Cindy said, “Daddy can’t stay, Cass. Bummer, huh?”
“Dah-dee.”
Chip gave Cassie’s chin a gentle tweak. She continued playing with his beard. “I’ll try to kick by later this evening. Stay as long as you need me.”
“Great,” said Cindy.
“Dah-dee.”
“Dah-dee,” said Chip. “Dah-dee love you. You cute.” To Cindy: “Not a good idea at all, coming for two minutes. Now I’m really gonna miss you.”
“We miss you too, Daddy.”
“I was in the neighborhood,” he said. “So to speak—this side of the hill, at least.”
“The U?”
“Yup. Library duty.” He turned to me: “I teach over at West Valley C.C. New campus, not much in terms of reference resources. So when I have some serious research to do, I go over to the university.”
“My alma mater,” I said.
“That so? I went to school back east.” He tickled Cassie’s belly. “Get any sleep at all, Cin?”
“Plenty.”
“Sure?”
“Uh-huh.”
“Want some herb tea? I think I’ve got some chamomile in the car.”
“No, thanks, hon. Dr. Delaware has some techniques to help Cassie deal with the p-a-i-n.”
Chip looked at me while stroking Cassie’s arm. “That would be terrific. This has been an incredible ordeal.” His eyes were slate-blue with a slight droop, very deep-set.
“I know it has,” I said.
Chip and Cindy looked at each other, then at me.
“Well,” I said, “I’ll be shoving off now. Come by to see you tomorrow morning.”
I bent and whispered goodbye to Cassie. She batted her lashes and turned away.
Chip laughed. “What a flirt. It’s inborn, isn’t it?”
Cindy said, “Your techniques. When can we talk about that?”
“Soon,” I said. “First I need to get a rapport with Cassie. I think we did pretty well today.”
“Oh. Sure. We did great. Didn’t we, pudding?”
“Is ten o’clock a good time for you?”
“Sure,” said Cindy. “We’re not going anywhere.”
Chip looked at her and said, “Dr. Eves didn’t say anything about discharge?”
“Not yet. She wants to keep observing.”
He sighed. “Okay.”
I walked to the door.
Chip said, “I’ve got to be running, myself, Doctor. If you can hold on for one sec, I’ll walk out with you.”
“Sure.”
He took his wife’s hand.
I closed the door, walked to the nursing station, and went behind the desk. Vicki Bottomley was back from the gift shop, sitting in the unit clerk’s chair, reading RN. No one else was around. A box wrapped with Western Peds gift-shop paper sat on the counter, next to a coil of catheter tubing and a stack of insurance forms.
She didn’t look up as I lifted Cassie’s chart from the rack and began leafing through. I skimmed through the medical history and came upon Stephanie’s psychosocial history. Wondering about the age difference between Chip and Cindy, I looked up his biographical data.
Charles L. Jones III Age: 38. Educational level: Master’s degree. Occupation: College professor.
Sensing someone looking at me, I lowered the chart and saw Vicki whipping her head back toward her magazine.
“So,” I said, “how were things down in the gift shop?”
She lowered the journal. “Is there something specific you need from me?”
“Anything that would help me work with Cassie’s anxiety.”
Her pretty eyes narrowed. “Dr. Eves already asked me that. You were right here.”
“Just wondering if something occurred to you in the meantime.”
“Nothing occurred,” she said. “I don’t know anything—I’m just the nurse.”
“The nurse often knows more than anybody.”
“Tell it to the salary committee.” She lifted the magazine high, concealing her face.
I was considering my response when I heard my name called. Chip Jones strode toward me.
“Thanks for waiting.”
The sound of his voice made Vicki stop reading. She straightened her cap and said, “Hi, Dr. Jones.” A sweet smile spread across her face, honey on stale bread.
Chip leaned on the counter, grinned, and shook his head. “There you go again, Vicki, trying to promote me.” To me: “I’m A.B.D.—that’s ‘all but dissertation,’ Vicki—but generous Ms. Bottomley here keeps trying to graduate me before I earn it.”
Vicki managed to work up another dirt-eating smile. “Degree or not, what’s the difference?”
“Well,” said Chip, “it might make quite a difference to someone like Dr. Delaware here, who genuinely earned his.”
“I’m sure it does.”
He heard the acid in her voice and gave her a quizzical look. She got flustered and looked away.
He noticed the gift box. “Vicki. Again?”
“It’s just a little something.”
“That’s very sweet of you, Vicki, but totally unnecessary.”
“I wanted to, Dr. Jones. She’s such an angel.”
“That she is, Vicki.” He smiled. “Another bunny?”
“Well, she likes them, Dr. Jones.”
“Mister, Vicki—if you insist on using a title, how about Herr Professor? It has a nice classical ring to it, wouldn’t you agree, Dr. Delaware?”
“Absolutely.”
He said, “I’m prattling—this place addles me. Thank you again, Vicki. You’re very sweet.”
Bottomley went scarlet.
Chip turned to me. “Ready if you are, Doctor.”
We walked through the teak doors into the hustle of Five East. A child being wheeled somewhere was crying, a little boy hooked to an I.V. and turbaned with bandages. Chip took it in, frowning but not talking.
As we approached the elevators he shook his head and said, “Good old Vicki. What a shameless brownnoser. But she got kind of uppity with you back there, didn’t she?”
“I’m not her favorite person.”
“Why?”
“I don’t know.”
“Ever have any hassles with her before?”
“Nope. Never met her before.”
He shook his head. “Well, I’m sorry for you, but she seems to be taking really good care of Cassie. And Cindy likes her. I think she reminds Cindy of her aunt—she had an aunt who raised her. Also a nurse, real tough egg.”
After we passed a gaggle of dazed-looking medical students, he said, “It’s probably territorial—Vicki’s reaction to you. Some kind of turf battle, wouldn’t you say?”
“Could be.”
“I notice a lot of that kind of thing around here. Possessiveness over patients. As if they’re commodities.”
“Have you experienced that personally?”
“Oh, sure. Plus, our situation heightens the tension. People think that we’re worth kissing up to, because we’ve got some sort of direct line to the power structure. I assume you know who my dad is.”
I nodded.
He said, “It rubs me the wrong way, being treated differently. I worry about it leading to substandard care for Cassie.”
“In what way?”
“I don’t know, nothing specific—I guess I’m just not comfortable with being an exception. I don’t want anyone missing something important because they hung back or broke routine out of fear of offending our family. Not that Dr. Eves isn’t great—I have nothing but respect for her. It’s more the whole system—a feeling I get when I’m here.”
He slowed his pace. “Maybe I’m just talking through my hat. The frustration. Cassie’s been sick with one thing or another for virtually her whole life and no one’s figured out what’s wrong yet, and we also … What I’m saying is that this hospital’s a highly formalized structure and whenever the rules change in a formalized structure, you run the risk of structural cracks. That’s my field of interest: F
ormal Org—Formal Organizations. And let me tell you, this is some organization.”
We reached the elevators. He punched the button and said, “I hope you can help Cassie with the shots—she’s gone through an absolute nightmare. Cindy, too. She’s a fantastic mother, but with this kind of thing, self-doubts are inevitable.”
“Is she blaming herself?” I said.
“Sometimes. Even though it’s totally unjustified. I try to tell her, but …”
He shook his head and put his hands together. The knuckles were white. Reaching up, he rotated his earring.
“The strain on her’s been incredible.”
“Must be rough on you, too,” I said.
“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 really 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.”
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