I grabbed a rag from under the seat and swiped the moisture off the windshield. Annie arranged the flaps of her coat and shivered. “Next time, let's skip the party.”
“We'll pick up where we left off, at my house, with dinner and a good bottle of wine.”
“Um-hmm,” Annie purred. “And no beepers.”
“No beepers,” I said, kissing her lightly on the mouth. “This is completely infuriating,” I said, my face close to hers.
“My mother always said, all good things come to those who wait.”
“Bullshit.”
I dropped Annie at her apartment, taking time for one last kiss. Regretfully, I watched her scurry up her front steps and disappear inside.
The drive across Somerville was uneventful. I turned onto the landscaped grounds, past the gold embossed sign. PEARCE PSYCHIATRIC INSTITUTE EST. 1804. The serpentine access road was deserted, the few remaining elms like a ghostly honor guard.
I parked, opened the car door, and heaved myself out. The emptiness was palpable. Only a few other cars were in the lot, clustered under a flickering streetlight. I inhaled the metallic, bitter cold and turned my collar against the wind.
I hurried up the hill. The rolling lawns were threadbare with patches of ice waiting to melt. Austere Victorian buildings that housed the units were right at home in the bleakness, but more recent additions, redbrick-and-glass monstrosities, looked naked and uncomfortable without any foliage to soften their contours.
I hopped onto the back porch and let myself in. A blast of overheated
air hit me in the face. Instantly, my glasses fogged. I wiped them as I strode down the hall, past the dining area where the patients ate, past the once-gracious living room with its grand piano and not-so-grand vinyl sofas and chairs. In the glare of fluorescent lighting, the pink walls were nearly the color of vomit.
A thin voice warbled from the reception area, “I left my hearrrrt ⦔
I could hear Nurse Gloria Alspag's coaxing counterpointâ“Mr. Fleegle, you can't stay out here without anything on”âwhich prepared me for the scene when I rounded the bend and got past the half-dozen patients who were watching the show.
Though I'm nominally in charge, Gloria is the backbone of the unit. She looked very tired, her shirttails hanging from her tan trousers, her short hair standing up as if she'd been running her fingers through it in frustration. She was waving a blanket like a bullfighter brandishing a cape, while skinny old Samuel Fleegle, stark naked, nimbly avoided it.
A night nurse herded two patients back to their room, while three more drifted out to take their places.
“Olé!” one of the watching patients cried. Others shouted encouragement.
“ ⦠in San Francisco ⦔ Mr. Fleegle held a mop handle and crooned into it. “Above the blue ⦔ There were little bits of white hair on his chest, like wisps of cotton balls, stuck to it. He was concave in the front and behind, the muscles atrophied in his derriere and chest. His face was flushed as his voice gathered strength.
Gloria gave me an exasperated look. “Mr. Fleegle, you're waking everyone up,” she said reasonably. “Please, sit down and be quiet.”
Just then Mr. Fleegle saw me standing there in my good suit. He raised his hand and wagged an index finger. “Waiter,” he said, his voice aloof and polite. “Could you get us two Manhattans?” He licked his lips. “With bourbon.”
I approached him and put my arm around his frail shoulder. “Mr. Fleegle, I'm so sorry, but we can only serve you at the bar,”
I told him, stepping into his delusion, hoping that in doing so, I'd be able to lead him out of it. “Why don't you sit here?” I maneuvered him gently over to the geri-chair Gloria had been trying to get him into.
Mr. Fleegle willingly sat down and saluted me. He seemed unfazed as Gloria shoved the tray in place to keep him from getting up.
He finished the song, holding one last tremulous note. Then, there was blessed silence and a scattering of applause. He waited expectantly, tapping his fingers on the tray in time to invisible music.
Gloria wheeled him into the dining room, where we could at least close the door. “How long's he been like this?” I asked.
“A couple of hours. Ever since his brother came in this evening, he's been getting happier and happier. We found an empty pint of Four Roses in his room. I've tried everything.” Gloria sank down into a chair and rested her head on the table. Mr. Fleegle had started the song over from the beginning.
It didn't seem as if Mr. Fleegle, after a lifetime as an alcoholic, should have had such an extreme reaction to a pint of booze. Still, metabolism changes as a person ages. Then I remembered. “Didn't Kwan put Mr. Fleegle on the Zerenidine trial?” I asked.
“Started him about a week ago.”
“That's probably it. Seems as if the drug binds to the same receptor sites that metabolize alcohol. Makes the alcohol much more potent and, I'm afraid as we're about to see, for a much longer period of time. Good thing he's a happy drunk.”
Gloria lifted her head off the table. “How much longer?”
I shrugged. “An hour. Maybe a few.”
“A few?” Gloria said.
“I need to help get the rest of the patients back to bed. Besides, there's really nothing to do but wait it out. He should be fine by breakfast, though he'll have a helluva headache.”
Mr. Fleegle's voice reached another quavering crescendo. Gloria moaned. “And so will I.”
SUNDAY, I awoke around noon, alone in bed. It wasn't what I'd hoped for. As I lay there, Channing's argument with Liam Jensen came back to me. The anger, the threats. I ran their words through my head. Most of it didn't make much sense. Someone was dangerously incompetent. Someone was dead? The only clear part was that whatever it was, Jensen wanted to hush it up, and Channing didn't.
I was still lying there when the phone rang. It was Channing.
“So, what did you think?” she'd asked, her voice taut with anxiety.
“About Olivia or Liam Jensen?”
“Never mind Liam. That's under control.”
“He didn't seem under control.”
“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, andâ”
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 Ritzâall 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 cupâor was it two?âa 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 nightâ”
“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 eventâthat'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”âhe nailed me with a hard lookâ“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.â” 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 bedsâa 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.