"You're probably right. I'm not sure how relaxing it would be to get avay; given everything that's going on."
"I wouldn't relax."
"You're really ready to do the remodeling?"
"Yes. I'm tired of talking about it, we can put this off forever arguing about where to put the recessed lighting and what kind of trim to put around the windows. It's time to just do it, and I know I'll feel safer living in town until all this .., other stuff settles. Out here it's just Adrienne and us."
She kissed me on the top of my chest, just below my collarbone, she said. "Alan?"
"Yes."
"I think maybe you should tell me about Sawyer."
"About Sawyer?" I said, startled.
"Well, yes,” she said. "About you and Sawyer. What went on. Whatever went on?"
"You're sure?"
"No. I'm not at all sure, asking makes me terribly anxious. But I think I need to know."
"Yes. I suppose I should tell you."
TEN
By the time August first finally arrived and my inpatient rotation on Eight East was due to start. I'd managed to learn a few facts about Sawyer. I had called back the clinic where she worked and discovered that it was an outpatient psychiatry clinic, the exact same clinic where I, too, would soon begin seeing outpatients.
I wasn't too surprised to discover that Sawyer Sackett. M.D., was a psychiatric resident, and since she'd been on campus longer than I had. I guessed that she was a second-year psychiatric resident. Mona Terwilliger had reluctantly confided that Sawyer had attended medical schools in Florida, and that her family still lived in Virginia, where she grew up.
I have to admit that I was disappointed to learn that Sawyer was doing her training in psychiatry. I'd pinned my hopes on pediatrics. Or family practice. Or maybe one of the surgical sub-specialties, like OB-GYN, although I had not actually spent any time praying that she wasn't training to be a psychiatrist. I wasn't looking forward to sharing turf with her.
What else did I know about Sawyer by the time my internship started?
Not much.
I wondered about that a lot. Worried about it some. But soon the pressures of my training took almost all of my attention.
• • •
The day my initial rotations were assigned and I knew that my first inpatient rotation was going to be adult Orange Team. I phoned Sawyer at home and asked her nonchalantly— I thought— what inpatient unit she worked on.
"Eight East,” she'd said, that meant the adult unit, the adolescent unit was on the seventh floor.
"Blue Team or Orange Team?" I asked.
"Orange,” she said.
"Me, too." I said. "I just received my assignments. This should be weird. You'll probably be doing my medical backups."
"Probably;" she said. I was trying hard to appear nonchalant. Sawyer was clearly succeeding.
The first meeting I attended on Eight East was rounds, the meeting was held in a conference area adjacent to Dr. Susan Oliphant's office. Susan was the ward chief for the Orange Team.
In addition to the ward chief, daily rounds were attended by all the residents and interns, by the chief psychologist— my supervisor. Dr. amy Masters— by the team social worker, Lorna Pope, by the head nurse, Kheri Link, and by any of her staff who were free to attend.
Unlike the residents who are making rounds on some of the medical floors of the hospital, the trainees in inpatient psychiatry don't traipse from room to room carrying charts and asking patients questions about their condition before being grilled by their attending. Instead, we sat in an oblong circle and reviewed history and therapeutic progress, medication status, community and group process, and family meeting information on all the current patients. I also quickly perceived that we were to try to act as though we were brilliant and compassionate enough to have a prayer of helping the troubled people down the hall.
The ward chief and the chief psychologist had roles different from those of the trainees, their job was to let us know when we were being brilliant and compassionate, and, conversely, when we were being ignorant and condescending. Occasionally they managed to accomplish this with an amount of humor and kindness that left our swollen egos unlanced. Usually they didn't bother being so delicate.
That first day in rounds. I found myself sitting in an
uncomfortable sled chair between Arnold Dresser. M.D., and Wendy Asimoto. M.D., two of the three residents on the team, amy Masters was across the room whispering something to Lorna Pope, the unit social worker.
Wendy and Arnie were leaning together in front of me, comparing notes about a seminar they had to attend that afternoon on the new CPT-IV codes. I didn't have a clue what a CPT-IV code was, but didn't want to embarrass myself by inquiring. I was sure it was something I should have already learned in graduate school and that my ignorance about it would soon cause me great humiliation.
A minute or so later. Sawyer entered the room along with a tall, thin woman with a narrow face, sandy hair, and brilliant green eyes. I tried to act unconcerned at Sawyer's arrival; I even pretended to be part of the tete-a-tete about CPT-IV codes that was occurring over my knees.
While Sawyer took a chair almost directly across from me, the woman who was with her walked across the room, fumbled with some mail that had been piled on the desk, and dropped her briefcase unceremoniously in the middle of the blotter, her back turned to the room, she asked. "Who are we missing?"
Dr. Masters said. "It appears we're dragging one of my interns. Susan."
Arnie smirked. "He's probably lost."
Loma added. "Susan, nursing is just finishing up a restraint. I don't think they'll be on time either."
"Who's being restrained?" Arnie asked, nervously, I thought. I didn't know him at all then, but later I would realize that Arnie's question was precipitated not by curiosity but by worry that one of his own patients was misbehaving, which Arnie would definitely consider a black mark on his record.
Loma said. "Sorry, Amie, I'm afraid it's Travis again, he was threatening one of the nurses this time, had her cornered in the corridor by his room. Thought she was that Frieda person he's always talking about, he was using his toothbrush, you know, holding it like a knife in front of him, he doesn't go down easily— it was a tough restraint, he's really strong."
Before Arnie could say anything Susan Oliphant asked, "How much Navane is he on, Arnie?"
Arnie said. "I upped it to forty."
"Is it enough?"
Arnie opened his mouth. For a second, nothing came out, he said, "Given the recent history, I think—"
Susan pressed him. "Is it the right drug?"
Wendy Asimoto said, "What about Thorazine or Haldol?"
I looked around the room at the psychiatric residents, at Sawyer, at the other two, they had started on July first, so they had been on the unit a month already.
A month was a lifetime in a training rotation.
They were experts.
The lexicon of medical school training said that students first see a procedure, then they do the procedure, and then they teach the procedure, well, Sawyer and her two comrades, arnie and Wendy., had already seen one, they had already done one, and now: with fresh blood on board— the other intern and me— they were going to be eager to teach one.
Susan Oliphant looked over her shoulder and scanned the room. "We'll deal with Travis in a few minutes. Let's get started somewhere while we're waiting for the other intern." She looked at me with mock seriousness before saying. "I don't like waiting for people, do I, Wendy?"
Wendy smiled her reply with her dark eyes, she said. "No, waiting is not your best thing. Dr. Oliphant."
Susan continued to fumble with her mail while she looked over her left shoulder at me.
"You must be Dr. Gregory. Right?"
I hesitated. I thought this might be a trick question. Technically; I wasn't a doctor, yet. I wouldn't receive my Ph.D, until after I completed my internship. "I'm Alan Gregory:" I said, sidestepping
the question.
The obfuscation didn't work with Susan Oliphant, she said. "Here, on Orange Team, you're 'Dr.' Gregory.
You get a temporary promotion, get to wear the figurative white lab coat. Patients in the hospital don't want to think students are providing their care, they want to believe that we're the best, most experienced damn healers who have ever set foot on this planet, they want to be treated by doctors. So for a few special months, you get a dispensation. You're Dr. alan Gregory. Everyone, meet Dr. Gregory and introduce yourselves."
Amie Dresser made a noise I couldn't quite interpret, but I would have guessed it had some familial resemblance to contempt.
Susan didn't turn around, she'd heard the noise too, apparently, she said. "Amie, the best therapists are those who don't believe they are God's gift. Dr. Gregory, introduce yourself to the team."
The room took on the silence of a chapel.
I wasn't ready.
I had prepared myself for this day for four years of graduate school. Classes, seminars, patients, supervision. Reading. God, so much reading.
I had prepared myself for this moment since four-thirty that morning. I was wearing my best gabardine trousers and a wool sport coat I considered stylish but not too trendy. My shirt was white, my tie brand-new, my shoes shined. My socks were interesting.
The reality was, though, that despite all my preparation. I felt like a kid, an impostor. I was still occasionally carded in bars. If I didn't look old enough to drink, how could I possibly be old enough to provide adequate treatment to a schizophrenic?
I felt confident enough with outpatients in clinic settings. I felt that my training had left me with many of the skills necessary to help the ambulatory distressed. Psychologists are trained to use the power of the therapeutic relationship to effect change in their patients. Often, in outpatient settings, those skills sufficed.
Psychiatrists, too, were trained in the art of psychotherapy. But, in addition, psychiatrists possess medical degrees and, thus, the knowledge and authority to assess medical problems and the privilege to prescribe drugs.
Clinical psychologists have a powerful arsenal that consists of one weapon: psychotherapy, the temptation, of course, when one is carrying nothing but a hammer is to treat everything as though it is a nail.
And I feared that my hammer, no matter how skillfully I wielded it, wouldn't work here. Not with this unit full of crazies.
Amy Masters caught my eye, and with an expectant smile, nodded at me to proceed, her face was as nonjudgmental as my grandmother's had always been. Dr. Masters had been here a long time, had seen a lot of interns come and go, she had seen the self-doubt, maybe felt some of it herself at one time, she had supervised the doubters.
And she was telling me to go on.
"Good morning." I said. "My name is Alan Gregory. I'm a new clinical psychology intem and I'm delighted to be here." Right then, having spoken my first untruth, I made the mistake of looking toward Sawyer.
She was smiling into her lap.
I was rescued by the rushed entrance of the head nurse and two members of her staff along with the other psychology intern, a young woman I'd met briefly at orientation earlier that week, her name escaped me.
She said, "Sorry I'm late. I couldn't get my key to work."
A trace of annoyance in her tone, Susan Oliphant asked, "Why didn't you just get buzzed in?"
The intern said, "I did. Problem was I was trying to open the wrong door. I got myself buzzed into the adolescent unit, all the patients there were younger than me, and I thought I had been assigned to a unit where the patients were supposed to be older than the doctors. Hi, everybody, I'm Alix Noel." She smiled a brilliant smile.
Amy Masters said. "Well, Alix, you're Dr. Noel now."
Alix looked at me, then at Amy Masters, she said. "Cool. I'm a doctor now? Does that mean I skip the rest of my internship? Even better, can I, like, totally forget my dissertation?"
Everyone laughed.
Of course, none of us knew then that that day was the first time that all of the dead doctors would be together in one room.
The introductions lasted about five minutes. I was looking forward to Sawyer's, hoping I might learn something. I didn't, she stated her name, said that she was a second-year resident and had a particular interest in forensic psychiatry, she smiled at Alix, didn't once look at me.
Since neither Alix nor I had yet picked up any patients, the residents took turns reviewing their current cases, they did the reviews from scratch for our benefit. History, medical history, reasons for admission, precipitating events, treatment course, meds. Everything.
Sawyer went first.
She was dressed in a tartan skirt that reached the middle of her calves and a long-sleeved white blouse that an hour earlier I would have bet good money wasn't even part of her wardrobe, the social bluster and gaminess that was so much of what I had seen on our quasi-date during the hailstorm was absent, she was precise, professional, perhaps even a little shy, she presented her four cases with confidence and a trace of humor, she accepted compliments and criticism from Dr. Oliphant and from her peers with the same grace. Perhaps my judgments were colored by my lust, but I thought she showed surprising sensitivity in presenting her two active cases, a young first-break schizophrenic and a severely depressed woman in her forties. Dr. Oliphant was pressing for electroshock; Sawyer wanted more time to work with her patient in psychotherapy.
I realized for the first time that the Sawyer I'd met at Mona's party, the Sawyer I'd risked life and limb to have cocktails with in a thunderstorm, had either been putting on an act for me or was putting one on right then. I also realized that I didn't know which was true.
That should have warned me off.
It didn't.
It intrigued me.
ELEVEN
After rounds, alix and I were introduced to the rest of the Orange Team staff and to the other therapists who worked on the unit, alix rushed off to an outpatient clinic appointment. I had a few minutes to kill before I was due to meet my new supervisor in the psych ER, so I loitered outside the nursing station hoping to learn when I would be assigned my first patient.
Sawyer walked up to me and introduced herself as though we had never met, she called herself "Dr. Sackett."
I got the message.
She suggested that since we would be working together, we get to know each other better, and wondered if I was free for a late lunch at the Campus Lounge on Eighth Avenue. I said I thought I could do that.
At one-thirty she was waiting on the sidewalk across the street from the campus. In my brief stay in Denver. I'd already learned that the tacky restaurant and adjoining bar were a hangout for the medical school staff and students. I waved and she smiled in a way that made her mouth widen
without the comers rising at all and said. "Hi. I forgot my appointment book. I'm lost without it. Totally lost. Why don't you come to my house instead? I'll fix a sandwich or something. Do you mind? Please."
"Not at all." I said, the levity in her mood surprised me, we hadn't been together since that night at the Firefly during the thunderstorm. I expected more of the same gaminess.
But it was absent. I considered it propitious.
We walked in silence for the block and a half to her home, with her arms crossed she held a small satchel against her chest like a schoolgirl, at her house. I followed her down a narrow brick walkway to the backyard, we climbed three rickety stairs and entered a tiny kitchen through a battered screened-in porch.
"Why don't you check the fridge, see if there's anything you want. I'm going to get out of this skirt. It's way too hot for today." She disappeared into another part of the house.
I hung my jacket over a kitchen chair and ignored the refrigerator, which was humming loudly. I used a glass from the dish drain to get myself a drink of water from a big glass bottle that was resting on a ceramic crock across the small room, the water tasted great, so I got another, and sat on one of the kitchen ch
airs.
Sawyer walked back in after two or three minutes, she had changed her outfit and was wearing a short-sleeved floral blouse, a lightweight khaki skirt, modest pumps, and panty hose.
She looked preppy.
I was surprised.
In her hands she held the day's mail, she smiled at me before starting to flip through it, quickly setting aside everything but an envelope constructed of good blue paper. "Excuse me,” she said, slitting the letter open.
She turned her back to me, crossed the room to the sink, and started to read. I couldn't be sure, but I thought I heard a whimper or moan escape her lips, she flipped the single page over and began to read the back, her posture weakened and she rested her elbows on the sink, her left hand sifted through her hair.
After a minute or so she stuffed the letter back in the envelope and hiked out of the room as though I weren't there.
I was alone for a good five minutes before she returned, she stood in the doorway.
"Bad news?" I asked. "The letter."
She lowered her eyes and moved her head in a way that wasn't yes, wasn't no.
"Want to talk about it?"
She swallowed. "It's nothing, the past."
"Didn't look like it was nothing." Impulsively, I grabbed her hand as she walked by me.
When she didn't pull away from me, I reeled her closer, she hesitated slightly, but not enough to warn me off. I continued to pull until she was facing me, not more than a foot from the chair. "What is it? What upset you?" I said.
I reached for her other hand, she tensed. I could feel her weight pull against me. For a second I thought she intended to move away, but she relaxed, stepped forward, raised her left leg, and straddled me on the chair, lowering herself gingerly to my lap.
She said, "It's nothing, really. Forget it. You're feeling a little more bold today than you were the last time around, aren't you?"
"This particular situation doesn't feel as dangerous as thunder and lightning and hailstones."
Her voice was heavy, she said, "You never know."
"Maybe you haven't heard? I'm a doctor now. Like you. So I get to be righteous. Cocky."
Manner of Death Page 9
