“I do. But the challenge now is to find out what’s safe for Melissa.”
“Yes,” he said. “Of course.” Avoiding my glance.
I called the waiter over and ordered another espresso. When it arrived, along with more hot water for Dutchy, he wrapped his hands around his teacup but didn’t drink. As I took a sip he said, “Forgive my presumption, Doctor, but what, in your educated opinion, is the prognosis? For Melissa.”
“Given family cooperation, I’d say good. She’s motivated and bright and has a lot of insight for someone her age. But it’s going to take time.”
“Yes, of course. Doesn’t anything worthwhile?”
Suddenly he pressed forward, hands flapping, fingers wiggling. An odd bit of fluster for such a staid man. I smelled bay rum and shrimp. For a moment I thought he was going to grab my fingers. But he stopped himself abruptly, as if at an electrified fence.
“Please help her, Doctor. I pledge everything in my power to aid your treatment.”
His hands were still in the air. He noticed it and gave a look of chagrin. Ten fingers plummeted to the table like gun-shot ducks.
“You’re very devoted to this family,” I said.
He winced and looked away, as if I’d exposed some secret vice.
“As long as she comes in, I’ll treat her, Mr. Dutchy. What you can do to help is tell me everything I need to know.”
“Yes, of course. Is there something else?”
“McCloskey. What does she know about him?”
“Nothing!”
“She mentioned his name.”
“That’s all he is to her— a name. Children hear things.”
“Yes, they do. And she’s heard plenty— she knows he attacked her mother with acid because he didn’t like her. What else has she been told about him?”
“Nothing. Truly. As I said, children overhear— but he’s not a topic of conversation in our household.”
“Mr. Dutchy, in lieu of accurate information, children make up their own facts. It would be best for Melissa to understand what happened to her mother.”
His knuckles were white around the cup. “What are you suggesting, sir?”
“That someone sit down and talk with Melissa. Explain to her why McCloskey had Mrs. Dickinson attacked.”
He relaxed conspicuously. “Explain why. Yes, yes, I can see your point. There’s just one problem.”
“What’s that?”
“Nobody knows why. The bastard never let on and nobody knows. Now if you’ll excuse me, Doctor, I really must be going.”
5
On Monday, Melissa was in a great mood, cooperative and polite, no more testing of limits, no remnants of the last session’s power struggle. But reserved, less eager to talk. Asking if she could draw instead.
The typical new patient.
As if all that had happened till now had been some kind of probation and this was the real beginning.
She started with the same kind of benign productions she’d presented to me during our first session, then progressed quickly to deeper pigments, sunless skies, patches of gray, foreboding images.
She sketched sad-looking animals, anemic gardens, forlorn children in static poses, flitting from subject to subject. But by the second half of the session she found a theme that she stayed with: a series of houses without doors or windows. Bulky, drunkenly listing, visceroid structures fashioned of painstakingly rendered stone and set amidst groves of skeletal trees under a gloomy, crosshatched sky.
Several sheets later she added gray shapes approaching the houses. Gray that turned to black, and became human. Men-shapes wearing hats and long coats and bearing lumpy sacks.
Drawing with such fury that she ripped the paper. Starting over.
Pencils and crayons diminished to nubs, consumed like kindling. Every finished product was shredded with glee. She worked that way for three weeks straight. Leaving the office without comment, at session’s end, marching like a little soldier.
By the fourth week she began to round out the last ten or fifteen minutes with silent stretches of game playing: Chutes and Ladders, Crazy Eights, Go Fish. No conversation. Competing with great determination and little apparent pleasure.
Sometimes Dutchy brought her to the office, but increasingly it was Hernandez, who still regarded me with a jaundiced eye. Then other chaperons began to appear: a series of dark, lean youths— young men who smelled of work-sweat and looked so alike that, in my mind, they became interchangeable. I learned from Melissa they were Hernandez’s five sons.
Alternating with them was a big, doughy woman about Dutchy’s age with tightly braided hair and cheeks like wind-bellows. The owner of the deep Gallic voice. Madeleine, the cook/maid. Invariably, she arrived sweating and looking fatigued.
All of them slipped away the moment Melissa stepped over the threshold, returning to pick her up precisely at session’s end. Their punctuality— and avoidance of eye contact— smacked of Dutchy’s tutelage. Dutchy, the few times he showed up, was the most adroit at escape, not even stepping into the waiting room. No follow-up on my request to collect data. I should have been resentful.
But as time went on, it bothered me less and less.
Because Melissa seemed to be getting better. Without him. Without any of them. Ten weeks since therapy had started and she was a different child, unburdened, conspicuously calm, no more kneading, no more pacing. Allowing herself to smile. Loosening up as she played. Laughing at my repertoire of grade-school jokes. Acting like a kid. And though she continued to resist talking about her fears— about anything substantive— her drawings had become less frantic, the sack-men were vanishing. Windows and doors sprouted like buds on the stone faces of houses that now stood plumb-straight.
Drawings that she preserved and presented to me with pride.
Progress? Or just a seven-year-old putting on a happy face for her therapist’s sake?
Knowing what she was like outside the office would have helped my assessment. But those who could tell me shunned me as if I were a virus.
Even Eileen Wagner was out of the picture. I’d phoned her office several times and gotten her answering service, despite being careful to call during business hours. Slow practice, I supposed. She was probably moonlighting to make ends meet.
I called the Medical Staff Office at Western Pediatrics to find out if she had another job. They had nothing else listed. I phoned her office again, left messages that went unanswered.
Strange, considering the dedication she’d shown in arranging the referral, but everything related to this case smacked of strange, and I’d gotten used to it.
Remembering what Eileen had told me about Melissa’s fulminating school phobia, I asked Melissa the name of her school, looked up the number, and called it. Presenting myself as her doctor and not clarifying when the clerk assumed pediatrician, I asked to speak with Melissa’s teacher— a Mrs. Vera Adler, who confirmed that Melissa had missed a good deal of school early in the semester but since then her attendance had been perfect and her “social life” seemed better.
“Was she having social problems, Mrs. Adler?”
“I wouldn’t say that, no. I mean, she was never a problem of any sort, Doctor. But she wasn’t the most outgoing child— kind of shy. Off in her own world. Now she mixes more. Was she ill before, Doctor?”
“Just the usual stuff,” I said. “Just following up.”
“Well, she’s doing fine. We were starting to worry, she was absent so much, but she’s fine now. A very nice, extremely bright little girl— she tests out on the Iowa at the ninety-ninth percentile. We’re so glad she’s gotten adjusted. . . .”
I thanked her and hung up, heartened. Said to hell with the grown-ups and continued to do my job.
By the fourth month of treatment, Melissa was treating the office as if it were a second home. Sauntering in smiling, making a beeline for the drawing table. She knew every cranny, could tell when a book had been moved from its usual place, was quick to put
it back. Restoring. Showing an unusual eye for detail that jibed with the perceptual sensitivity Dutchy had described.
A child whose senses ran on full throttle. For her, life would never be boring. Could it ever be tranquil?
As the fifth month began she announced she was ready to talk again. Informing me that she wanted to be a team— just like I’d said at the beginning.
“Sure. What would you like to work on?”
“The dark.”
I rolled up my sleeves, ready to muster every kernel of wisdom I’d gathered since grad school. First I taught her to recognize the physical warning signs of anxiety— how she felt when the fear came on. Then I trained her in deep relaxation that evolved into full-blown hypnosis because of her ease at drifting into imagery. She learned self-hypnosis in a single session, could sink into trance within seconds. I supplied her with finger signals she could use to communicate while under, and finally began the desensitization process.
Seating her in a chair, I told her to close her eyes and imagine herself sitting in the dark. A dark room. Watching as her body grew taut and her index finger popped up, I warded off the tension with suggestions of deep calm and well-being. When she’d relaxed once more, I had her return to the dark room. On/off, over and over again, until she could tolerate the image. After a week or so, she’d mastered the imaginary darkness and was ready to tackle the real enemy.
I drew the outer office drapes and manipulated the light-switch rheostat, getting her accustomed to gradually increasing dimness. Stretching the time that she sat in partial darkness and reacting to evidence of tension with instructions for deeper and deeper relaxation.
Eleven sessions into the treatment, I was able to pull the blackout drapes closed, plunging both of us into total darkness. Counting the seconds out loud and homing in on the sound of her breathing. Ready to move in at the merest catch or quickening, determined she’d never experience prolonged anxiety.
Rewarding each success with high praise and low art— cheap plastic toys that I bought in bulk at the five-and-dime. They thrilled her.
By the end of the month, she could sit in blackness— which sometimes made me lose my balance— for an entire session, free of tension, chatting about school.
Soon, she was as nocturnal as a bat. I suggested it might be a good time to work on her sleep. She smiled and agreed.
I was especially eager, because this was my bailiwick. During my internship I’d been presented with several cases of children with chronic night terrors and had been impressed with the level of disruption the episodes caused in kids and their families. But none of the psychologists or psychiatrists at the hospital knew how to treat the disorder. Officially, there was no treatment other than tranquilizers and sedatives whose effects were unpredictable in children.
I went to the hospital library, chased down references, found plenty of theory but nothing about treatment. Frustrated, I sat for a long time thinking and decided to try something outlandish: operant conditioning. Bald behavior therapy. Reward the children for not having terrors and see what happened.
Simple-minded— almost crude. Theoretically, it made no sense. As the senior staff was quick to inform me over their fuming pipes. How could unconscious behavior— arousal from profoundly deep sleep— be consciously manipulated? What could voluntary conditioning accomplish in the face of hard-wired deviance?
But research had emerged recently that suggested greater voluntary control over body function than had ever been imagined: patients learning how to raise and lower skin temperature and blood pressure, even mask severe pain. At Psychiatric Case Conference, I asked for permission to try to decondition night terrors, arguing that there was nothing to lose. A lot of head-shaking and words of discouragement, but consent was granted.
It worked. All my patients got better and stayed better. The senior staff started implementing my plan with their patients and achieved similar results. The chief psychologist told me to write it up for a scientific journal, listing him as co-author. I sent the article in, overcame skeptical reviewers with columns of numbers and statistical tests, and got published. Within a year other therapists had begun to replicate my findings. I received requests for reprints and phone calls from all over the world, was asked to give lectures.
Had been doing just that the day Eileen Wagner had approached. It was the lecture that had led me to Melissa.
And now Melissa was ready to be treated by the expert. But there was a problem: The technique—my technique— depended upon family cooperation. Someone needed to monitor the patient’s sleep pattern precisely.
I buttonholed Dutchy on a Friday afternoon, before he had a chance to dash away. He gave a resigned look and said, “What is it, Doctor?”
I handed him a pad of graph paper and two sharpened pencils and, adopting the demeanor of a full professor, gave him his orders: Before bedtime, Melissa was to practice relaxation. He wasn’t to badger or remind her; it would be her responsibility. His job was to record the occurrence and frequency of night terrors. Nights without terrors were to be rewarded the following morning with one of the trinkets she seemed to love so much. Nights following terrors were not to be commented on.
“But, Doctor,” he said, “she’s not having them.”
“Not having what?”
“The terrors. Her sleep’s been perfectly calm for weeks. The bed-wetting’s also ceased.”
I looked over at Melissa. She’d stepped behind him. Half a small face peeked out. Enough for me to see the smile.
Pure joy. Reveling in her secret, as if it were confection.
That made sense. The way she’d been brought up, secrets were the coin of the realm.
“The change has really been quite . . . remarkable,” Dutchy was saying. “That’s why I didn’t feel it was necessary to—”
I said, “I’m really proud of you, Melissa.”
“I’m proud of you, Dr. Delaware,” she said, starting to giggle. “We’re an excellent team.”
• • •
She continued to get better more rapidly than science could explain. Leapfrogging over my clinical games plans.
Healing herself.
Magic, one of my wiser supervisors had once said. Sometimes they’ll get better and you won’t know why. Before you’ve even started doing what you think is so goddam clever and hotshot scientific. Don’t fight it. Just put it down to magic. It’s as good an explanation as any.
She made me feel magical.
We never got into the topics I’d thought essential to explore: death, injury, loneliness. A Mikoksi with acid.
Despite the frequency of sessions, her chart was thin— I had very little to record. I began to wonder if I was functioning as anything more than a high-priced babysitter, told myself there were worse things to be. And, faced with the onslaught of difficult cases that seemed to grow each month as my practice burgeoned, I was thankful for the chance to be passive and magical for forty-five minutes a day, three times a week.
After eight months she informed me that all her fears were gone. Risking her wrath, I suggested reducing our time together to two sessions a week. She agreed so readily that I knew she’d been thinking the same thing.
Nevertheless, I expected a few backward steps as the loss sank in and she attempted to buy herself time and attention. It never happened, and at year’s end she was down to one session per week. The quality of the sessions changed, too. More casual. Lots of game-playing, no drama.
Therapy winding itself down. Triumph. I thought Eileen Wagner would like to know, made one more attempt to reach her, got a disconnected-number recording. Called the hospital and learned she’d closed her practice, resigned from the staff, left no forwarding address.
Puzzling. But she wasn’t my concern. And one less report to write wasn’t something I’d mourn.
For such a complicated case, it had turned out surprisingly simple.
Private Eyes Page 7
