A Breath After Drowning

by Alice Blanchard

  The harsh fluorescent lights illuminated a multitude of scars and scabs on the girl’s undernourished body. Kate counted at least fifty old injuries, along with some newer abrasions—mostly scrapes and small puncture wounds. Whether these were self-inflicted or evidence of abuse had yet to be determined.

  Yvette rolled her eyes in disgust as she finished bandaging the fresh wounds. “I gave her a Children’s Tylenol for the pain. I’ll put her on one-to-one until she’s admitted.”

  “If she’s admitted,” Kate corrected.

  “If that child isn’t admitted by the end of the day, I’ll call social services myself.” She left in a huff.

  Once they were alone, Maddie asked, “What kind of doctor are you?”

  “A psychiatrist.”

  “Oh.” The girl scrunched her nose.

  “Why? What’s wrong?”

  “I don’t like psychiatrists.”

  Kate smiled. “Why not?”

  Maddie shrugged. “Just don’t.”

  “How many psychiatrists have you been to, Maddie?”

  “Three.”

  “Back in Wilamette?”

  “Blunt River. At the hospital there.”

  “And you didn’t like any of them?”

  “The worst was Dr. Quillin. He smelled funny.”

  Kate couldn’t help laughing. “Well, the truth is, us doctors are only human. Despite our white coats and fancy degrees, we all have failings. For instance, my stomach growls when I’m hungry. And I mean… it can get really loud.”

  “Mine too.” Maddie giggled.

  “It’s embarrassing.”

  “Mine sounds like a lion.”

  “Mine’s more of a ticked-off badger.”

  They had a good laugh over that.

  “So tell me about Dr. Quillin. Besides the funny smell.”

  Maddie wrinkled her nose. “He used to call himself a ‘professional listener.’ I was supposed to do all the talking, but Mommy said, ‘I’m not paying you to listen! I’m paying you to fix her!’ So she took me to see Dr. Hoang. But he couldn’t fix me either. And neither could Dr. Madison.”

  “Actually,” Kate told her, “psychiatrists aren’t supposed to fix people.”

  Maddie seemed surprised. “They’re not?”

  “No. We don’t have that kind of power. See?” She held up her hands. “No magic wands. No fairy dust. I can’t cast any spells. I can’t fix you all by myself, Maddie. But I can help you fix yourself. And I know for a fact that it works, because I’ve seen it with my own eyes.”

  The girl smiled hopefully.

  “Can I ask you something?” Kate said. “Do you ever see things other people don’t? Any visions? Angels? Perhaps something scary?”

  Maddie shook her head.

  “What about voices? Do you hear voices in your head?”

  “Only one,” she admitted.

  “One voice? What does it say?” Kate asked.

  “Bad stuff.”

  “Like what?”

  “It tells me I’m stupid and dumb and smelly. Stuff like that.”

  “Ah.” Kate nodded. “And what does it sound like?”

  “Like… um…”

  “Is it masculine? Feminine?”

  Maddie shrugged.

  “Boy? Girl? Soft? Childlike?”

  She shook her head mutely.

  “More like a grown-up?”

  Maddie nodded.

  “Grown-up? Okay. But you don’t know if it’s male or female?”

  No response.

  “Does it sound like a character on TV?” Kate persisted. “Or maybe a person you know in real life? A teacher or relative? Your dad perhaps?”

  Maddie said nothing. There were goosebumps on her legs.

  Kate sensed the child knew exactly who the voice sounded like, but wasn’t ready to reveal it just yet. “Does the voice ever tell you to hurt yourself?”

  “I’m cold.”

  “Maddie…?”

  “It’s cold in here.”

  Kate decided not to press it. Sometimes you had to pick your battles. New patients had a tendency to scare easily, and if you pushed them too hard in the beginning, you risked losing them forever.

  She draped a hospital blanket over Maddie’s legs. “We’ll talk about this some other time. You can get dressed now. The nurses’ aide will be right in. Are you hungry?”

  Maddie perked up. “My stomach’s been growling,” she said excitedly, putting her hands over her belly. “Did you hear it?”

  Kate picked up the patient chart and walked to the door. “The nurses’ aide will take you to the cafeteria. They have pizza and everything.” She turned and left, scribbling notes, but once she got outside the exam room, she realized her mistake. She’d let her patient down. Their one connection— their growling stomachs—hadn’t merited any reaction from her. By not sharing Maddie’s inside joke, Kate had responded like a typical doctor. Worse, she’d responded like her father. And that cut to the bone.

  At the same time, you couldn’t get too close to your patients, or they might become confused. Roles merged. Lines blurred. How close was too close? It was up to Kate to maintain a healthy doctor–patient relationship and define the boundaries. But she could just hear the gears in Maddie’s busy brain ticking away. Why didn’t you take me to the cafeteria, Dr. Wolfe? Why are you abandoning me just when I was starting to like you? Kate was supposed to draw the most deeply personal information out of this child, and yet she wasn’t supposed to get too personal. It was a balancing act.

  The on-duty aide, Claire, was busy texting her boyfriend in the break room. Kate filled her in on Maddie’s condition and asked her to escort their new patient down to the cafeteria. Then she went upstairs to her third-floor office and called James.

  “Guess what? I’ve got a new patient,” she told him. “A cutter. She hears voices. Well, one voice at least. An adult-sounding voice of indeterminate gender. Her mother dropped her off this morning and left her here to fend for herself…”

  “So… right back on the horse, eh?” he said thickly.

  She could tell he wasn’t happy about it. “She asked for me,” Kate explained. “We met earlier this morning. Turns out she doesn’t like male psychiatrists. They smell funny, among other things. But hey, it’s a good thing, right? It’ll keep me out of trouble.”

  “I guess,” he muttered.

  She grew defensive. “I can’t just sit around twiddling my thumbs.”

  “No one’s suggesting any thumb-twiddling.”

  “Besides, she needs me.”

  “They all need us, Kate. Don’t get sucked into that trap. Anyway, I’ve got my hands full right now—the plumber’s here.”

  “Does he look like he knows what he’s doing?”

  “More than me. He’s almost done. Then I’m coming to the hospital.”

  “For the team meeting?”

  “Yeah. More Agatha drama. We’ll talk about it later. Do me a favor, though. Come home as soon as you get this new patient oriented. Okay? Promise me.”

  “I promise.”

  “Love you.”

  “Later, ’gator.”

  * * *

  Kate passed the time waiting for Mrs. Ward by catching up on her paperwork and taking back her regular appointments— they’d been distributed among the other child psychiatrists in the unit, but now that her vacation had been postponed, Kate decided to resume her regular duties. Her overworked colleagues were more than happy to oblige.

  Around three in the afternoon, her phone rang. It was Mrs. Ward.

  “I’m in the parking lot,” she said in her dry voice.

  Kate glanced at her watch. “I thought we said four?”

  “Well, I’m here, aren’t I?” Mrs. Ward snapped.

  Kate sighed inwardly. “My office is on the third floor. Just follow the signs to a pedestrian passageway and—”

  “No. You don’t understand. I’m not coming in.”

  “Excuse me?”

  “I�
�m not coming into the hospital.”

  Kate stood up from her desk and walked over to her window. Across the well-maintained courtyard was the hospital’s multi-story parking garage. Six glass-walled pedestrian walkways provided safe passage into the west wing from all levels of the garage. “Mrs. Ward, please. We need to discuss Maddie’s case…”

  The voice rose a pitch. “I’m not coming in!”

  Okay. Nosocomephobia—fear of hospitals. Religious obsession. Yikes. Deep breath. “Where are you now?” Kate asked.

  “Second level. North side. Next to a stairwell.”

  “I’m on my way.”

  She found Maddie’s mother sitting behind the wheel of an idling blue Toyota Camry plastered with Six Flags bumper stickers. The car faced out of the parking space and the motor was running, as if she were primed for a quick getaway. Mrs. Ward wore pink Gap sweats and a confused look. She sat gripping the steering wheel and she seemed oddly familiar to Kate.

  “Hello?” Kate tapped on the glass. “Mrs. Ward?”

  The window ferried down. The thirty-something woman with short dark hair wore large sunglasses that hid her eyes. She had a gaunt face with a nose that looked as if it had been broken at some point in the past. Kate noticed a few small green bruises on her neck. There was a dryness about her—dry skin, dry hair—that complimented the unusual scratchiness of her voice. She had the crouched, tenuous demeanor of a battered woman, as if she’d taken a pounding all her life.

  “Where’s your husband?” Kate asked.

  “He works long-haul. He just got back from a three-week stint. He’s out cold on the sofa. I didn’t want to wake him.”

  “Not for something as important as this?”

  “Not for anything.”

  “Why? Would he get angry?”

  The woman stared at her. “Look. I came here like you said. It’s just me. End of story.”

  “Okay, fine. We can talk in my office,” Kate said firmly. “Follow me, please.”

  “No,” Mrs. Ward said, just as firmly. She handed Kate a heavy, rumpled shopping bag through the rolled-down window. “Here. Take this.”

  Kate hesitated. “What is it?”

  “Clothes. For Maddie. Please.” When Kate didn’t take the bag, Mrs. Ward let it drop to the ground; it landed in a grease puddle.

  Kate scooped it up. “You can’t just leave your daughter here, Mrs. Ward. We need to discuss her situation and make an evaluation. And then if we decide to admit her, you’ll need to fill out some paperwork—”

  “Show me the paperwork. I’ll do it right here.”

  Kate took a frustrated step backward, sorely tempted to walk away, but this could be her only chance to get a signature on paper. She took out her phone, called the nurses’ station, and asked Yvette to grab the paperwork and bring it out. Then she leaned into the car and said, “What’s going on, Mrs. Ward?”

  “Nelly.”

  “Are you all right, Nelly? Is everything okay at home?”

  “I’m here about my daughter.”

  “What’s the problem with Maddie? We found her cutting herself in Admissions. Jabbing a pencil into her thigh. We found dozens of old scars on her body.”

  “She does that to herself,” Nelly sputtered. “Like I said, she’s sick in the head. Possessed or something.”

  “She may be suffering from a mental disorder and the self-harm could be a sign of an early break,” Kate said.

  Nelly stepped on the gas, and the car jerked forward, giving Kate a start and forcing her to jump backwards. She almost tripped over the cement divider. Nelly hit the brakes and shrieked, “Do you think this is easy for me? Do you?”

  Deeply shaken, Kate struggled to regain her composure. The woman had almost run her over. She took a deep breath and reminded herself this wasn’t about her or Mrs. Ward. It was about Maddie. “No, I don’t think it’s easy for you,” she asserted. “Please don’t go. Someone is bringing out the paperwork now.”

  Nelly sat trembling behind the wheel. “Are you going to be her doctor?”

  “Not if you don’t want me to.”

  “Just the opposite.” She stared straight ahead. “Maybe you can help her.”

  “Can you elaborate? We need more information about Maddie’s illness, her symptoms. When did they start? Why do you think your daughter’s possessed?”

  “She won’t listen to reason. She locks herself in her room and refuses to come out. She hates her dad and me. She hoards stuff like a little pack rat. She bites and cuts herself. She refuses to go to school. She hears things that I don’t hear, and it scares the living daylights out of me. I’m at my wit’s end. So I brought her here, because I know you’ll take good care of her.”

  Yvette came jogging into the garage, her nametag on its lanyard bouncing all over the place, puffing and gasping for breath. She thundered to a halt and thrust the paperwork into Kate’s hands. “Is that everything you need?” she wheezed.

  “Perfect. Thanks, Yvette.”

  “Good, because I’m not doing that again.” Yvette nodded at Nelly and headed back to the hospital with the commanding, take-no-prisoners stride of the psychiatric nurse.

  “Okay,” Kate said, thumbing through the standard admission forms. “We’ll need to admit Maddie for observation. She’s clearly a danger to herself. Please write down your home address and an alternate number where you can be reached in case of an emergency. And reconsider coming inside so that we can discuss Maddie’s treatment. It would be extremely helpful if—”

  “Pen,” Nelly barked. She stuck a scrawny, bruised arm out the window and waved her hand with exaggerated impatience. “We just have the one phone. We can’t afford cell phones or what have you.”

  “Here.” Kate handed her the pen and the paperwork, and watched as she signed on the dotted line.

  “Is that all?”

  “Plus today’s date,” Kate said. “And I’m going to need your insurance card number. And you need to sign there. And there.” She pointed through the rolled-down window. “And if you could fill in her medical history, any health problems…”

  “She was a healthy child. Where else? Is that all?”

  “There.” Kate pointed. “And the HIPAA. Last page. Two places. That’s right.”

  Nelly finished signing the forms and handed everything back. “We all done here? We good?”

  “Yes.”

  Kate tried one more time—not because she thought it would work, but so she’d be able to say that she had given Maddie the proper standard of care. “Won’t you please come inside? Just for a short while? The more information the better.”

  The woman sighed and adjusted her hands on the wheel. “She was a good girl. Cute as a button. Now it’s hard work. I miss my daughter. I want my little girl back.”

  “All right. We can keep her for up to a week for observation…”

  “She’s healthy. She’s had all her vaccines. I was good about that.”

  “This paperwork will allow us to admit her for observation for seven days, ten days tops, but I’ll need you and your husband to come in tomorrow for a meeting…”

  “Can I go now?”

  Kate took a breath. “How’s tomorrow afternoon?”

  Nelly removed her sunglasses and rubbed her eyes, revealing her whole face for the first time. Kate suddenly felt numb with shock. Nelly didn’t seem to notice, and said, “Please. Just take care of my little girl. Make her better. Because I sure can’t.” She released the hand brake and took off in a scarf of dust.

  “Wait!”

  The car disappeared around the corner, and Kate could hear the Camry’s tires squealing through the twists and turns of the vast parking garage. She looked down at the woman’s scratchy signature and felt a swirling nausea. Nelly Ward. Except that wasn’t the name she’d gone by when Kate had last seen her. In high school she’d been Penelope Blackwood, niece of Henry Blackwood, Savannah’s killer.

  Feeling lightheaded, Kate took off after the Toyota. She hurried down
the cement steps until she got to the ground level and took off running across the brick courtyard. But by the time she reached the entrance gates, Nelly Ward was gone.

  10

  KATE FOUND JAMES IN the Adult Psych Unit, where the more violent patients were cared for. He stood in front of the door to the time-out room, looking through a nine-by-twelve-inch window. The time-out room was where patients could scream and throw tantrums without injuring themselves—basically a padded cell.

  “Hey,” she said.

  He turned with a distracted look. “Kate? Is everything okay?”

  “Yeah. Can we talk?”

  “Hold on a second.” He spoke to a clipboard-carrying resident about the patient in the time-out room—a middle-aged man who never smiled and rarely moved, but who was now railing against the entire world. James escorted her into the day room, where sunlight spilled through the wire-mesh windows.

  Most of the patients milling around in the shabby communal area were heavily medicated. The furniture was bolted to the floor and the paintings were glued to the walls.

  “What’s up?” he asked with a concerned look.

  “My new patient—the one I told you about? Her mother just signed the admission forms. There’s her signature, Nelly Ward. At first I didn’t recognize her. But then she took off her sunglasses, and I realized I’d gone to school with her. She’s aged badly and dyed her hair dark brown, but it’s definitely her. Her name used to be Penelope Blackwood. Penny for short. She’s Henry Blackwood’s niece.”

  “Are you sure?” James said.

  “They live in Wilamette, which is right across the river from where I grew up. And there were only a few Blackwoods in Blunt River County that I know of. Henry Blackwood and his brother’s family.”

  James rubbed his chin. “Did you ask her about it?”

  “No. She was gone by the time I realized who she was. But here’s the thing. On the night Savannah went missing, Blackwood was supposed to be with his niece Penny the whole time. She was his alibi. But during the trial, Penny testified under oath that her uncle had disappeared for six hours that night. She must’ve changed her name from Penny to Nelly.” Kate shook her head. “I don’t understand. Why would she drive all the way down here just to drop off her daughter at my hospital? She knows who I am, right? I didn’t change my name. I’m not trying to hide my identity. Besides, there’s an excellent psych unit right across the river, with plenty of good female psychiatrists… so why pick me? It doesn’t make sense.”