Twice Dying

by Neil Mcmahon

  “I assume this didn’t come out of the blue.”

  She started walking again. Monks paced beside her.

  “You know the term NGI?” she said.

  He did. Not Guilty by reason of Insanity, the designation for psychotically violent offenders who were found unable to understand the criminal nature of their act. In California, they were outside the criminal justice system and not subject to regular imprisonment. Usually they were remanded to high-security mental institutions.

  “I’ve been consulting for Clevinger Hospital, in the East Bay,” she said. “It has a top-line NGI rehabilitation program. Big-time funding and prestige.”

  Monks knew about Clevinger, a county institution with a psych ward that verged on the notorious: by all accounts a cheerless place.

  He said, “The money must be good.”

  “With the county? You know damned well it’s not.”

  “Then what’s the draw?”

  “A chance to work with the great man who founded the program. At least that’s what I thought.”

  “Who’s the man?”

  “A psychiatrist named Francis Jephson. He’s British. Heard of him?”

  Monks shook his head. “I don’t deal much with psychiatrists.”

  “He was very polite all through the hiring process, but it didn’t take me long to figure out he didn’t want anything to do with me,” she said. “He conducts all the NGI therapy in private. All their testing. When I offered to help, he patted me on the hand and told me in so many words to go powder my nose.”

  Monks’s laugh was involuntary. “Sorry. He obviously doesn’t know you very well.”

  “It pissed me off.” She ground out the cigarette against a lamppost.

  Monks waited.

  “One of the NGIs is scheduled for release next month,” she said. “John James Garlick. He’s a woman beater: hospitalized several girlfriends, finally killed one.”

  “He’s getting out?”

  “Officially, he’s been a model rehab client.”

  “Just asking.”

  “I don’t like it either. I’ve been having problems with him from the first. I’ve caught him baiting the general ward patients in calculating ways.”

  “That’s a red flag?”

  “One of several. Signs that there’s no real thought disorder. So I took a good hard look at his file. Everything was nice and neat. Too neat, especially this.”

  She took a manila envelope from her purse and pulled out several sheets of paper. She held one up to the lit front of a shop. Monks could make out a graph with perhaps a dozen lines plotted across.

  “It’s called the Psychosis Assessment Profile,” she said. “It’s administered every few months to rate patient improvement and adjust medications. One of the tests I’m supposed to give that Jephson won’t let me. Garlick’s shows him going from highly psychotic to within the normal range, over twenty-two months. I’ve been a clinician twelve years now, Rasp, and I know what I see. Garlick is no more psychotic than you or I. He never was.”

  Monks said, “The graph’s a fake?”

  “That’s just openers. I started thinking I’d seen a file like that before. It took me a while to remember: a man who was released right after I started at Clevinger: Caymas Schulte. He’d raped and strangled a nine-year-old boy. I wasn’t around him much, but I had the same take as with John Garlick: dangerous, sociopathic, but in control of his actions. I went into the records library one night after the regular staff was gone. Went through ten years of files and found Caymas Schulte’s, and three more besides.”

  She held up the remaining sheets of paper, fanned out to show the graphed lines. Except for minor variations, they were identical.

  “All with similar diagnoses, schizo-affective disorders,” she said. “All reporting similar reactions in the same categories. The same steady improvement. There are probably others I missed. I think they’re sociopaths that Jephson’s been selecting. Not every patient: maybe one in eight or ten. He provides them a false diagnosis of schizophrenia, then coaches them through his program.”

  She folded her arms, as if daring him to disagree.

  “I believe you, Alison,” Monks said. “But I don’t get the why of it.”

  “It gives him a statistical edge that keeps him top dog. They’re guaranteed successes.”

  Monks had seen his share of medical scams, but usually the payoff was obvious: cash.

  He said, “You think he’s embezzling from his funding?”

  “I don’t think it’s about money. You’re talking an ego that’s off the charts. He was a Wunderkind thirty years ago. Cambridge. Princeton. But he made claims he couldn’t back up. He kept changing jobs—moving down the ladder. A place like Clevinger’s the end of the line. Or it was, until he started working his miracles.”

  “He’s taking a hell of a risk.”

  “The real risk is to the public, Rasp. These men are out on the street after two years, with no parole and nobody keeping track of where they are. They’re supposed to report to outpatient clinics for medications, but there’s no way to make them. They can change areas, even identities, cover their tracks. They just don’t have any conscience, and there’s no therapy for that. Like John Garlick. He’ll be out in a few weeks and he’s going to kill more women, I know it.”

  Monks stepped away, clasping his hands behind his back. The night wind brought the scent of wet salt air, and with it came a touch of memory: standing on the bridge of a navy troop transport, starting west across the Pacific from Mare Island.

  He said, “Did you confront Jephson?”

  “I tried to spook him. I told him I’d found out that some of the released NGIs had stopped reporting for meds and named the men with the phony charts. He sat there like an iceberg: that fucking British reserve. He knows damned well that if I take him on, I’m the one who’s going to get hammered.”

  Monks smiled grimly. “Whistle-blowers tend to lose friends.” It was a lesson he had learned the hard way.

  “It finally started sinking in that was why he approved my appointment. I was just what he wanted: junior, female, dumb.”

  Her eyes were wet and angry. Monks’s hand moved to touch her cheek, a gesture so instinctive it surprised him. He stopped himself, letting his hand fall back to his side.

  “Dumb enough to find out something nobody else suspects?” he said.

  “Dumb enough to shoot my mouth off and warn him. I’ll bet you anything that man Stryker, the one asking the questions about me, is a private detective. Jephson’s trying to find something to fire me. I’m good at my job, dammit. It’s nobody’s business what I do in my own rime.”

  A lot of people wouldn’t agree, Monks thought. Starting with the SFPD and the American Psychological Association.

  He said, “What makes me worth an antique razor?”

  She smiled, brushing her eyes with the back of her hand.

  “I want you to slice open Jephson’s rotten spot.”

  “Rotten spot?”

  “You know the name Vandenard?”

  He blinked. “I’ve seen it in the society pages. I don’t travel much in that part of the newspaper.”

  She held up the manila envelope again.

  “I’ve been doing my homework. Robert Vandenard, the family’s main heir, murdered a man back in ’84.”

  A vague recollection of the event tugged at Monks’s memory.

  “He committed suicide later, didn’t he?” Monks said. “The Vandenard boy?”

  “There was a lot that happened in between that wasn’t made public. Jephson got him pronounced NGI. Not long after that, the Clevinger program got funded big-time.”

  Monks said, “Let me guess. By Vandenard Foundation money.”

  “No surprise, huh?”

  “That sort of thing happens all the time,” Monks said. “I could see it as questionable ethics. But not illegal.”

  “How about what came next? Robby Vandenard was one of Jephson’s first ad
missions. Instead of life in Atascadero, he did twenty-four easy months in Clevinger, and he was out, free as a bird.”

  Monks’s gaze turned east, to the misted lights of the grand hotels on Nob Hill: the Mark Hopkins, the Sir Francis Drake, the Fairmont, holding themselves like wealthy dowagers in dated finery, looking coldly down on the upstart newer buildings of the city.

  The kind of money where the line between illegality and questionable ethics could be erased.

  “I need to find something on Jephson to protect myself, Rasp,” she said. “I don’t like fighting dirty. But I don’t have any choice.”

  “Blackmail isn’t in my line, Alison.”

  “I’m not talking blackmail. I’m talking about taking down a bad physician, outside the courtroom. Isn’t that what you do?”

  She was watching him. Her hair and skin wore a faint damp sheen of mist. Monks tried to sort through his emotions. The evening’s events in the Emergency Room, still playing in his mind like a background tape. The invisible chain of responsibility tugging him to return to the hospital. His past with Alison Chapley, with that uneasiness still close to the surface.

  Her nearness, now, this minute.

  Monks said, “I’ll think it over. I’d better get back.”

  She handed him the sheaf of papers.

  “Can you come back inside for just a minute? There’s someone I’d like you to talk to.”

  Her wineglass had not been refilled. The bartender was at the far end talking to friends, and ignored her signal for what seemed to Monks a pointedly long time. Finally he approached with obvious coolness, a stocky man with a handlebar mustache and a tilt to his head.

  “Warren, this is Dr. Monks.” Neither offered a hand. “He’s an investigator,” she said. “He’s going to help me about that man who said he was from the licensing board. Will you tell him what you told me?”

  The bartender shrugged. “It’s history.” He started moving away.

  “Warren,” she said. This time there was a faint tone of pleading. “It doesn’t have anything to do with here, it’s somebody trying to get me fired from my job. I’m going to get it straight.”

  He leaned forward across the bar and said with sudden harsh intensity, “Are you fucking crazy? First that and now this?” His head gestured contemptuously at Monks. “There’s a million bars in this town, honey. Go find one.”

  Sudden comprehension came to Monks. The bartender was her drug connection, a not-friend who assumed that Alison had drawn the attention of police. He had cut her off, and that was why she had brought Monks here: to repair the damage.

  He knew how it went: irritations and tension building into anger that hovered just below the surface, until finally something, usually some-thing small, pushed the button and you blew up, usually at the wrong person.

  Usually, you did not care.

  Monks said to him, “Where’d you get the cowboy hat?”

  His eyes narrowed. “I don’t own a cowboy hat.”

  “I can see it.”

  The bartender reared back, then thrust a finger toward Monks’s chest. “You’re out of here, asshole.”

  “I’ve got a special dictionary at home,” Monks said. “Next to the word ‘shitweasel,’ there’s a picture looks just like you.”

  He walked to the door, half expecting the bartender to follow, his mind already supplying novelty headlines for tomorrow’s Chronicle: DOC DECKED IN DUKE-OUT, SAWBONES SLAMS SALOON STUD, PHYSICIAN FAILS TO HEAL SELF. The last time he had punched a man had been some years before, when he had taken a verbal cheap shot from a cardiac surgeon in a hospital cafeteria line, but you could not really call that a fight.

  He waited on the sidewalk, fists tightening when the door opened. It was Alison, alone.

  “I’m sorry,” she said. “I had no idea.”

  Monks said, “Yeah, you did.”

  She smiled, very slightly, the look of a child found out in something mischievous.

  “You can take the boy out of Chicago, but you can’t take Chicago out of the boy.”

  He shook his head and walked on, but allowed himself to be caught, his arm hugged, a warm wet kiss planted on his cheek.

  “Are we still on?” she said.

  He nodded stiffly.

  They paused at her car. Monks recognized it with confused warmth: a vintage champagne-colored Mercedes sedan that had been the scene of more than one fevered teen-style coupling.

  He held the door open. She brushed deliberately against him as she slid behind the wheel.

  “You left just when things were starting to get interesting,” she said.

  Monks watched her go, back to the Bolinas house with its windows that turned golden in the afternoon sun and its ocean-facing deck where she had first begun to unveil herself to him.

  Alison Chapley might not like fighting dirty, but she surely knew how.

  Monks got back to the hospital a little before midnight. Fatigue had settled on him, and he had decided on a nap before taking on charts-In the old days, thirty-six hours on his feet had been routine, but now half that was pushing it. He walked to the ER physicians’ office, a room just big enough to hold a desk, sink, and cot, and unlocked the door quietly, not wanting to wake another doc who might have beat him to it.

  The interior was dim, and it took him perhaps three seconds to absorb the tiny bytes of visual information. There was a figure on the cot, but not sleeping: sitting upright. A man with a youngish face topped by straw-colored hair. He stared back at Monks, mouth open in dismay.

  Vernon Dickhaut.

  A second figure, wearing the top half of an ER nurse’s magenta uniform, was crouched between his splayed legs, fingers positioned as if gripping a clarinet. Her head swiveled, eyes flaring like those of a deer caught in headlights. There was a faint wet popping sound and a glimpse of glistening pink flesh.

  Monks coughed. “Excuse me. I just need to grab this.” He scooped his daypack from the desk, keeping his back turned to the frozen figures, and closed the door quietly behind him.

  Nothing like crisis to bring out that life-affirming instinct, he thought, and trudged out to the Bronco to cry to catch some sleep.

  Chapter 3

  The next morning, Monks sat in the physicians’ office washing down ibuprofen with night-old coffee and dictating charts in standardized medical format.

  ESPOSITO, ISMAEL

  CHIEF COMPLAINT

  Multiple gunshot wounds to chest and abdomen.

  HISTORY OF PRESENT ILLNESS

  Mr. Esposito is in his mid teens—

  Monks’s mouth twitched at the use of present tense, but this was catch-up work, theoretically done before the outcome was known.

  —with no history in this hospital. Approximately 30 minutes before admission, he was wounded in a street gunfight.

  The desk phone rang.

  “Carroll! What the fuck are we, Mother Teresa? Surgery alone is going to be five thousand bucks!”

  The voice was a familiar one, blending elements of growl and shout: Baird Necker, the hospital’s chief financial officer, who presumably had just arrived and found the incident report on his desk. As expected, neither of the gunshot casualties had either cash or insurance. There would be minimal compensation from the city and possibly bits from MediCal. Not nearly enough to cover the costs.

  “I think everybody involved was aware that this wasn’t a money-making situation,” Monks said. “You know, the people who were up to their elbows in mesentery?”

  A pause. Monks waited patiently. Baird looked and behaved something like a boxer dog, a fierce-presenting alpha male, but he could never last long without lapsing into fundamental decency.

  More sedately, he said, “I understand our obligation, Carroll. But we’ve got to find a way to control this kind of thing. It’ll drive us under.”

  “They’re not going to stop shooting each other, Baird. They seem to like it.”

  “We can’t help anybody if we’re out of business, right?” A wheed
ling tone had crept in.

  “Next time Triage Base calls, you tell them no.”

  A longer pause, and at last, a heavy exhalation. “Okay, I’ll try to split the damage up so everybody gets fucked equally.”

  The phone slammed down, then rang again instantly. “Sorry about the kid,” Baird said, and hung up.

  Monks gave a final glance at the chart of Ismael Esposito, then stood and poured another half cup from the urn. It gave off a burnt smell. Ismael had lasted less than an hour. When the surgeons went in, they found two finger-sized holes in the abdominal aorta, a situation that allowed them approximately one minute after deflation of the MAST suit before the heart emptied of blood. They managed to clamp the aorta in time, but could not have known that the right pulmonary artery had also been clipped and weakened by the lung-puncturing bullet. The renewed pressure from the clamped aorta blew it open. By the time they got into his chest, his system had pumped the right lung full of blood, and they were simply unable to catch up again. The technical term was exsanguination.

  Rafael Vasquez had been transferred to the medical facility of SF County jail, and Ismael’s brother, finally quieted by reality, had been taken in for questioning. The flattened slugs would make their way from pathology to some ballistics warehouse, there to remain, in the unlikely event they might ever be matched to weapons.

  It was a few minutes after 8 A.M. Monks was not due back for five more days, one of the benefits of emergency medicine: he preferred working two or three shifts at short intervals, then taking several days to himself. He had been planning a favorite excursion: a long, lazy canoe drift on Tomales Bay, with a cooler of sandwiches—hard salami, roast beef, Swiss cheese, and kraut, dripping with vinegar dressing—washed down with bottles of icy Moretti beer.

  He stacked the charts and turned to the papers that Alison Chapley had given him.

  On top were the five Psychosis Assessment Profiles she had shown him: John James Garlick, still in Clevinger, and four other NGIs who had been released over the past several years. Each sheet had a graph of the test’s results, ratings from one to one hundred in a dozen categories: hallucinations, voices, self-control, anger, paranoia, and so on. The lines on each graph were dated, showing the test’s results at roughly three-month intervals. All five showed significant improvement within the two-year rehabilitation period, from highly psychotic to acceptably normal.