by Gary Braver
“Yes.”
“How do you explain that?”
“That the security door malfunctioned.”
“Have you heard of it failing any other times?”
“No.”
“Have you ever known the security system on the Alzheimer’s ward to ever fail?”
“No.”
“Then how do you explain it failing this one time?”
“I can’t.”
“What about the front desk? Did she suddenly turn invisible, or did she turn into a bird and fly out?”
“Mr. Beck, you’re bullying my client and I won’t stand for it.”
But he disregarded Flowers. “Well?” Again he bore down on René as if trying to stun her in his glare. But the more hostile Beck turned, the more resistant René became. It occurred to her how easy it was to lie, to maintain a kind of Orwellian doublethink—holding two contrary thoughts in your head at the same time. And with every question, she felt a separation from her more real essence—like a retreating doppelgänger. To justify the growing split, she kept reminding herself of the “higher good”—of Lorraine Budd recalling her high school friend from 1940-something and Ernestine spelling her nurse’s name and Louis Martinetti remembering his army days. “I don’t know.”
“You don’t know. Is it possible the front desk attendant maybe left for a few moments to go to the restroom or get a coffee, and while she did Clara slipped by?”
“It’s possible. But I really don’t know.”
“And where exactly were you when she got out the door?”
“At home.”
“You say your job is to monitor patients’ medications, correct?”
“Yes.”
“And you have a pharmacy degree?”
“Yes.”
“So you understand the medications that are prescribed to patients?”
“Yes.”
“Good. So if a patient is taking anything that might be harmful to themselves or others, you would know?”
“Yes.”
He opened up a folder and pulled out a sheet.
“Was Clara Devine on any medications that would cause her to become violent?”
Maybe. “No.” She heard the syllable rise easily out of her throat but imagined that her eyes were blinking red polygraph alerts.
“Are there any she was taking that could have such violent side effects?”
“No.”
He opened a file folder and removed a sheet. “The medication sheets on file at the nursing home lists Atenolol. What’s that?”
“A beta-blocker. It reduces heart rate, blood pressure.”
“What about Aricept?”
“That’s for her dementia.”
“No possible side effects?”
“No.”
“What about Paxil?”
“That’s for her depression and general anxiety.”
“How does it work?”
Brenda Flowers tried to protest the line and manner of questioning, but he persisted as if he were on some slightly manic autopilot.
René could see that Beck was enjoying his schoolroom inquisition, but she would not crack as she shot back the answers as if she were taking her orals back in pharmacy school. “Paxil is the brand name of paroxetine, a class of drugs known as selective serotonin reuptake inhibitors. It affects the activity of neurotransmitters in the brain, in particular serotonin and norepinephrine, which help regulate one’s mood.”
“You’ve done your homework, I see. So have I,” and he whipped out a file card from his folder. “Did you know that Paxil can cause delirium, irrational talk, and hallucinations, irritability and hostility, even manic reactions including ‘great excitement and psychotic rage, followed by depression’—all of which this drug is supposed to prevent? Is that not so, Ms. Ballard?”
“All drugs have side effects, and a small percentage may be adverse.”
“But are these not side effects that could have led to Mrs. Devine’s attack on Edward Zuchowsky?”
“That’s remotely possible.”
“Remotely possible? Well, did you know that England has recently banned the use of Paxil for children and teenagers under the age of eighteen because the drug has been linked to suicide, suicidal behavior, and violent outbursts? Did you know that?”
“I had heard that, yes.”
“And yet your home still prescribed the drug to her.”
“Clara Devine was seventy-six years old.”
He made wide-eyes. “Oh, so it only adversely affects people under eighteen? How is that possible? Brains are brains, no?”
“No. Childhood depression is different from adult depression, probably because children’s brains are still developing. So antidepressants may not have the same effects—beneficial or adverse—in children as in adults or geriatric patients. While it’s difficult to weigh the risk-versus-benefits of any medication, Clara Devine had been on the same doses of Paxil and her other medications for many months. So I’d say that it’s very unlikely that any of those meds caused such a dangerous impulse.”
“So you’re saying that nothing she was on could have accounted for her violent behavior.”
“Not to my knowledge.”
“But how would you know if you’ve been on the job for only eight weeks?”
“Because I saw her medical charts, and because there’s no report of psychotic rage, hostility, or combative behavior that would point to her killing of Mr. Zuchowsky.”
Beck rocked back in his seat and looked down at this list. “Once again, are you certain there were no drugs she was on that could have led Clara Devine to kill Mr. Zuchowsky—some kind of stimulant or antipsychotic drug that produced the opposite effect?”
In a flash she saw the nurses’ notes: “More alert.” “More verbal.” “Remembered his granddaughter’s name.” And Louis Martinetti’s swearing, “We’ll get them back is all.” And she heard her father’s exasperation: I can feel the holes.
Besides, she really didn’t know if Memorine had anything to do with the killing. That was the truth. And that’s what the purpose of this deposition was. Furthermore, this Cameron Beck was a royal prick. “Not to my knowledge.”
Beck snapped closed his file folder. “Thank you, Ms. Ballard. That will be all.” He stood up and shook her hand. “Good day.”
When they left the office, Ms. Flowers said, “Sorry about that. But he can get a little intense at times. You should see him in the courtroom. How do you feel?”
“Fine,” she said. Piece of cake? René felt as if she had just eaten a slab of suet.
30
FOR THE BETTER PART OF A WEEK, René pored through the various nurses’ reports of residents enrolled in the Memorine trials, hearing the nasal persistence of Cameron Beck’s voice—“any adverse side effects?” What she discovered was a marked increase in cognitive tests scores of nearly fifty percent of the subjects as well as improvement in their basic daily functions. In fact, Louis Martinetti had progressed twenty percent on his Mini-Mental State tests. That statistic particularly delighted René, as if the demon was being vanquished for both Louis and her father.
But in about a quarter of the reports, nurses had noted spells of “regressive behavior” and of “odd spells” when patients would become dissociated from the moment and lapse into past-time hallucinations—like Louis Martinetti thinking he was back in the army—or “childhood delusions.”
Flashbacks.
According to her time line, those residents were part of the first trial group.
“Her mood would suddenly change, like that,” Alice said when René asked about Clara Devine. “Suddenly she’d start talking in rhymes. Or she’d have conversations with people who weren’t there. That’s not unusual for dementia residents.” Then she added, “But the thing is these spells could last a long time, and they were pretty coherent. It was kind of weird.”
The notes also indicated that flashback spells had been observed in Mary Curley, who, like Clara
Devine, was being treated with antipsychotic drugs and tranquilizers. So was Louis Martinetti.
“It’s what we did if they became too disruptive or when the families visited.”
The medication orders had been signed by Jordan Carr.
Of course, Clara Devine was at McLean’s Hospital for psychiatric evaluation and would not be back for weeks or months—if ever.
During his rounds one afternoon, René approached Jordan Carr about his medication orders when he became defensive. “That’s what’s used for treating psychotic delusions. Do you have a problem with that?” His face had taken on the rashlike mottling again.
He clearly did not like the implication of her question: that they were burying a potential adverse side effect of Memorine. His manner also reminded her of the professional divide that separated them. “No,” she said.
“Good.” Then to clear the air, his manner changed. “I hear your deposition went well.”
“It’s not something I’d like to go through again.”
“Well, you won’t, I’m sure.” Then out of his shirt pocket he removed two concert tickets. “By the way, I’ve got two tickets to the symphony next Friday night. Mnemosyne by the Hilliard Ensemble.”
She thanked him but said she was busy, which was a lie. It was also the second time she had turned down a date with him. Jordan Carr was handsome, charming, brilliant, rich, and accomplished—a real catch in most women’s books. His interest in her had not gone unnoticed by some nursing home staffers who wondered if her relationship with Jordan had transcended the professional. It hadn’t, and René did not want to encourage that. She was not comfortable dating a professional colleague. Nor was she ready for another boyfriend. All she wanted was to continue carving out her career without complications.
From the upstairs window she watched Jordan leave the building. A couple of weeks ago he had purchased a second Ferrari, a silver 1999 Maranello. Out of curiosity, the other night she went online and looked up the model. She came up with one hit from Atlanta with the same red with tan interior. The asking price was $240,000.
As he pulled out of the parking lot, her eye fell on her little blue Honda Civic with the dented front fender. She felt like the member of a different species.
“Did Dr. Carr leave?” Alice asked, as René returned to the nurse’s station.
“Yes.”
“Oh, well. A fax just came in for him.”
Just then one of the aides called her to help with a patient. “Here, hon, slip this in Dr. Carr’s mailbox for me like a good kid, okay?” And she handed René the sheets and scurried away to the aide. Even Alice was beginning to perceive René as Jordan’s girl.
René walked over to the mailboxes and happened to glance at the sheet. It was from Massachusetts General Hospital Emergency Department, Archives. It was a blood assay made back in August.
She glanced at all the chemical analyses, but what caught her eye was the name of the patient. It struck her as odd since he was not one of Jordan Carr’s patients. In fact, when she had mentioned her visit a few weeks earlier, Jordan had said that he was unfamiliar with the case of Jack Koryan. Never heard of him.
31
RENÉ FOUND MARY CURLEY IN ONE of the activity rooms. Three other women were at the main table doing cut-and-pastes with an aide. But Mary sat alone in a corner with puzzle pieces piled in front of her.
As she approached her, René became aware of Mary’s outfit—a ruffled white blouse under a pink and white jumper. Some residents needed help getting dressed. Others could dress themselves. According to the charts, Mary was in the latter category because of her improved functionality. But what startled René was that Mary looked like a geriatric Little Bo Peep. “Hi, Mary. Remember me? My name is René.”
Mary looked at her. “I remember you.”
René didn’t really believe her since several weeks had passed. “The last time we met, you were doing a puzzle of a kitten.”
“That was Daisy. She’s over there.” And she pointed to a shelf of puzzle boxes.
René was shocked at her recall. But Alice’s words shot through her head: This is what it’s all about.
“That’s right!” But as soon as the words were out, René’s eyes fell to the picture puzzle—a little girl with a dog. And the little girl was dressed in a pink and white jumper. “Mary, that’s a very pretty dress. Where did you get it?”
Without missing a beat, Mary said, “My daddy.” She clicked another piece into the puzzle. “He’s going to take me to the museum today.” And she checked her naked wrist as if reading a watch.
“He is? Isn’t that nice? Which museum?”
“The Museum of Fine Arts in Boston,” and she enunciated the words with slow deliberation.
But what sent a jag through René was the woman’s voice. As if somebody had flicked a switch, Mary sounded like a little girl. Even her deportment seemed to shift as she rocked her head with each syllable, the pink tip of her tongue wetting her lips.
“He’s going to take me to see the mummies. You like mummies?”
“Yes. I like mummies,” René said, feeling as if the room temperature had dropped ten degrees.
“No, you don’t. That’s not what you said yesterday. You said you didn’t like mummies. You said they were all dry and scary-looking, and you didn’t want to go the museum.”
“But I didn’t see you yesterday.”
“You did so.”
“Mary, what’s my name? Do you remember?”
Mary looked up at her with a slightly quizzical expression. “Barbara Chin, silly.”
“My name isn’t Barbara Chin. It’s René.”
Mary snapped another piece into the puzzle. “I’m not afraid of mummies. And you shouldn’t be either. They’re dead.”
As Mary continued her weird monologue, René noticed how she kept licking her upper lip like a child and how she fidgeted with the folds of her dress and twisted strands of her hair as she studied the scattered puzzle pieces, or put a twist of them in her mouth, sucking the ends as she searched for connections.
But what unnerved René was not just the full-faced innocent hazel eyes entreating her to explain her fear of mummies. It was that voice: It had none of the resonance and timbre of an elderly woman but the thin violin sharpness of a little girl’s.
“I remember you have a dog also,” René said, as Mary completed the spaniel’s head in the picture.
Mary licked her lips and her face lit up. “His name is Jello.”
“Yes, Jello. I like the name. What kind of dog is he?”
“He’s a golden retrieber.”
“Retriever.”
“That’s what I said, retrieber.”
René kept feeding her questions not just in fascination at Mary’s recall, but the weird sense of double exposure. Half the visual cues told her that René was having a conversation with a seventy-eight-year-old woman. But the dress and gestures and voice were those of a child. Every so often Mary would look up full-faced at René, her watery eyes staring at her full of little-girl innocence but through a face of crinkled, doughy flesh and liver spots. These were not the eyes of a dementia patient who looked out in fear and confusion at a meaningless kaleidoscope of colors and shapes. Nor were these the eyes of a woman who was being stripped away inside. These were the eyes of a child pressed into the face of an old woman.
“Mary, can I ask you a question?”
Mary looked up at her blankly, her eyes perfectly round orbs of milky blue innocence.
“Where are you?”
For a hushed moment, Mary just looked at her with that broad soft open face. “Henry C. Dwight Elementary.”
“And how old are you?”
“Seven.”
“No,” René began. But she was cut off as Mary grabbed her hand, and for a second René thought she wanted to be helped up. But she pulled it to her mouth and in the instant before she took a bite out of it, René snapped it away.
Mary hissed at her. “I don�
�t like you.” Then she pushed her chair back and stood up. She inspected her wrist again and started moving away.
“Mary, where you going?”
Then in that little-girl voice again, she said, “Jello needs to go out.” And she got up and shuffled out of the room.
32
“IT WAS CREEPY. SHE WAS IN a time zone of seventy years ago.”
“That’s not unusual with these patients,” Nick said.
“But this was different. She was coherent, not scattered or fragmented. Neither was her delusion. She was back in her childhood and apparently enjoying it, except when she tried to take a bite out of me.”
They were jogging along the river again. The day was cool and overcast, and because it was October only a few sailboats were on the water.
“Then that’s something we’ll be looking into,” Nick said. “Which brings me to why I called. Feel like moonlighting? I’m going to need help tabulating data for the trials. We’re getting lots of positive results, but I’m concerned over these flashback events.”
She was relieved to hear him say that. She was beginning to wonder if she was the only one who saw this as a potential problem.
“That’s something we have to deal with. And that’s going to mean cross-referencing these events with population demographics, genetic profiles, et cetera.”
“What exactly would my job be?”
“Your title would be behavioral data analyst.”
“Why do I have the feeling that you just made that up?”
“Because I did, but who’d be better than a consulting pharmacist?”
“I’m flattered, but won’t that be a conflict of interest?”
“Au contraire, and didn’t I see that coming? You’re an employee of CommnityCare pharmacy, which makes you an outsider to both the homes and GEM Tech. And since you’ll be in my employ, that puts you out of range of GEM.”
She thought that over for a moment, feeling a slight uneasiness.
“Unless, of course, you have problems with receiving compensation from me.”
