Breakdown, p.5
Breakdown, page 5
“I’m a guy who needs to moonlight, Dr. Delaware. Three days a week I work at an applied behavioral analysis home for autistic adults. The wife and I just bought a house, so I do extra hustle. Mostly that’s taking care of old folks who need watching for a weekend when their regular caregiver’s away. Also some terminals at home and some hospice care.”
“Tough stuff but better than this,” I said.
“Death I can deal with, Doc. It’s normal, it’s expected. This, on the other hand, is a weird setup. The Hyphen has no clue about psychiatry or anything else for that matter. Once I realized I’d be stuck here by myself the thought of some crisis coming up began scaring the hell out of me. I mean I’m authorized to call the referring physician but what’s that worth? Stuff happens fast, no way am I going to bear responsibility if God forbid there’s a situation.”
He pointed to Door A again. “No problems so far, knock wood, but I still find myself checking all the time to make sure she doesn’t hurt herself. She’s wearing the clothes she came in with but I took these and put them away because there’s nails in the heel.”
From a desk drawer he removed a pair of flat shoes, once black, now gray. “I’ll grant you one thing: The room’s pretty well designed for psych patients. Can’t spot any easy way to get into trouble. But still…”
“Thanks for trying to keep her safe.”
His smile returned. “You and I would say ‘safe,’ The Hyphen would probably say it’s optimal injury resistance. Anyway, so far, Ms. Chase has been easy.”
“Any symptoms I should know about?”
“Not unless you count nonstop sleep. Which happens with acutes, right? They put out all that energy then they need to hibernate. She was kind of agitated when the ambulance brought her in—fighting the restraints, grinding her teeth, so I was expecting the worst. But I talked softly to her and she calmed down and soon she was out like a light. It was like she just needed to hear a human voice.”
“What time did she arrive?”
“Around eight yesterday morning. The agency calls me at six, my wife, she’s also an RN, is leaving for her shift at Kaiser, it’s my turn to get our boy off to preschool and the agency’s like ‘Right now, Kevin.’ And I’m like you’ve got to be kidding. Then they told me what I’d be getting paid and I said, ‘Son, you’re off to preschool early.’ ”
“Generous compensation.”
“Three times the usual, plus a great food allowance. But I’m starting to feel like I’m the one who got committed. I mean, look at this—talk about solitary confinement. I’m glad you’re here to take charge.”
“That food allowance is for takeout?”
“You see a stove or even a microwave? The neighborhood’s pretty ethnic and The Hyphen has charge accounts everywhere, so that’s cool. I had Moroccan for lunch, Korean for dinner, fresh rolls from a bakery this morning. I ordered extra for Ms. Chase but she’s stayed asleep and I ended up tossing it because there’s no fridge, who needs food poisoning? She changes her mind, I’ll get her fresh. I did manage to get some water into her—dribbled it slowly through her lips. It took a while, you know how flaccid they can get, I had to make sure nothing ended up in her trachea.”
“She drank without resistance?”
“She moaned a little at first but I kept telling her she was okay and, again, it seemed to help. I figured hydrating her was the right thing to do.”
“Good call.”
He seemed relieved. “I mean at some point I have to make decisions and if she got dehydrated, the only alternative would be to I.V. her and who wants to do that? Plus, do you see an I.V. setup anywhere? On order, claims The Hyphen. Same for syringes, tubing, the fridge, everything else that would make this place real.”
I pointed to the red-crossed cabinet. “What’s in there?”
Kevin Bracht walked over and tapped the metal door. It swung open. Other than a box of bandages and a packet of rubber gloves, empty.
I said, “No meds in stock?”
“Not even aspirin. Everything needs to be ‘patient-specific,’ meaning an M.D. needs to order even OTC stuff. Fortunately, she came in medicated, EMTs gave me her pills, they’re in my desk.”
He walked to the opposite end, retrieved a vial.
Ativan, 3mg, twice daily.
Bracht said, “EMTs said the doc at Ravenswood suggesting kicking it up to three times if she gets agitated but I haven’t been comfortable with a secondhand verbal order.”
“That could add up to a large dose,” I said. “Even twice a day is serious. Five years ago she didn’t have much body weight. She any heavier now?”
“Nope, real skinny. Maybe that’s why she’s still out of it. So you want that off the table?”
“I’m the wrong kind of doctor to ask.”
I showed him my card.
He said, “Psycholo— child psychologist? The Hyphen knows that?”
“She sure does.”
“No offense, Doc, but why?”
“She needs to build up brownie points for the government by documenting treatment, got me here by claiming Ms. Chase asked for me. You hear anything like that?”
“Haven’t heard a syllable out of her. How’d she find you?”
“I evaluated Zelda’s son five years ago. He’s eleven years old and his mother’s locked up and The Hyphen claims there was no mention of him in the chart other than his name. That’s what motivated me to show up.”
“This is messed up.”
“Did the EMTs give you any sort of history when they brought her in?”
“Nope, just the meds.” He walked over to Door A, unlatched the wooden flap, peeked through a mesh window, crossed his fingers.
“Still sleeping.”
I went over and had a look for myself. The opening was small, affording an attenuated view, but wide enough to reveal a blanket-covered form on what looked like a conventional bed. Buttercup-yellow walls, natural light streaming from a high, stationary window.
Kevin Bracht said, “What now, Doc?”
“I’m going in.”
CHAPTER
7
Kevin Bracht unlocked the room and handed me the key. I shut the door quietly but failed to squelch the penitentiary clang that said serious hardware was in play.
The form on the bed faced the wall, obscured by the blanket but for errant strands of hair.
I said, “Zelda?”
No response. I tried again, a bit louder. Lifted the hair. Greasy, bristly. Her neck skin was warm and gave off a vinegar smell. I found a pulse. Slow, steady.
Stepping away, I examined the cell.
A chair was positioned at the side of the bed. Soft brown vinyl for the cushions, hard brown plastic for the frame. Low-watt LEDs on the ceiling provided soft light. The sun augmented, filtering through a high window. The view through the glass was sooty sky peppered with listless blue, creating the kind of blurry abstraction you see at amateur art fairs.
I walked around. The floor was plastic pretending to be oak parquet. The walls were covered in sheets of washable, pebbly stuff you find only in institutions. On the positive side, the hue was a cheerful buttercup yellow and the matching blanket appeared fluffy.
The bed was the big surprise: generous pillow-top mattress atop a box spring.
Bolted to the floor.
In the left-hand corner were a lidless toilet and a sink the size of a salad bowl, both stainless steel with rounded edges. Not a sharp surface anywhere but that didn’t matter. Given the right circumstances, the roll of toilet paper near the commode or the toothbrush on the sink could be used to self-destroy.
My eyes rose to a framed print high above the sink, unreachable unless you were a basketball center. Poorly painted landscape.
After meeting Kristin Doyle-Maslow, I was thankful it wasn’t Munch’s The Scream.
By hospital standards, a decent place but anywhere you can’t leave is prison and a day and a half after its debut, this place had acquired the reek of confinement.
I bent to take a closer look at the inaugural patient. The strands of hair were dishwater laced with gray. Thirty-five years old; I could only imagine what life had been like since she lost her job.
Where had she lived? How had she gotten by? Why had she repeated the trespassing that got her busted in Sunland? Had the Bel Air backyard belonged to another ex-lover? Or a man she imagined as such?
Where was her son?
I sat down on the brown chair, tried to shift it closer to the bed. No movement. Another bolt-job.
Zelda continued to sleep and I thought about what it would be like to get stuck in here.
My chest tightened and I felt my pulse begin to race. An issue I’d thought I dealt with years ago.
You could call it claustrophobia. I think of it as a nasty little childhood memento.
All those hours spent hiding in crawl spaces and sheds, crouched behind shrubbery, or squeezing between rocks, trying to escape my father’s unpredictable drunken rages.
I’ll never enjoy small spaces but I really thought I’d gotten past notable anxiety. Even Robin doesn’t know. No reason for her to know.
But here it was again. Nothing serious, I could handle it. Just as I did years ago, practicing my own preaching, drawing upon all those nifty cognitive behavioral techniques.
Mostly, though, I choose to avoid anything close to confinement, maybe because I don’t want to let go of the memories, fearing freedom will soften me when the next big threat rolls around.
I’ve constructed a world for myself that allows lots of elbow room, living in a spacious, sparely furnished house with a view of miles of canyon and an occasional snip of ocean on clear days. My work—short-term custody and injury work for the court, consults on murders with my best friend, a veteran detective—allows me to come and go as I please.
I run for exercise, choosing times when I’m unlikely to encounter company.
I spend a lot of time by myself and when the dreams arrive unbeckoned and I really need to step out of myself, there’s always the grand distraction of helping others.
Now here, in this absurd, surreal place, the person I’d come to help remained drugged up and inert and I craved escape.
Deep breath. Focus.
After a bit of that, I scooted to the edge of the chair and touched Zelda’s cheek. Coarse with some kind of rash.
Not a stir. I patted her again, more firmly.
My third attempt caused her to frown.
I said, “Zelda?”
She murmured but kept her eyes closed. Then she sat up, shook her shoulders, and looked around. The blanket rolled free, revealing what I first thought was an institutional yellow top but turned out to be a cheap Tijuana blouse with ragged black stitching along the seams.
“Zelda?”
She lay back down, rolled away from me, returned to sleep.
I sat there and did more deep-breathing, closed my own eyes and tried to summon up a pleasant scene.
What I ended up thinking about was a small boy building castles with tiles and that brought on the what-ifs.
A woman’s voice shook me alert.
“You.”
Not an accusation, just a pronoun uttered without inflection.
As if the word existed in a vacuum.
Zelda Chase had sat up again, blanket gathered at her waist. This time her eyes were wide open and aimed at me.
“You,” she repeated.
“Do you know who I am, Zelda?”
Confusion.
I said, “Dr. Delaware.”
Her lips screwed up like a pig’s tail. She scratched her chin, then her cheek, then her forehead. Burped loudly and did it again and rotated her head and flittered her fingers.
Five years had wreaked decades of damage, the once-oval face a lopsided hatchet collapsed at cheek and jaw. A caved-in mouth said most of her teeth were gone. Her complexion was livid—street sunburn—her lips shrunken and blistered and parched. Deep furrows ran vertically from her nostrils to her chin. Her eyes were pink where they should’ve been white. Thirty-five years old, but I’d have guessed fifty-five, minimum.
“Zelda—”
She drew her hands up defensively but without confidence, like an outclassed boxer.
I sat back as far as I could in the immovable chair. “Alex Delaware. We met a few years ago.”
Nothing.
“I was told you asked for me.”
The hands dropped a bit. The near-stuporous confusion behind them might’ve been mental illness but I bet the real cause was Kristin Doyle-Maslow’s manipulation. Zelda had no conscious need to see me; The Hyphen’s project required an inaugural documented patient and I was the sucker who’d responded to a guilt trip.
I tried anyway. “We met five years ago, Zelda. When you were seeing Dr. Sherman.”
Blank stare.
“He was your psychiatrist, Zelda.”
A single blink.
“I’m a child psychologist, Zelda. I spent some time with Ovid.”
Blink blink blink.
“I got to know Ovid while you saw Dr. Sherman. While you lived in the Beverly Hills Hotel.”
Blank as the wall behind her.
I continued, prattling like a serious obsessive. “Dr. Sherman and I arranged babysitting for Ovid so you could return to work. Actually, I did. From the HGK agency?”
Now a hapless smile, the kind you see with aphasia patients who know something’s wrong but aren’t sure what it is.
“Do you know where you are, Zelda?”
Brow-knitting consternation. I repeated the question, expecting very little.
She said, “Here.”
“Where’s here, Zelda?”
“This…”
“Do you know what this is?”
She squinted. Laced her hands together and dropped them into her lap.
Maybe the lack of acuity was a good thing, what the hell would I tell her? You’re a federally funded lab rat?
Where was the boy?
I said, “Yesterday, you were in a hospital, Zelda. You were moved here but just for a couple of days.”
No reaction.
“Do you know what day it is, Zelda?”
“Now.”
My next question was routine and idiotic. “How about a day of the week?”
I might’ve been speaking Albanian.
“Do you remember what got you to the hospital, Zelda?”
Her hands pulled apart and shot up, blocking her face. Twin fists made small tight arcs.
“Zelda, I’m sorry if these questions—”
“Disappeared,” she said, suddenly loud and harsh.
“Who disappeared, Zelda?”
“Mommy.”
“Your mother—”
“No no,” she said, punching air. “Nononononononono.”
All those syllables but any budding anger was gone—more like a weary mantra. She slumped, pressed her hands to her temples.
I said, “Mommy—”
“Gone.”
“When?”
Nothing.
“You were looking for your mommy.”
She snuffled.
“You didn’t find her.”
She regarded me as if I were the crazy one. “I find her, they don’t put me here.”
“Of course—so you were looking for Mommy when—”
Growling in frustration, she slammed back down, drew the blanket over her head.
“Zelda—”
The blanket heaved. I waited.
This time her sleep was punctuated by aggressive, raspy snoring.
For the next half hour I waited, passing time and suppressing my tension by conjuring pleasant imagery. Intruded upon far too often by bad thoughts.
Eleven years old.
When Zelda’s breathing slowed further and she showed no sign of waking, I used the key and let myself out.
—
Kevin Bracht looked up from his book. “Anything?”
I shook my head.
“So what now, Doc?”
I gave him my card. “I’ll be by tomorrow before she’s discharged. Let me know if there’s any sort of problem.”
He walked me to the door. “What’ll happen to her?”
“I’ll try to get her somewhere safe.”
“But only if she agrees. What a system.”
I knew what he meant. The rule for involuntary commitment was clear: If a patient displayed imminent danger to others or self, I’d be obligated to file. If not, total freedom, no exceptions. That started me wondering what Zelda had done to qualify in the first place. I asked Bracht if he had any idea.
“Nope, they just brought her in and said she’d been arrested.”
“I didn’t see any abrasions or signs of a struggle.”
“Me, neither. Except for that initial period when they restrained her, she’s been exactly what you just saw. Should I try to push more meds? Off the record.”
“No, just keep an eye on her.”
“You bet, Doc. I could also look out for a reason to recommit her.”
I shook my head. “If it’s real, you’ll know.”
“True.”
When I reached the door, he said, “I hope I wasn’t out of line. About another hold. I was just thinking of her safety. I mean, what’s someone like her going to do out there?”
“That’s how I took it, Kevin. I’m glad you’re here.”
“Thanks, Doc.” He laughed. “Wish I was.”
—
I stepped back into the maze of cubicles. Kristin Doyle-Maslow was at a nearby station, working an iPad. She didn’t seem to notice as I approached but when I was a foot away she startled and clicked off.
Not before I had a look at her screen.
Watching a movie. Something with shields and lances and lots of blood.
I kept going.
She said, “What’s the status?”
I said, “Quo.”
“Huh? Oh, ha ha. So when are you coming back?”
“When will she be discharged?”
Back to the iPad; she touched a screen. “Three p.m. tomorrow.”
“I’ll be here before then.”
“What if there’s an event?”
“An event?”
“A problem.”
Why not just say that? “Your nurse has my number. Do you have any post-discharge plans?”
