“Transference?”
“Channing identified so strongly with her patient's feelings of despair that she experienced them herself.”
“And that's why she killed herself?”
“That's what this person was suggesting as a partial explanation.”
Annie hung there with her mouth open. “Wait a minute. Are you telling me that destructive feelings are just floating around and you can catch them?” Annie asked. “Like the flu?” I nodded. “Sounds like an X-File.”
“I guess it sounds pretty out there. But it does happen. A good therapist has to be able to walk in another person's shoes. When you empathize too much, you can end up with feelings that aren't your own. Even acting on those feelings.”
Annie put her hands on her hips. “Next thing, you'll be trying to sell me a bridge.” When she saw I was serious, she downshifted. “Okay, so let's suppose for a minute you're right. Why didn't she leave a note? She's got a seventeen-year-old daughter and she doesn't leave an explanation? I mean, a few words on a computer screen explain nothing.”
“I agree. It doesn't add up. Channing never got over her anger at her own mother for taking the easy way out, as she called it. She'd be furious if people thought she'd committed suicide, too.”
“So you can't let them think that.”
“But then they'll think Olivia did it.”
“You can't let them think that either.”
“Somehow, this has become my problem, hasn't it?”
“I think that's how you wanted it,” Annie observed. She had the makings of a fine psychologist.
“But if Channing didn't kill herself,” I said, “and Olivia didn't do it ⦔
“Then someone else did and engineered it to look like suicide. Did she have enemies?”
I barked a laugh. “A few. And I can't help wondering if all the rumors about her lack of clinical judgment, the drubbing she took in
JAMA
, if they're not all connected somehow.”
“A plot,” Annie said.
I knew she was pointing out how far-fetched this was starting to sound. But to me, it was just starting to make sense. “Dr. Smythe-Gooding suggested Channing was taking too much anxiety medication. In high doses, over a long enough period of time, that could have altered her judgment.”
Annie said what I was thinking: “I wonder if they have the autopsy results back yet?”
“I was over talking to MacRae today. He said they might have the final results tomorrow.”
Annie nodded. “I can get them. They probably have preliminary results now, even if they're not in final format.”
I pictured Annie and MacRae cozy in his office, reading the preliminary report together. Before I could stop myself, I said, “I forgot. You have an in over there.”
Immediately, I wished I could have reeled the words back in. As Gloria would have noted, I sounded like a bull elephant.
Annie recoiled. “And what's that supposed to mean?”
“I dunno,” I mumbled. “Just that you and he seem to be finding a lot of opportunities to ⦠collaborate.”
Annie shook her head. “I haven't had anyone else monopolizing my time, exactly,” she said pointedly.
I winced. Bad enough she was seeing someone else. But did it have to be MacRae? It wasn't just because he'd gotten the better of me in a fistfightâI'd ended up inhaling duck shit, my nose pressed into the boat dock and his foot grinding into my ass.
I said, “I thought you told me you two didn't have much in common, other than cops in the family.”
“His father died awhile back,” Annie said. “My mother and I went to the funeral. They got together, my mom and Mrs. MacRae, and it was like old times. They're both widows now. Getting back their friendship at this point in their lives is a gift.”
“And what about you and MacRae?” I heard the words before I'd decided to say them.
Annie crossed her arms over her chest and gazed at me. “He
and I go way back,” Annie said. “Though you know the question doesn't even deserve a response. And it's also none of your business.” Her eyes flashed with anger.
I couldn't see it. How could she be attracted to me and be interested in him at the same time? “If you don't think it's any of my business, then I guess you're right. It isn't.”
“What did you think I was going to do? Wait around, cooling my heels while you make up your mind whether you're ready for someone in your life?” I opened my mouth but nothing came out. Annie stood. “I'd better be going, before one of us says something we'll regret.” She carried her glass to the sink. “Keep the beer.”
Long after the front door shut, I sat there staring at the pair of unopened bottles of Sam Adams sitting forlorn on my kitchen table, my self-righteousness dissipating like a bad smell in the room. I felt like a jerk.
I WAS reviewing charts at the nurses' station Wednesday morning when Kwan appeared. Then, Jess hurried by, back straight, a tissue in her fist.
“Incompetence,” Kwan growled. “Why is it that nothing gets done around here unless you do it yourself?”
Gloria stalked over to us. “Bully,” she said to Kwan.
“Come on, Gloria, she's unreliable,” he appealed. Gloria's mouth tightened, skepticism pulling it down at the corners. “Out of her depth.”
“And what did she do?” I asked.
“It's what she didn't do,” Kwan answered. “She was supposed to enroll Lydia Small in the Zerenidine trial,” Kwan said. “Yesterday.”
Grief-stricken over Channing's death, Jess had left Monday afternoon and called in sick Tuesday. She'd returned today, only to face Kwan's wrath.
“Can't she still do it?” I asked.
Gloria answered, “You haven't heard? Last night Mrs. Small fell and broke her hip. She's been transferred to the General. Painful for Mrs. Small. Inconvenient for someone who shall go unnamed.”
If we'd been talking about anything else, Kwan would have had
a snappy comeback that would have defused the tension. Instead, he lowered his voice. “If she's not going to do her job, she's not going to make a good psychiatrist. We can't allow our emotions to rule. People's lives are at stake here.”
“People's lives or your research?” Gloria asked.
“Right now it's my research that's keeping this unit in the black.” Kwan gave us both a hard look.
“That may be,” Gloria retorted. “But I know for a fact it doesn't do squat for patient care. You're here the same amount of time you always are, only now you're juggling drug trials along with your patient load. You can't tell me one thing doesn't affect the other.”
“It doesn't look good when we can't fulfill our study enrollment,” Kwan huffed. “And
that
doesn't do squat for the hospital's reputation as a leading research institution.”
He marched off, fuming.
“He can be such an asshole,” Gloria muttered.
“I heard that,” Kwan shot back over his shoulder.
I sighed. I hoped the old Kwan, the one with a sense of perspective, wasn't on permanent leave.
I started down the hall, intending to go up to my office. Protecting the hospital's reputationâit was the same excuse Liam Jensen trotted out to keep Channing from airing something in public. A death. I wondered whose. Perhaps an adverse event that Jensen was all too willing to overlook?
I paused outside an oversize closet we use as a shared office for the half-dozen or so temporary and part-time staff on the unit. Jess was sitting there, staring at a blank computer screen.
“His bark is worse than his bite,” I said. I entered the room and sat down.
She lifted a trembling hand to her face. “He's right. I haven't been doing my job. I've been letting my personal feelings interfere.”
“Grief is a legitimate emotion, even for a psychiatrist. Don't be so hard on yourself.”
“I can't believe she's dead,” Jess said, her voice raspy and quiet. She was weeping. Tears flowed freely down her face. “I can't eat.
I can't sleep. I can't focus on my patients. I haven't been able to think about anything else.”
“Channing was more than a mentor to you.”
Jess stared at the windowless wall. “Channing has been my anchor, my safe haven, all through my mother's illness.”
“Your mother's been ill?” I asked.
“Early onset Alzheimer's. She was only fifty years old. A psychologist. She diagnosed herself, a year ago Thanksgiving, long before her doctors even admitted that she was sick.”
I'd seen too many families try to cope with the incomprehensible brutality of Alzheimer's, watching a soul slip away while the body remained vital and strong. “I'm sorry,” I said. “A terrible waste.”
“I remember when she stopped practicing. It was the day she came home with a black eye. Blamed it on her own poor judgment. She'd gone in to evaluate an agitated patient and sat down with him between her and the door. When he exploded, she couldn't get out.
“My father and I tried to keep her home.” Jess swiped the heel of her hand across one cheek, then the other. “But she was deteriorating fast. We hired caregivers during the day, but I never knew when there was going to be a crisis and I'd have to rush home. Seemed like every other minute I was dealing with someone flipping out.
“I could talk to Channing about how angry it made me, having to stretch myself thin, sacrifice any personal life, and at the same time how much I loved my mother. Putting her into an institution was one of the hardest things I've ever done.”
Jess touched the old-fashioned gold locket she was wearing on a chain around her neck. She rubbed the engraved surface between her thumb and forefinger. “Channing helped me get past the guilt. She was a friend, and more.”
Jess's bond with Channing sounded intense and personal. Jess idolized her. I wondered, what was Jess to Channing? A fledgling to be helped along? A daughter to be nurtured?
“I guess that's why this is hitting you so hard,” I said. “You're
grieving for a friend, but you're already emotionally raw from your mother's illness. It must feel like you're reliving that loss as well.”
Jess put her hand over her eyes. “I keep wanting to pick up the phone”âher voice brokeâ“call her.”
I touched her arm. “Do you feel up to working with patients?” I asked.
“I'm a psychiatrist,” Jess said, her voice ragged. She put her head back and ran her hands through her hair, intertwining the fingers behind her neck. “I'm supposed to know how to control my emotions. That's one of the things I've learned from my mother and from Channing. How to behave like a professional.” She straightened. “I need to work.”
“That's good. Because we need you to work.”
Jess gave me a weak smile.
I was on my way back to my office when Gloria and Kwan intercepted me. “Destler just called,” Gloria said. “He wants to see the three of us in his office. Now.”
“Shit,” I said. I'd heard about unit heads and their staffs getting the Summons. It was never good news. Had punching holes in our conference-room walls been a prelude to something worse? I looked at my colleagues. I'd resign before I'd let them decimate our staff.
“His underground must be working overtime,” Gloria said. “He's probably heard we're under census.”
Kwan expanded his chest and tugged on the ends of his jacket. “It appears the barbarians are at the gates again. Time to rally the troops.” That was the Kwan I knew and cherished.
The three of us trudged across the campus to the Administration Building, through the massive double doors and up the wide marble staircase to Destler's office. Virginia Hedgewick sat at her desk. She glanced up and pushed her wire-rimmed glasses to the bridge of her small, pointy nose. A fireplug of a woman who wore boxy
suits and sturdy shoes, Virginia had been at the Pearce for more years than anyone could remember, though she hadn't aged a day since I'd first met her ten years ago. She was affectionately known as The Hedgehog, in part because she looked like one, and in part because she'd rolled herself into a ball, figuratively speaking, while the institution changed around her. How she'd ended up as administrative assistant to the CFO of the hospital was a source of wide speculation.
“Sorry about the last-minute summons,” she said, glancing up at the wall clock. “I congratulate us all. You're practically on time. He's here, of course, but that's because he pulled another all-nighter. I know you folks always say that it's not healthy to be a workaholic, but if you ask me, Dr. Destler thrives on it.”
She opened the door to the inner sanctum. Destler was standing as we trooped in, his hands behind his back. He reminded me of a fat, round white peach with his pale pink skin and blue eyes rimmed by reddish eyelids. The room was thick with his sweetish odor, as though he carried a pocketful of aging apple cores.
From a Sargent portrait hanging behind Destler's massive mahogany desk, Miss Wilhelmina Pearce, granddaughter of Silas Pearce, the benefactor of the institute, stared down at us. Long strands of pearls cascaded over her ample bosom.
We sat. Destler remained on his feet. He had a chart on a metal easel alongside his desk. “This is excellent,” Destler enthused, not wasting a moment to acknowledge the tragedy that had occurred less than forty-eight hours earlier. “I'm glad you're all here. Sorry about the last-minute notice.”
“Good news?” I said, hoping to smoke whatever it was out into the open.
“As you know, over the last four years we've come through a difficult period.” That was an understatement. The average stay at the hospital had shrunk from a year to twenty days. Managed-care patients had replaced most of our wealthy clientele. “We're constantly fine-tuning.”
He turned to his chart. The last column was labeled COST
EFFECTIVENESS, and it had red and black checks all the way down. I scanned quickly to find our unit. We were at the bottom with a red check-minus. I didn't need his M.B.A. to know that wasn't good.
Destler tapped an anemic-looking green bar on his chart. “I'm afraid throughput on the Neuropsychiatric Unit is lower than anywhere else in the hospital.”
Throughput was The Number at senior staff meetings. It represented how many patients you could push through, given your resources, in a standard amount of time. If patients were the lifeblood of the unitâa turn of phrase popular with administrators like Destlerâthen improving throughput meant higher blood pressure for the unit as an organism. We could handle that only up to a point before the staff had a collective stroke.
“That doesn't surprise me,” I said. “After all, our patients are neurologically impaired. You can't just pump a couple of pills into them and send them on their way.”
“All patients need special care, Peter,” Destler said, giving me his benign Buddha smile.
“And they need specially trained staff,” Gloria added, rising partway out of her chair. “Remember what happened to Carol Tillingham.” We all remembered the nurse who'd been floated onto our unit one day and tendered her resignation the next. “It wasn't her fault. Regular psych nurses get eaten alive with patients like ours.
“I know how you feel, Nurse Alspag,” Destler said. I could feel Gloria twitching. She reacts to patronizing the way the rest of us do to poison ivy. Destler didn't notice. “That's why I asked you here to brainstorm with me. Better to stay ahead of the curve and avoid the kind of unpleasantness you all experienced before I came aboard.”
That shut us up. When Destler had arrived at the Pearce, the place had been a war zone. Cost cutting hadn't kept pace as reimbursements shrank. There were ominous rumblings of impending bankruptcy, layoffs, mergers. The surrounding community was
in a tizzy as the board considered selling off land to housing developers. It had been everything I could do to keep Gloria from accepting one of the job offers she had.
“And with all three of you,” he beamed, “we should be able to come up with an excellent solution. So let's think on it.”
There wasn't much to think on. To make his little bar creep up, we'd need to increase the number of beds, decrease the number of staff, or shorten the length of stayâpreferably, all of the above.
Destler suggested, “We could broaden your mission, combine the Neuropsychiatric Unit with Geriatrics andâ”
Kwan cut him off. “Just because many of our patients are older, that doesn't mean you can mix them in with the general geriatric patient.” He was talking real slowly and leaving spaces between his words, the way he does when he tries to explain the fine points of men's fashions to me or baseball to Gloria. “Patients who have dementia don't mix with patients who don't.”
Destler pursed his lips. “I can see your concern.” Kwan started to say something, but Destler held up his hands. “Just for a moment, let's consider the benefits. With a larger, more diverse core population, we can probably eliminate a psychiatrist, maybe even two.” There went Kwan's job. “Bring in a clinical nursing supervisor.” So much for Gloria's. “And then, what role does a neuropsychologist play in all of this now, really?” He raised an eyebrow at me. “More and more, psychiatric hospitals are about
medicine
these days.”
As opposed to what, I wondered.
Destler chuckled. “The one bright spot is the research you have going on.”
Kwan shot me a triumphant look.
“I'm encouraging more units to get involved in clinical trials. That gives us additional resources to work with. And the pharmaceutical companies are excellent partners. Just this morning, in fact, I got a call from one of the VPs at Pharmacom. He was calling to say how pleased they are with the Zerenidine trial.” He paused. I waited for the shoe to drop. “They did have one concern.”