Susan realized that refusing any type of visitation, then dropping Sharicka on the Ansons the day of her discharge did not serve anyone’s best interests. The purpose of home visits was to ease the patient back into everyday life as well as prepare the family for the future in gradually increasing increments. A single overnight would also reward Sharicka for trying and, with any luck, rekindle the hope her family had all but lost. “Does Sharicka even want a home visit?”
“She’s practically pleading.”
Susan walked down the hallway with Saranne, pausing to glance in the open doorway where Sharicka snuggled on her mother’s lap, her father hovering like a guard dog. He looked up as doctor and nurse walked by and gestured silently to Susan.
Susan held up a finger and nodded to indicate she would return shortly, then continued to the second massive iron door with Saranne. The nurse unlocked it, and they walked onto the unit and straight into the staffing area. Saranne could barely wait to ask, “What do you think?”
Susan found herself nodding quietly for too long. From the corner of her eye, she saw Shaden coming to join the conversation. “I … think …,” Susan started without a clue as to how she intended to complete the sentence, “… it might be … possible.”
Shaden jumped right in, easily guessing the topic of the conversation. “She hasn’t done anything wrong in a while, Dr. Calvin.”
Susan wondered if Shaden even remembered that, earlier the same week, Sharicka had put a piece of a latex balloon into another child’s medication cup.
“Since she started taking her meds faithfully, she’s been so different.”
Susan had to admit Shaden made a good point. Sharicka did seem to have made a miraculous change in the last couple of days. “Maybe we should demand a full week of positive behavior before we inflict her on the world.”
“It’s just a home visit,” Saranne reminded Susan. “It’s routine. Most kids start those a week after they’re admitted.”
“Besides,” Shaden added, “the Ansons are going away next weekend. It’s today, or they have to wait two weeks.”
The nurses seemed so earnest and eager, and both had excellent reputations on the unit. Susan sighed. “I do believe Sharicka is making an honest effort. But do you really think she’s ready?”
Shaden made an important point. “If she were on some of the older antipsychotics, no. They can take weeks or months to really work. But she’s on hefty doses of Antoladol and Vilyon.”
Susan knew the second-generation neurotransmitter stabilizers did act quickly. Some psychiatrists started at subtherapeutic doses and worked their way up slowly, but Sharicka was already at the maximum dose for her size. Her previous R-1 had raised it, not knowing that Sharicka had been hiding her medications. “You’re sure she’s swallowing them?”
Shaden could have taken that as an insult. It implied, and quite rightly, the nurses had not acted thoroughly and properly in the past. Providers assumed people took their medication; and, under most circumstances, would not bother to check. It was a patient’s prerogative not to fill a prescription or take a medication, even one he required to live. But an underage mental patient in a locked unit ought to have better than usual attention paid to such details. “Sharicka is taking great pains to prove to us the meds are going down her throat.”
Susan doubted she wanted the specifics. “I’ll talk to the Ansons,” she promised, “but I’m not going to push them. If they decide they can’t handle her, we wait at least a week before presenting the possibility again.”
Shaden bobbed his head, clearly finding the conditions reasonable. “I’d like to come with you.”
Susan bit her lower lip. She was not the sort of person to squash conflicting opinions, and he was Sharicka’s most frequent caretaker. Although he had a soft spot for the girl that did not always seem logical, he was a competent professional with far more PIPU experience than she. The Ansons had run into people like Shaden many times. They would understand his point of view. Just maybe, Shaden would learn to value theirs as well. “All right. When do you want to do it?”
Shaden smiled. “They’ve had a solid forty minutes together. How about now?”
“Now suits me fine.” Susan swallowed her misgivings, turned toward the door, and they headed for the conference room together.
Chapter 17
Saranne handled unlocking the metal door and escorting Sharicka back to the ward, while Susan and Shaden remained with the Ansons. They looked different to Susan somehow: less morose, more animated and alive. Lucianne’s eyes had a faintly hopeful glimmer, and Elliot’s face bore just a hint of a smile. He stepped forward, his hand outstretched. “Good afternoon, Dr. Calvin.” He took her hand and shook it, nodding at the nurse as he did so. “Shaden.”
“Good afternoon, Dr. Anson,” Shaden replied respectfully.
Susan addressed the mother, still sitting on the chair where Sharicka had recently perched in her lap. “Hello, Dr. Anson.”
Susan shut the door as the others took seats around the table; then she joined them. The couple sat together, doctor and nurse across from them. Lucianne spoke first, “Sharicka says you ‘fixed’ her. I hope she doesn’t mean …”
They all chuckled, though somewhat uneasily. The idea had to flash through more minds than just Susan’s that Sharicka should never bear children. It chilled her to even consider the cruelties someone like Sharicka could inflict on a helpless infant. “Sharicka will always be Sharicka,” Susan said. “I’m concerned we’re all prematurely optimistic, but I have to admit she does seem to have become honestly committed to improving her life and the lives of those around her.”
Shaden nodded vigorously. “She credits Dr. Calvin with inspiring her to do her best. She’s taking her medications like clockwork, and she hasn’t acted impulsively in days. She’s even made some real friends among the other patients.”
Though Susan could not deny the truth of those statements, she wished Shaden would tone down his rhetoric. The Ansons had seen the many cycles of Sharicka, and they knew better than to pin their hopes on a few days of cooperation — or so she hoped. She had read enough books, had studied enough couples and parents, to know human emotions lived in the moment. She had seen mothers in supermarkets ready to fricassee their young one moment and buying them ice cream the next. Nature had endowed children with the ability to bring out the best and worst in adults from moment to moment, and love tended to drive humans to illogical faith and actions.
Lucianne sucked in a deep breath, releasing it gradually through pursed lips. “You say she’s committed to improving her life. But, given her” — she glanced at Shaden, then back to Susan — “her diagnosis, is that even possible? Can she even understand morality? The difference between right and wrong?”
“All sociopaths understand the difference between right and wrong, especially ones as intelligent and well-raised as Sharicka,” Susan replied. “I’ll bet she could recite the rules of your household, and the reasons for them, in her sleep. What they lack is empathy, compassion, guilt, remorse.”
Susan took the discussion into the realm of Lucianne’s understanding, childhood special education. “You know how children with a nonverbal learning disability rely on spoken words and explanations? They can’t intuitively grasp nonverbal communication. They don’t ‘get’ tone of voice, figures of speech, gestures, personal space, facial expressions, humor, and so forth?”
Lucianne and Elliot both nodded, and the mother added, “If you catch it early, those things can be taught with repetition, verbal explanations, physical outlines, and behavioral rewards. It works for higher-functioning autistics, too.”
Susan appreciated that they had not only followed her example but improved upon it. “If you start young enough, you can internalize the lessons to the point where at least some of those skills can seem almost normal. Kids with NLD can eventually use idioms correctly. They may not tell jokes, but they know one when they hear it and laugh in the appropriate places. Their
own faces may be expressionless, but they learn to recognize other people’s moods by rote.”
“Right.” Lucianne cocked her head in consideration. Color formed in her cheeks and gradually spread to light her entire face. “Are you suggesting we might be able to teach Sharicka … remorse and compassion?”
Susan did not know. Historically, the success rate for treating people with sociopathy was abysmal. However, that had changed in the last few years with the creation of the second-generation neurotransmitter stabilizers. Since antisocial personality disorder could not technically be diagnosed before age eighteen, the literature about treating children for it was nonexistent. She wondered if they had just stumbled upon a brand-new treatment for juvenile conduct disorders. “I’m not sure,” she admitted. “Until now, Sharicka hadn’t shown any insight into her problem. Now that she acknowledges it, and has expressed and acted upon the intention to change, I think we might have a chance.”
Elliot laced his fingers on the tabletop. “She does seem … different,” he admitted. “More like … our Sharicka. The one who used to fall asleep watching a movie in my lap. The one who loved ‘hangaburs’ and ‘pockasickles’ for dinner and begged for just one more story at night.”
Lucianne smiled at the memory. For the first time since Susan had met her, she looked like a typical mother misty-eyed over a child’s scribbled drawing of her. “Do you think … now that she’s really taking her medication …?”
Susan felt torn. “I think … she is really trying, yes.”
“She loves your family,” Shaden cut in.
Susan did not like his phraseology. It made it sound as if Sharicka stood apart, that they had never really accepted her as a full-fledged member. “She loves her family,” Susan corrected. “I’m sure she always has, but she had more difficulty expressing it off her meds. Now, she talks about you … wistfully. She wants to go home.” Susan realized just how differently her conversation was going with the Ansons this time, and felt awkwardly balanced on a swaying tightrope. She wanted to encourage them to look at the situation more positively; success never came out of a defeatist attitude. However, she did not want to get their hopes so high that they dropped all caution. Sharicka was still a very sick little girl.
The father scratched his beardless chin. “Dr. Calvin, it sounds as though you’re saying you … fixed Sharicka.”
Susan shook her head. “I didn’t do anything but observe her. Sharicka heard I had helped some other patients, and it inspired her. She’s making changes all on her own, and I think that’s a good sign.”
The mother looked from her husband to Susan and back again. She glanced briefly at Shaden before returning her attention to Susan. “Some people don’t believe there’s anything wrong with Sharicka. She’s good at … making people think she’s” — she turned her gaze to her husband, as if seeking his assistance — “misunderstood. When, actually, she’s … sneaky. And frequently mean.”
Shaden frowned. Susan touched his leg warningly under the table, and he did not speak aloud.
“You know me better than that, Dr. Anson.” Susan tried to fully capture the mother’s attention. She had eyes so pale they seemed almost colorless, a steely gray with just a hint of blue. “Sharicka has a serious psychiatric condition. However, she is four years old, and we can’t keep her in the hospital indefinitely.”
“We talked about an institution,” Lucianne reminded her.
Susan knew the Ansons liked her because she had never downplayed the significance of Sharicka’s illness the way most providers did, and she had never questioned their integrity or intentions toward their daughter. Suddenly, Susan felt like a traitor. “I’ve looked into that. There’s not a single institution in the country that will take a child under the age of thirteen.” She tried to dodge Lucianne’s stare. “There’s no possible way we can keep her here for a year, let alone nine years. At some point, we have to release Sharicka to a family. She’s your daughter, first and foremost, but we would all understand if you decided yours was not the right home for her.”
Lucianne followed Susan’s gaze, refusing escape. “You can’t possibly be talking discharge.”
“Not in the next week or two,” Susan said quickly. “But it’s time to start thinking about it.” She felt confident the Ansons had already discussed the possibilities and had come to at least a superficial decision.
“What happens if we refuse to take her?”
Elliot replied before Susan could. “She becomes someone else’s problem.”
“Foster care,” Shaden said. “And, eventually, adoption.”
Lucianne’s jaw drooped until it all but touched her chest. She snorted suddenly, bringing her lips back together. “Downplaying all of her issues, no doubt. They’ll foist her on some unwitting, well-meaning family and tell them not to worry. Love will conquer all.”
Susan could not deny it. Sharicka knew how to win hearts, how to present her best side, how to manipulate even trained psychiatric nurses. Most social workers would be putty in her hands.
“She’s best off with us,” Elliot Anson said firmly. “We loved her, unconditionally, before we knew what she would become. We love her even now. We’ll always love her.” His eyes blurred as he clearly fought back tears. “I doubt anyone else will have the time to form a bond that strong before she does something hateful to them. Bouncing around foster and adoptive houses can’t possibly be in Sharicka’s best interests, let alone anyone else’s.” He put his arm around Lucianne, who also looked on the verge of tears. “She’s trying, Luci. We have to reward that effort.”
“How?” the mother asked, with clear suspicion.
Susan broached the subject cautiously. “We were thinking maybe … a home visit?”
“You mean an overnight?” The mother still did not sound convinced, but she also did not refuse outright.
Elliot was nodding. Clearly, he would prove easier to convince. “There’s a limit to the damage a four-year-old has the strength to do, especially under the watchful eye of two wary parents in a childproofed home.”
His wife turned on him. “She was under the watchful eye of two parents in a childproofed home when she almost drowned Misty.”
“That was before we knew what she was capable of. They were outside alone, without us. We won’t let that happen again.”
Susan allowed the discussion to evolve, not daring to add anything to it. For the first time, she found herself secretly siding with Sharicka, hoping the Ansons decided to take her home, to give her this one small chance. However, Susan also realized they knew Sharicka better than she ever could. She tried to imagine something demonic taking over her kind and gentle father. If he had murdered her mother, could she have ever taken him back into her home? She supposed she could if the demons were vanquished. But are Sharicka’s demons vanquished? How could we ever know for sure?
“Can we stop her?” The mother sighed deeply. “I love my daughters, Dr. Calvin. Both of them.”
Shaden held inordinately still, but Susan nodded broadly. “It’s hard to do what’s best for both of them.”
“I’ll stay right with her,” the father promised. “She can’t do anything bad with me glued to her side.”
Susan could see Lucianne wavering. It soon became clear, however, that as Susan studied her, she studied Susan. Finally, she spoke. “Dr. Calvin, I trust you. What do you think we should do?”
It was exactly the question Susan did not want to field. She had been trained to avoid it, to firmly state that such a decision belonged solely to the family. “I … understand your hesitation. It’s completely logical and makes perfect sense.” Susan had little choice but to play both sides. “On the other hand, that you’ve decided not to terminate your parental rights to Sharicka means you still have hope for her. If we believe she’s trying, and I know I do, then home visits are the necessary first step toward working her back into the family. We could wait another week. Maybe even two.” Susan raised a hand, palm up, and finally de
liberately braved Lucianne’s eyes, now blue-gray pools of water. “Much longer than that, we’re going to get serious resistance from your insurance company.”
Apparently, the parents’ honest angst was not lost on Shaden. His tone turned as gentle as Susan had ever heard it, especially when forced to defend Sharicka. “Doctors Anson, in my years of experience, I find that insurance companies are more open to time extensions if they see you trying. If you bring Sharicka for a home visit, they’ll be more likely to bargain. If it goes well, that’s wonderful. If not, it will give us ammunition to use against them if they try to deny your coverage.”
The mother bobbed her head ever so slightly. “So you think we should take her home … today?”
Susan did not feel wholly comfortable with that. “I’m saying I think either decision is reasonable and defensible.”
The mother made an irritated noise, still trying to pin down Susan. “If she were your daughter, would you take her home? Yes or no?”
Cornered at last, Susan could do nothing but speak the truth. “I like to think I would, Dr. Anson. But, as I’ve said several different ways, I don’t think a right decision and a wrong one exist here. There are only intuition and faith.”
Nothing remained to be said, and the father took over the conversation. “Give us a few minutes to talk about it, and we’ll give you our answer before we leave.”
Relieved, Susan rose. She preferred to let the parents make their own decision. Following her cue, Shaden also stood up, and the two left the room. Susan knocked on the locked door. Saranne’s face appeared in the window; then the door whisked open, and the two came through it. Saranne locked it behind them.
I, Robot: To Protect Book 1 Page 23
