by Nate Kenyon
“I see. So there’s a personal element in your interest. But it has to stay out of your professional conduct. I say this because what I’m going to talk to you about requires it.”
“Professor, with all due respect, if I didn’t think I was capable of remaining professional, under any circumstance, I wouldn’t be enrolled here.”
It came out a little more forcefully than she’d intended. But Shelley simply nodded and smiled. “You’ve done well in my courses. Don’t think I haven’t noticed. That’s one of the reasons you’re here today. And the reports from your internship at the DSU clinic are stellar. You haven’t chosen a topic for your dissertation?”
“Not yet.”
“There’s a girl whose case I’ve been keeping an eye on for a long time,” Shelley said. “Right now she’s in the Wasserman facility downtown. She’s severely medicated, completely withdrawn for the past several weeks, though she has shown the ability to communicate. The director of the clinic has asked for my help in the past, and we’ve had some success. We haven’t been able to reach her this time.”
“Is there a diagnosis?”
“Dr. Wasserman believes she has a schizophreniform disorder.”
Jess felt the familiar early buzz of excitement that came with an opportunity. “How old is she?”
“Ten.”
“Awfully young for that sort of illness to manifest, isn’t it?”
“It is. Here’s the nuts and bolts of it, Jess. I’m not sure the diagnosis fits, but Dr. Wasserman disagrees. We do agree, however, that she may be more responsive to someone younger, less polished, if you forgive the description. To be honest, we could have given this to a counselor on staff, but I wanted to give the experience to one of my own.”
“I’m glad to have it.”
“Good. You have a rare mix of intellect and empathy. I think you might appeal to her. I want you to test her—Stanford-Binet, Weschler, Peabody, Rorschach. Let’s hear any hypotheses you might have, suggestions for treatment. Then, if I like what you’ve done and Sarah shows progress, I’ll allow you to present the case to the board of trustees.”
“It would be an honor, Professor.”
“You’ll do just fine, I’m counting on it. But I want you to understand something. This is not some case study from a textbook. It is not a hypothetical situation. This is a very disturbed child we’re talking about. She can be unpredictable, even violent. She’s had an unusual history from the moment she was born. I know because I delivered her. I’ve been keeping tabs on her ever since.”
Jess tried to picture a younger Professor Shelley in hospital scrubs. She had heard that the professor had been a practicing physician, but had thought it nothing more than a rumor. Shelley was a very good teacher. It seemed to Jess that she had been born to it.
“This girl is…unusual. She’s been in foster care and institutions since she was little more than a year old. I don’t know if she’s seen the outside world more than a handful of times in her life. Don’t misunderstand me. Most of the time she is simply catatonic, and that may be all she’ll be for you. But I want you to be on your guard.”
Shelley rose, signaling an end to their chat. A thread on her cardigan dangled down and trailed through the papers on her desk, at odds with the rest of her. She didn’t seem to notice.
—2—
The Wasserman Children’s Psychiatric Facility is located in the Boston neighborhood of Mattapan, in a section of town that has not enjoyed the improvements new money can bring. It sits on the edge of a 250-acre parcel of land that formerly housed the Boston State Hospital for the mentally ill, until that campus was shut down in 1979.
The location is an odd mix of desolate, abandoned wild-lands in the middle of urban sprawl. In this particular neighborhood and its cousins, Roxbury and Dorchester, it is not unusual to hear gunshots on a sunny Wednesday afternoon. Still, the facility is as pleasant as it can be considering the circumstances, a large brick building resembling an elementary school, set well back from the road and against a backdrop of wild grasses and shrubbery, with a wide lawn and a playground in the rear. The only details that set it apart from other buildings of its type are the wire mesh and bars on the windows, and the chain-link fence and guardhouse, where the man or woman on duty has a police baton and pepper spray within easy reach. There are many disturbed young patients here, some in their late teens, not all of them easily controlled.
Dr. Wasserman stood when Jess Chambers entered his office, and extended his hand. He was a bit younger than she had expected, mid to late forties, balding in front and mildly effeminate, wearing a forest-green turtleneck and corduroys, and delicate glasses with thin wire frames balanced upon a hawkish nose. His grip was moist and limp, and he had a slight eye tic that made it seem as if he were trying to wink at her.
“So glad you could come. Jean has told me all about you. You’re quite a student, isn’t that so? Lovely to know of the talented young people joining the profession.”
“Thank you.”
“Please, sit.”
Dr. Wasserman’s office was in marked contrast to Professor Shelley’s organized clutter. Everything was neatly in its place here, from the framed diplomas and awards on the walls, to the neatly labeled file cabinets. A polished-wood coatrack stood in the corner. The huge oak desk was bare except for an intercom, pen and pencil, notepad, file folder, a lamp, and a notebook computer. Too neat; to Jess, it hinted at a compulsive personality.
Wasserman sat down behind the desk and leaned forward on folded hands, as if imparting a secret. “Jean has told me the course and fieldwork you’ve completed so far, and has assured me you are competent. So I’ll skip by that and assume that you’ll handle Sarah extremely gently.”
“Of course.”
“Now, there are some things you should know before we proceed further. One, Sarah has no relatives and no visitors. She rarely leaves the grounds. If you’d like to take her anywhere during your visits, and I mean anywhere, even inside this building, you must contact me first. Agreed?”
“Fine.”
“Secondly, she is on a strict schedule of medication. This schedule must be kept to the minute. We’ll try to plan your visits at alternate times, but that will not always be possible.”
“What is she on?”
“Hmmm.” Wasserman pushed at his glasses with a finger, opened the file folder on his desk. He punctuated each word by tapping on the file. “Let. Us. See. Neuroleptics, mostly. And sedatives. Sarah is extremely sensitive and can be devilishly clever. We had a new orderly here once who felt such a number of pills weren’t necessary. Sarah managed to get out of her room. It took us hours to find her. She’d holed up in a ventilation shaft. Lucky she didn’t make it out to the street.”
Lucky for who, Jess could not help thinking. “I understood from Professor Shelley that you would tell me a little about Sarah’s psychiatric background. It would help to know the case history. Perhaps if I could look at your file—”
“We’d prefer you to open your own file. Start fresh, so to speak. We’re really looking for a new perspective from someone who has no preconceived notions of the case. I can tell you all you need to know for the moment. Feel free to ask me what you like.” Wasserman stood up abruptly and took a white lab coat from the rack near the window. “Shall we take a quick tour?”
The Wasserman Facility was indeed a converted school building. “We’re a modest enterprise, privately endowed, but we do receive the occasional grant for research purposes. We have three psychiatrists on call, not including myself of course, four full-time counselors, and a number of support staff. Classrooms and evening quarters on the second floor, private rooms and conference areas on the third. This first floor is mostly staff offices, along with a small exercise facility and playroom. And then there’s the basement, where the more difficult patients are given quiet time.”
It was like most facilities Jess had seen. White tile floors, prints of colorful paintings hung on cream-colored walls
, along with the occasional cluttered bulletin board and posters of children’s television characters. They passed a small room that contained the sad remains of someone’s birthday party: sagging balloons tied to the door handle, trash bags spilling over with paper plates and napkins. The corridors were cool, clean if a little tired. Everything had the look of having been scrubbed too many times.
Jess was reminded of her mother’s struggle to keep her brother out of places just like this. Her youngest memories of Michael were filled with a sense of nostalgia mixed with regret. The Chamberses did not have enough money for proper treatment, and after her parents’ divorce an even larger burden was assumed by Jess’s mother. Eventually they had moved from the little saltbox in Edgecomb to a trailer park on Indian Road in White Falls. During their years living there Jess was constantly confronted with reminders of a life that could be hard and cruel. Drunks, wife beaters, and abused animals were her constant neighbors.
They walked back down the hall, their footsteps echoing through the empty corridor. An open doorway revealed a black man in blue janitor’s overalls pushing a mop across a bare floor; he smiled as he glanced at them and then away, his mop moving with more purpose.
“That’s Jeffrey,” Wasserman said, after they’d passed. “He’s sort of a jack-of-all-trades around here, I’ve had him for years. He cleans up the place, acts as a general handyman, even helps with the patients. They love him.”
The raised voices of children grew louder as they turned a corner and passed by the empty cafeteria. “Forgive me,” she said, “but you seem young to be running a place like this.”
“My grandfather started a clinic many years ago in West-wood, and moved to this location when I was just a boy. He was a great man. I’m simply following in his footsteps.” Wasserman stopped in front of a set of wide double doors. “This is one of my favorite places.”
Inside the carpeted room were different kinds of play sets, tunnels and rings, blocks, tables, and chalkboards. Eight or nine children crawled and tumbled over themselves and played with several white-shirted adults, and for a moment Jess was fooled into thinking she was in a playroom like any other, before the details bled through. Wire mesh over the windows. A child of perhaps six in the corner rocking slowly back and forth in repeated, rhythmic motion, another muttering to himself and patting his head roughly with his palm. A third rubbing her chapped hands together again and again over a plastic toy sink.
She had done group casework before, assisted in community outreach programs, visited hospitals and sat in on counseling sessions. But this would be different.
Face it, head-on. This is what you want, what you need.
Her brother’s death had given Jess a deep resolve to make the health care environment easier and more accessible for mental health patients, especially children. It had been a long road, but now here she was and it was time to put up or shut up.
“We try to keep the numbers down,” Wasserman was saying. “They’re easily distracted.”
“Is she here?”
“Sarah? Oh no. These children are minimally supervised and generally nonviolent. We’ve had to keep her separated for some time now.”
A young man spotted them from across the room. He moved in a sidestep, shuffling motion, skirting the younger children and coming to their side like a nervous bird looking to be fed. “Twenty-three. Twenty-three steps.”
“Hello, Dennis.” Wasserman smiled. “Dennis helps out with the younger children.”
“Do I go to bed early tonight?” Dennis said. He had a plump, boyish face; he was dressed like a boy of six or seven, red baseball cap, blue striped pullover shirt and blue shorts, Velcro shoes with long, white socks pulled up almost to his knees. The stubble on his cheeks stood out in awkward contrast to the rest of him. “Is it Thuuuurrrs-day? Thursdays are early nights. Friday I go outside. Not Wednesday.”
“This is Miss Chambers, Dennis. She’ll be visiting us for a while. You might see her, and if you do I don’t want you to be afraid. She’s our friend.”
“Do you love me? Then say it. Sa-aaay it.”
“I love you, Dennis.”
“I make her spirit glow.” Dennis smiled brightly and shuffled away, muttering to himself and pulling at the brim of his cap.
“One of our roles here is to place various psychopathologies in a developmental context. Most of Dennis’s mannerisms would not seem all that out of place in a four-year-old. However, in a boy of almost eighteen, they are extreme. At the core is our belief that most adolescent pathologies stem from normal childhood development.”
“Sigmund Freud.”
“He pioneered the concept, yes.”
“But you don’t adhere to his theory of psychosexual development.”
“Not as a general rule. Piaget’s cognitive theory is more appropriate.”
They watched the group of children for a moment. “There are things to learn about each of them,” Wasserman said. “For example, Dennis doesn’t like to be touched. Most of the time he’s harmless and quiet, but if you touch him he’ll become extremely agitated. That is a simple rule. For Sarah, you’ll have to learn more.”
“And what about biological causes of mental disorder?”
Wasserman looked at her like a parent at a misbehaving child. She was suddenly aware that he was lecturing to her. “This is a progressive facility, Miss Chambers. Our staff is well educated. We treat chemical imbalance with medications, and provide support with play therapy and modeling.”
Wasserman turned and proceeded out the door. After a moment, and a deep breath to calm her singing nerves, Jess followed, her briefcase tucked tightly under her arm.
“Sarah’s in the basement level at the moment, in one of our quiet rooms,” Wasserman said, as they walked to a set of elevators next to the fire stairs. “You might be a bit shocked at first by her appearance. Let me assure you that everything has been done to make her life here as comfortable as possible. However, she’s been very difficult recently. There are precautions that must be taken in regards to her safety and that of those who work around her. She’s deceptively strong, and as I said before, she can be very clever.”
“I’m curious, Doctor. Why did you introduce me to Dennis?”
“To show you that not all of our guests are so severely restricted. And to see how you reacted to him.”
“I hope I didn’t disappoint you.”
“It’s important that they not sense your discomfort. If you’re unsure of how to proceed in a given situation, and all of us are at some point, it is best to refer to your superior.”
The elevator doors opened onto another world. Heavy cinder block walls and bare concrete floors met them as they stepped from the elevator into a narrow rectangular room. The overhead lighting was bright and unwavering, but it was the shadows Jess noticed. Clinging like cobwebs to the corners, they disappeared when she turned her gaze on them, but then returned to lurk at the edges of her sight. Perhaps it was her mood.
A heavy woman wearing a white coat stepped out from behind a desk as they approached. She was large through the shoulders and hips and very dark-skinned, and moved with a quiet shuffle so that she seemed to avoid the light, slipping through it like one of the shadows.
“This is Maria. She’ll be here whenever you need anything. Maria is well trained in handling our difficult patients. And her English is getting much better. Isn’t that so?”
“Si,” Maria said. Pockmarked skin stretched across darkly plump cheeks. Her expression was inscrutable, but her eyes darted nervously back and forth. “Gracias, thank you.”
They entered a corridor lined with solid metal doors on either side, each of them with an eye-high, centered window. The air smelled damp with the slightest hint of lemon cleanser.
Jess could hear noises from behind the walls, thumps and muffled shouting. She concentrated on Wasserman’s back as he spoke over his shoulder.
“Most of our patients are assigned a counselor and a team that works together
to ensure that things are progressing. I’ve taken a personal interest in Sarah, and in this instance you’ll be working directly with Maria and myself. Often you’ll be alone. Sarah tends to react badly to crowds.” Nearly at the end of the corridor, he stopped at a door and turned to her. “Are there any more questions before you have a look?”
About a million of them. Jess squared her own shoulders and faced him. “I have to admit here, Dr. Wasserman, I don’t feel comfortable with what you’ve given me. Really it would be better if I could study the file. I need to know what tests she’s been given, what sort of diagnoses have been made—”
“Sarah has a schizophreniform psychotic disorder. She was diagnosed at age six. As I’m sure you’re aware, diagnoses of this sort prior to six years of age are extremely rare. Sarah was always difficult, but by her sixth birthday she was showing signs of marked withdrawal, looseness of association, and a breakdown of reality testing. There were hallucinations—”
“I understood that those didn’t start until early adolescence.”
“Not in this case.” Wasserman paused and seemed to choose his words carefully. “Sarah began to believe…still believes…that she could influence people. That she could bend things to her will. Fantasies of omnipotence are not uncommon—again, this stems from early childhood—but in Sarah these fantasies extended far beyond the normal stages. And then the phobias and the suicide attempts began. Recently she has grown so uncontrollable that we’ve had no choice but to confine her to the basement for good portions of the day. She fought us by withdrawing in her therapy sessions and refusing her medication. She hasn’t spoken a word in over three months now.”
Wasserman’s gaze kept slipping from the tiny window in the door, to Jess’s face, to some point in the corridor beyond her head.
“What about her parents?”
“Sarah has no surviving relatives, as I believe I told you. That’s the case with so many of the children here, unfortunately. They’ve been either orphaned or abandoned, and the foster care system is simply not well equipped to handle those with more severe mental disorders.” Wasserman glanced at his watch and then dug a set of keys out of the pocket of his white lab coat. “Now, Jean and I agreed that your first contact with her should be alone. Our intent here is to shake things up, draw her out, expose her to someone she might eventually be more comfortable with and who is not associated with me or my staff.”
