Stella and collapsed onto his leather couch, letting the foam surge up the bottleneck before taking his first sip.
He turned his attention to the article. Jules Cotard had been a neurologist—they wouldn’t call them psychiatrists for a number of years—working in Paris toward the end of the nineteenth century. He’d been born in 1840 and interned at the Hospice de la Salpêtrière. Funny name, thought Nat. The Saltpeter Hospital. He reached over for his iPad and Googled it and found the place was an old gunpowder factory that had been turned into one of Paris’s biggest hospitals, and one of its grimmest. A warehouse for prostitutes, the insane, the criminal-minded. It had been attacked during the September massacres of 1792, and some of its patients—the mad ones—had been pulled from their beds and slaughtered on the streets.
God, he loved this stuff. Psychiatry had been so much more interesting when they’d known only half as much about it.
Cotard had focused on stroke victims, diabetics, and—this was a departure—the delusional. That must have been what brought Mademoiselle X into his office in 1880, a woman who swore that she was dead. Cotard became fascinated by her case and called her affliction délire des négations. He was the first to describe the condition, so the medical authorities would give it the formal name Cotard delusion.
Mademoiselle X was clearly disturbed. Violently so. She not only denied the existence of God, which was a rather extreme position in Paris—even in 1880—but also told Cotard that she herself had died long ago. Interestingly, Cotard had done just what Nat had done with Becca; that is, pointed out the obvious. You’re alive, you’re standing, you’re breathing. Mademoiselle X had replied that she’d been cursed, and so had to wander the earth. Her bodily organs had been stolen—she didn’t say by whom—one by one. Her brain, nerves, chest muscles, intestines had all been taken from her body, leaving only the outer shell of skin and bones. Therefore, she felt no need to eat, as she was slowly decomposing and needed no nutrition.
I need a more detailed description of the interviews, Nat thought. Family background, a fuller listing of the symptoms, any earlier signs of psychoses.
He read on. The article had broadened out to a discussion of the delusion throughout history. Cotard was most common in elderly women suffering from schizophrenia, though cases had been found in the young, often accompanied by clinical depression and/or organic brain damage.
No mention of a hysterical form able to be passed on from one family member to another. Walter Prescott hadn’t detailed any accidents or head injuries in Becca’s past. He’d have to ask him about that. But somehow Nat didn’t think so . . .
This paper was mediocre at best, a bare-bones survey. He was surprised that the Neurology editors hadn’t demanded more detail. But the syndrome was so rare that it might have been pitched as the equivalent of a human-interest story, light reading for the clinical trade.
Nat tossed the paper on the hardwood floor, feeling a sore throat beginning to come on. He took a shot of NyQuil and crawled into bed in the top floor of the loft as gray light darkened the room. The rounded shape of Grant’s
Hill outside his windows began to merge with the dusk.
He felt the sheets, cool on his skin. The room began to grow warmer. As his mind drifted away, he wondered if he’d set the thermostat too high again.
An image floated into his head, a black-and-white image in a black frame. Something from a book? A family portrait? He couldn’t recall one like it in his house growing up, and the outlines of the figures seemed smudged, refusing to come into focus. Something from a museum maybe? He hadn’t been to a museum since he’d been in New York two years ago. He let the image float away.
Then the beginnings of a dream. The face that swam into view as he sank into a pleasant stupor was his aunt, Aunt Sophie, his father’s sister. Aunt Sophie. Funny, he’d always called her that, even when she’d become a surrogate parent to him. After the accident that killed both his parents.
Aunt Sophie had been a highly unwilling substitute for his father and mother. She didn’t mince words, old Soph. She had her own money from a family inheritance that had kicked in at thirty-five and, ten years later, wasn’t looking to take on a moody, sarcastic thirteen-year-old. As far as he could tell, Sophie had the perfect life down pat, the envy of her married friends. A closet full of designer dresses, beaus in Boston and New York, trips to Europe whenever she felt like it. She was brutally direct, beautiful in a dark aquiline way and not at all motherly.
He’d have to drop Aunt Sophie an e-mail over to France, where she’d moved “to get away from the Northam pond scum.” Alone. Always alone.
It was the thing that Sophie had said to him, that first night in her sleek apartment off State Street, which had stuck with him. It was two nights after his parents’ funeral, which he’d gotten through without shedding a single tear, much to the amazement and worry of his friends. But Sophie had tucked him into the bed in the strange room, which smelled of the perfumed clothes she’d stored there before he’d arrived, and studied his face on the first night of his new life.
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