by G. H. Ephron
By the time we got around to business, only a ring of rumflavored cream remained at the bottom of the box.
“A new patient, Maria Whitson,” Gloria read the name from the board, “admitted last night. She tried to commit suicide. It’s not the first time. Overdosed on an assortment of prescription drugs washed down with a pint of vodka. Her father brought her in after she called him on her cell phone.”
“I saw her this morning after they pumped her stomach,” Kwan said. “Kept asking if I was you.”
“Me?” I asked, surprised. “She knows me?”
“Well, she must not. Or she’d have known that I’m not you, don’t you think? After all, I am so much better-looking, not to mention the fact that I dress better.”
I grinned. “Though you have to admit, after working together all these years, we have developed an uncanny resemblance.”
Kwan continued, “She was definitely confused. Suffering from delirium. We’ll have to wait till her system clears to tell what’s going on. In the meantime, I’ve recommended suicide precautions.”
Gloria jotted a note into her little book.
I reached for Maria Whitson’s file from the nearby metal rack, opened it, and started to read: “Thirty-two years old. Divorced. No kids. Injured her head a few years ago when she got hit by a car. Since then she’s been on the drug-du-jour program. They’ve got her taking a major tranquilizer, something for ulcers, lithium, Darvocet, an antidepressant, and, of course they’ve stuck her on two benzos at significant dosages.” I shook my head but didn’t hop on my usual soapbox about the dangerous, unpredictable long-term effects of these drugs. “A year ago she slit her wrists and climbed into a warm bath. Father found her that time, too. They treated her for severe depression and bulimia related to sexual abuse.”
“Buh … lee … mee … ah.” Gloria whispered, scratching more notes. Suicidal patients with eating disorders require special attention from the nursing staff.
“Jeez, Louise.” I whistled. “This explains all the drugs. It looks like every time she got a new diagnosis, they added another drug. Listen to this: organic delusional disorder, bipolar illness, psychotic depression, post-traumatic stress disorder, multiple personality and borderline personality. Good grief. She was referred by Dr. Baldridge.”
“Baldridge?” Gloria and Kwan echoed my surprise. Baldridge ran a little kingdom at the other end of the Pearce campus. I couldn’t remember the last time we’d gotten a referral from him. Maybe the brain injury put her in a slightly different category from his average patient. Or maybe he’d just run out of wonder drugs.
I snapped the file shut and hung it back on the rack. “Gloria, how about we start walk rounds today by giving Ms. Whitson a mental status exam? Do you think she can tolerate the stimulation of having all the staff around her?”
“She’s fragile but adjusting. I think she’ll be all right with it”
Maria Whitson’s room was the last one at the end of a corridor. The door was open. I knocked and entered, my colleagues close behind.
The corner room had two tall windows but the light that made it through the gray window shades did little to brighten the barren green walls and mud-colored linoleum tile floor. Invisible beneath the shades, metal screens were padlocked in place.
The mattress of the hospital bed had been stripped and the room smelled of disinfectant. In a corner, Maria’s silent form looked like a pile of dirty laundry. She stared listlessly down into her lap. Her blond eyelashes were caked with white bits that stood out against the red outlines of her eyes. Her flesh was pale and doughy soft.
Kwan knelt beside Maria. “Hello,” he said, “I’m Dr. Liu. I examined you earlier this morning.”
Maria slowly raised her head to look at him. There was no recognition. Her eyes drifted about the room as he continued, “These are my colleagues.” He introduced each of us in the courtly, respectful tone I’ve heard him, time and again, use so effectively with our patients.
He introduced me last. “And this is Dr. Peter Zak, the head of the unit here.” As he said my name, she gave a slight start that dislodged a clump of stringy hair from behind her ear. “Dr. Zak would like to talk with you. Would that be all right?”
I held out my hand. Though she didn’t grasp it in response, for an instant I had the sense that someone was peering over the barbed wire. Almost as quickly as I caught it, the look was gone.
“I would like to ask you a few questions,” I said.
She looked at me blankly.
“Can you tell me who you are?” There was no response. “Your name?” I waited. “Your name is …”
Her mouth shaped the word, and in a little-girl voice she said, “Maria.”
“Maria … ?”
“Whitson.”
“Ms. Whitson, do you know where you are?”
No response.
I could feel Gloria’s solid, reassuring figure moving to back me up. She came and squatted alongside me. I altered my position slightly as Gloria inched in closer. She took Maria Whitson’s hand, the nails bitten down to the quick, a silver pinkie ring embedded in the flesh. “Maria?” she asked in a concerned, professional tone. “Do you remember me? I’m Gloria Alspag. I met you this morning. I’m the nurse in charge here. How are you doing? Is there anything we can get for you?”
We all waited. Maria opened her mouth but said nothing. She chewed on her lower lip. She began a low keening, rocking to and fro, hugging herself as if she were her own baby. The rocking slowed as she tilted her head to the side, allowing the clump of hair to shift away from her eyes.
Slowly and deliberately, she wiped her nose with the back of her hand. She asked, “Could I have a drink of water?”
Gloria started to get up but I placed my hand on her shoulder. I wanted Gloria to stay right where she was and hold the connection.
I stood. There was a little stack of paper cups on the bedside table, along with a telephone and an orange plastic pitcher. I took a cup and reached for the pitcher.
Maria started violently, and began to shake her head. “No, no, no, no. Poison,” she whispered.
“How about some bottled water?” Gloria suggested.
She didn’t say no, so I went out and filled the cup from the water dispenser in the nurses’ station. I came back and handed the cup to Gloria.
“Thank you, Dr. Zak,” Gloria said. Then she offered the cup to Maria. Open-mouthed, Maria stared. The four of us waited, held captive in that moment of indecision. Accepting the water would be an act of trust. Finally, Maria wrapped her fingers around the cup. A collective sigh released the tension in the room. She drank greedily, dribbling some water down her chin, her eyes darting back and forth.
When Maria finished, she held the empty cup in front of her. Gloria gently took it from her.
“Would you like to sit in a chair?” Gloria asked her.
Maria looked around as if realizing for the first time that she was on the floor. She struggled to get up. Gloria and I each took hold of an arm and hoisted her up and into a chair.
I pulled up another chair opposite her and looked for eye contact. “Ms. Whitson, do you know where you are?”
Maria’s hands gripped the chair arms. She looked confused. She started, “I’m” — and then looked at each of us in turn — “where?” She shrank in her seat and whispered, “I’m scared.” She paused, listening to the echoes of her own voice. “Where, scare,” she repeated softly, “where, scare, scare, where …”
“Ms. Whitson, you’re in a hospital. This is the Pearce Psychiatric Institute. We’re the doctors and nurses who are here to take care of you. You’re safe here.”
She looked dazed, and again the keening sound began as she curled up in a ball, hugged her knees, and started to rock herself back and forth.
I asked her, “Ms. Whitson, do you know why you’re here?” I paused, hoping she’d fill the void, but she said nothing. “You’ve been having some problems, and apparently they must be quite serious because y
ou tried to commit suicide.”
The rocking subsided as she uncurled.
“We’re here to help you. What I need to do is get a sense of how you’re doing, and one way we do that is by asking you some questions. I’d appreciate it if you could respond as best you can. Can you do that?”
This time there was a cautious but perceptible nod.
I took a pencil from my pocket and held it up. “Can you tell me what this is?”
I thought I saw a little smile start. Then her mouth worked as she struggled to shape the word. Finally, she whispered, “Pencil.”
Encouraged, I continued, “That’s fine. And what’s this?” I asked, pointing to an empty chair. But her attention had already wandered and she was staring at the silver ring embedded in the flesh of her little finger. With little jerking motions she tried to twist it around.
“Ms. Whitson?” She stopped twisting for a moment and then started again. “Ms. Whitson? Could you put your right hand on top of your head?”
A hand floated upward and rested on top of her head. White lines scarred her wrist. Her head tilted sideways. She met my eyes. Then her gaze shifted to the faces of my colleagues and on to the flat, gray expanse of a window shade. The hand remained planted on top of her head.
“Ms. Whitson, could you wave your left hand and stick out your tongue?”
Now a definite smile appeared. Her lips parted and the tip of her tongue emerged. But the right hand on her head and the left one in her lap remained still.
I went through the other silly-sounding questions designed to take an instant picture of that mish-mash we refer to as mental status. Near the end, although I already knew the answer, I asked, “Have you ever thought about taking your own life?” This got her attention. She jerked slightly and then narrowed her eyes. I waited, wondering if she trusted me enough to answer.
Hesitantly, she nodded.
Encouraged, I continued, “Is that something you think about occasionally or a lot of the time?”
A tear spilled over and started down her cheek.
“I know this is difficult. Let me just ask you a few more questions. Do you ever see things that other people don’t see? Or hear things that other people don’t hear?”
This question seemed to confuse her. At first she shook her head, no, and then she stopped and looked at me, as if not sure what the answer was.
Finally, I asked her, “Do you feel safe here?”
Slowly and deliberately, she nodded. A smile tugged at the corners of her lips. It was an odd moment. I had the distinct impression that she was enjoying a little private joke.
13
CHIP HAD been calling me every other day since I’d started working on the case. Just checking in, he’d say, and then like a good coach who’s afraid that his star player is getting cold feet, he’d start pumping me up. In the week since Sylvia Jackson’s collapse, he’d been calling me daily. When he left only the brief message, “Let’s huddle to talk about the case,” I knew he was worried. We were experiencing more than the usual bumps in the road.
We met at the Stavros for a late lunch. I got there first and sat down at a table. Jimmy came over beaming. “Back so soon!”
“Hey, Jimmy. I’m meeting some people.”
“Anything I can get for you while you …” He stopped, mouth open. I turned to see what he was gawking at. It was Annie, striding across the room, her hair frizzled in an aura of light and shadow around her face. I realized I wasn’t used to noticing what women looked like. She slid into the chair opposite me.
“Jimmy, this is Annie Squires.” She offered him her hand and he took it.
Annie ordered two Diet Cokes and two Greek salads — one for herself and one for Chip. I ordered an iced tea along with a plate of fried calamari.
Annie gave me a concerned look. “You’re looking tired.” I didn’t have a ready answer. “Sorry, I hate it when people say that to me.”
“You’re right. I haven’t been sleeping. Losing my boat. And knowing that there’s someone out there. It feels like it’s starting all over again.”
Annie was watching me intently, her mouth quivering. “Maybe it would be for the best if you stopped —”
“No,” I said, surprised by the vehemence in my voice. “Before the boat accident, maybe. But not now. Now it’s personal.”
“Personal is not necessarily a good thing in this business.”
“Look, I can either lie down and play dead or fight back. If I give up on this case, if I back out now, then whoever is doing this wins. I can’t let that happen.” Even to me, the words sounded like hollow bravado, but Annie let it pass. “And I think we have a case. I haven’t finished testing Sylvia Jackson yet, but I can tell you this much: what you show her one minute she can’t remember the next.”
“Yeah, but being shot in the head isn’t some test. You think she could forget that? And if she can’t remember, then what is she remembering when she says Stuart shot her?”
“Someone can believe something happened because in some way, it solves a problem for them. Maybe it’s just too painful for that thing not to have happened. People even turn other people’s experiences into their own memories. You know, someone tells you a story about what happened to them, and later, you’re telling it as if it happened to you. And you’re not even aware that it happened to somebody else.”
“Happened to somebody else,” Annie whispered. Then, without any segue, she said, “Did you know that I have a sister?”
“No, I didn’t.” There was a lot about Annie that I didn’t know.
“What you’re saying reminds me of something that happened once. My sister was asking me if I remembered a night when my parents were fighting, both of them smashed out of their gourds and my mother broke her arm. My sister had to drive her to the hospital. She could remember all of the details. How frightened she’d been that a cop would stop her and arrest her for driving without a license. How my mother lied to the people at the emergency room, saying she’d fallen down the cellar stairs. How my mother threw up when they gave her the codeine for the pain. But what my sister couldn’t figure out was why I didn’t drive my mother to the hospital. See, I’m two years older than her.” Annie paused, looking at me intently. “The thing is, all that stuff about driving to the hospital, watching my mother throw up? It happened to me, not her. I was fifteen. I don’t know where my sister was that night — maybe sleeping at a friends’ house or staying over with a relative — but she wasn’t even at home. I must have told her about it later. She’s thirty-four now and she really thought it happened to her.”
We sat in silence for a few moments. The memory had made Annie’s eyes retreat behind a glaze of tears. I reached for her hand but she had jerked it from the table and straightened in her seat. “Chip, you made it,” she said.
I turned. Chip was standing behind my right shoulder. He was rummaging in his briefcase, trying to look preoccupied. I wondered how long he’d been standing there. Annie took out a tissue and blew her nose. “I ordered you a salad,” she told him.
Chip sat. Once again, we cut the small talk and got down to business. I described Sylvia Jackson’s test results so far. “She was only able to identify a few of the items that disappeared. She confused the two sets of pictures. She scored off the scale, way down at the low end.”
“Can we argue that Sylvia Jackson shouldn’t be able to remember the night of the murder?” Chip asked.
“Unfortunately, it’s never that clear. But what we can say is that stuff just isn’t getting into her short- or long-term memory. With her, we’re dealing with a kind of double whammy. Head trauma that creates amnesia and also permanent damage to the structures that mediate memory. We can demonstrate that she’s unable to take in new information and recall it, and we know she was unconscious for a long period of time. All the literature and all of our clinical knowledge suggests that it’s unlikely that she’s going to remember what happened immediately before she got shot.”
“You can’t find a stronger word than ‘suggests’?” Chip asked.
“Sorry. Psychology is a soft science. What’s intriguing is that she makes things up. She knows something is missing but she doesn’t know what. So she invents a missing item that was never there. Psychologists call it confabulation. Unconsciously, someone like Syl is aware that she has holes in her memory. She fills those holes with other real experiences borrowed from earlier memories, or with made-up stuff that sounds real. Someone coming out of a coma, in an altered state of consciousness, is going to be very, very suggestible.” It wasn’t hard to imagine the relatives, friends, medical personnel, lawyer, and police who might, inadvertently or otherwise, have provided Syl with the stuffing for the holes in her memory.
“Catch-22,” Annie commented. “Stuart Jackson could be found guilty because the jury believes Syl can remember when she really can’t. Or he could be found innocent because the jury believes she can’t remember when she really can.”
I shifted uncomfortably. “I’m convinced she can’t remember. Too bad we don’t know what really happened.”
“Peter, guilt is always a possibility,” Chip said gently. “Our job is to defend the accused, guilt or innocence aside.” That’s your job. To me, it matters. “So here we have a woman whose brain is this leaky sieve. She loses a lot of what she takes in, and then distorts some of what remains. A credible witness?”
“From the jury’s point of view? Definitely,” I insisted. “She’s sympathetic and vulnerable. And she believes every word she’s saying.”
“You have more tests?” Chip asked.
“I still need to finish up the personality tests.”
“How are personality tests going to tell us anything about whether she can remember what happened to her?”
“If you want to know whether the brain injury has damaged the memory, you need to know what the memory was like before the damage occurred. A piece of that comes from understanding personality, because who you are affects the way you remember things.”
Chip didn’t look convinced.
