Salter, Anna C (7 page)

"She asked to see you." Good. That meant we had at least some connection, however new and fragile. Suzanne went on, "One more thing, Michael. She needs to be admitted, but we can't admit that dog."

"Legally, you have to. She's a service dog."

"Legally we do, so we're not going to recommend admission for Camille because of it. Nobody thinks she would part with her, and we just can't put that dog on the ward. Risk management would go nuts, the other patients would go nuts, and I am well and truly worried the dog would go nuts. Just so you know, it's not an option."

Great. I had a woman so confused she was hiding in the shrubs having flashbacks, and hospitalization was out. But I couldn't really argue with it. I wouldn't put Keeter on the ward, either. What if Camille did lose control of her and she ate five or six patients? On the other hand, what was I supposed to tell Camille if she wanted to be admitted?

Probably the truth —which meant I'd have to take the flak for it later. If the higher-ups wouldn't admit Camille because they had no way to manage the dog, they'd never be willing to tell Camille that. That would be admitting she needed hospitalization and they didn't provide it —too much liability if something happened to her later. The administration would want the resident to tell Camille hospitalization wasn't needed.

Medicine has always had an ambivalent relationship with truth. It has been frequently harder to get medicine to admit the truth than to find it —witness that whole long history of lying to dying people about what was going to happen to them —as if they weren't going to find out, anyway. The good part was the hierarchy already thought of me as a "loose cannon," so I didn't have a lot to lose, reputation-wise —if you could call that a good part.

I put Willy's letter in the drawer. Unfortunately, the damn thing might be evidence for a future crime, and besides, I wanted to be able to reread it and think about it. There must be some way to figure out more about what Willy had in mind.

I headed down to the ED. Fred Flintstone had designed the elevators, so I took the stairs like most of the rest of the staff. I walked in the ED and headed for the nurses' station. "I'm looking for Dr. Stenson," I said. I was wearing my hospital ID pin with "Dr. M. Stone" on it, so the nurse, whom I didn't know, merely glanced up before directing me to a room down the hall. The movies didn't always get it wrong. It wouldn't be hard to impersonate a doctor. Great. Willy was already turning me into a complete paranoid. Already, I was thinking about how easy it would be for him to get access to the places I hung out.

I found Suzanne in the doctors' room writing notes in the chart. The doctors' room had a counter running around the room at sitting height, and docs were scattered around the room writing or making calls. Generally physicians wrote notes every time they saw a patient. This sounded good and it was good except it resulted in charts so thick that, after a while, nobody bothered to read the whole thing. Every once in a while, of course, that caused some sort of Big Problem.

Suzanne was an exception. She read the charts from cover to cover, no matter how many times the patient had been admitted. Suzanne kept reading for a moment before she looked up.

When she did, I saw the familiar circles under her eyes that told me she had been up all night. Medicine works its residents dangerously hard, putting them on twenty-four- or even thirty-six-hour shifts routinely. There are only a few states that outlaw it, and unfortunately, Vermont isn't one of them.

Of course, this is terrible for the patients, who get lousy care, and awful for the residents, who come to hate their lives. There is, too, the minor problem that it is bad for their training since nobody can think when they are that tired.

Despite all the excuses the hierarchy makes, it is done solely for one reason: money. Hiring people to work all those shifts would cost a ton of money. Residents are cheap, and basically, they have no rights.

Suzanne was slim—who had time to eat? —with shoulder-length dark hair and bright eyes. I don't know why psychology spends so much energy trying to develop IQ tests. You can make a pretty good guess at how bright people are by their eyes. Anyone who looked at Suzanne's and didn't know she was very, very bright indeed, needed an IQ test themselves.

"So," I said to Suzanne. "Always glad to have a patient of mine brighten your day. I know how bored you get sitting around with nothing to do."

"Actually," she said, "we don't see that many of your patients down here. I thought you were losing your touch, but, shucks, I found out you had only seen her once. I guess we can't expect even you to fix people in one visit."

"I don't know why not!" I replied. "Managed care does. So, what do you have?" I knew Suzanne didn't have a whole lot of time.

"Not much," she said. "What happened to this woman? She can't seem to tell us, and all we've got is she was crouched in the bushes hiding, going in and out of flashbacks."

"What's she saying during the flashbacks?"

Suzanne sighed. "Not much. She just goes into a panic state and curls up in a fetal position. Then we all start looking at the dog and hoping she doesn't think we're the problem."

"Meds?" I said.

"Enough Haldol to drop an elephant —assuming she didn't give it to the dog."

"You hope she gave it to the dog."

"A thought . . . ," she replied. "The question here," she went on, "is what do we do with her? We've done all the polypharmacy we can. We can't admit her. Does she have any relatives or friends who would look after her?"

"Not that I know of," I replied.

"So," she said, leaning back in the chair and crossing her arms, "what do you want us to do with her?"

"Fix her," I said. "What else?"

I headed out to see Camille. I would have preferred to read the chart first, but Suzanne still needed it.

On the way down the hall I fretted. Despite the fashionable view found in any pulp newspaper, good therapists don't tend to make patients worse. I had thought Camille was stabilized when she left my office, so why was she here? If she wasn't a regular visitor here, if this wasn't something she did every day, I'd have to face the fact that the therapy session had caused her to decompensate: It was a little tough believing in coincidence.

And if therapy was the problem, it meant I had a bigger one. If Camille couldn't talk at all about what happened without falling apart, no matter how long we spent putting things back together, or how indirectly we approached it, how were we supposed to get anywhere? She had to cross some open ground to get to any kind of shelter. What was I supposed to do if she couldn't do it?

Worse, I had a bad feeling Camille wasn't the only one who was facing open ground. This morning Willy had just been a vague possibility, a maybe-he'11-show-up-maybe-he-won't shadow in my mind. Now, he was setting up obstacle courses on my front lawn and sending me a written invitation.

The largest of the ED rooms looked like a miniature gymnasium broken into small areas by curtains. Groups of people were scattered through the room in the small areas; each group was separated from the other only by the curtains, partly drawn in some places, totally in others. The curtains didn't do much for the patients. True, nobody could see your mangled body as you lay there having it poked and prodded, but each patient could hear everybody else's business. It didn't help to be lying there with your broken elbow listening to a child crying on one side as they stitched up his face and an elderly woman sobbing on the other as they coded her husband for a heart attack.

But the ED, like the operating room, is one of the places where the patients' physical needs take precedence over their emotional ones. "Guest relations" —as the policies are called that try to humanize hospitals—tread lightly in the ED. You have to keep someone alive before you can worry about his or her feelings. A big room with everybody together meant staff could get back and forth from one patient to another quickly if they needed to.

I walked around the room and then realized, what a surprise, they hadn't been willing to put the dog in the common room. I headed back to the nurses' station and asked for Camille. I was directed to a small treatment room with the door shut. I knocked lightly and then poked my head in and asked, "Can I come in?"

Camille was sitting across from the door facing it with her back to the wall. At first she looked blank, and I realized she didn't recognize me right away. She looked spacey and disoriented and slowed down. I wondered how agitated she would be without the Haldol, which would likely control the flashbacks but was a major tranquilizer and antipsychotic and probably made her feel awful. Nobody who'd had it ever seemed to want to take it again no matter how crazy they felt.

I slowly opened the door and walked in. Camille's face focused and brightened. I could have been her best friend. It was the same kind of thing that happens when you run into someone you barely know a few thousand miles from home. Relationships are always relative.

I moved slowly. People with Posttraumatic Stress Disorder are edgy, and there isn't enough Haldol in the world to fix that. I sat down as far from Camille as I could get, which wasn't far enough. I knew anybody within ten feet of her would seem like an intrusion right now.

Keeter had lifted her head when I walked in. She was lying between Camille and the door. I didn't know much about the etiquette for dealing with guard dogs, but people always like it when you acknowledge them so I figured Keeter would too. I started to speak to Keeter and realized I shouldn't do anything to imply she was the dominant figure here, so I spoke to Camille first.

"Hi," I said softly. "I hear you've had a rough time." She didn't say anything, just put her head in her hands and started crying, or maybe she just continued crying. Her face was red and puffy and streaked with tears already.

"Good afternoon, Keeter," I said evenly. "Keeping a good eye on things, I hope." Keeter did not respond at all. She looked like she was thinking, "Ha, oldest trick in the book."

"He's back," Camille said. "I knew he would be!"

"He's back?" I echoed. This was going to be tricky. If I asked her too much I'd throw her into another full flashback, and she'd go away completely. But sooner or later I needed to know whatever she could tell me about whatever had happened. How much was it safe to ask?

Camille nodded and didn't say anything.

"The same guy?" I said, to prompt her.

She nodded again.

"You saw him?" I asked. It occurred to me that I needed to confirm the extent of the flashbacks. I was just assuming I knew what her flashbacks were like, but there are all kinds of flashbacks: emotional flashbacks, somatic flashbacks ... a full-blown sight-and-sound-hallucination being the most extreme.

She shook her head sideways.

"You didn't see him?" That was a little odd. I had pegged Camille for full-blown-there-he-is flashbacks.

She shook her head again. "It was dark. He must have been there the whole time." She paused to cry some more. "I was in bed."

"Camille, you know about flashbacks, right? You know he wasn't really there, that this was a flashback?"

She looked directly at me, and for a moment her gaze was so focused and intense it surprised me. "It wasn't a flashback," she said firmly.

There was a pause. I wasn't sure what to say. Camille just kept looking at me.

"You mean you think he was really there?"

"He was there. He was really there."

There was another pause. If she believed the guy was really back, her level of panic must be incredible. Flashbacks were bad enough, but at least with flashbacks she knew the perp wasn't really there to drag her off and start the whole thing again.

"Camille," I said softly. "How could he be back? Wasn't Keeter with you? Do you think Keeter would let someone like that get close to you? Weren't you home with Keeter?"

"He was there," she said insistently. And then she looked down again. "I never thought Keeter could stop him. Nobody can stop him."

There was another pause while I tried to regroup. This woman had probably had thousands of flashbacks. What had made this one so different? What made her think he was really there? Before I could speak, Camille went on. Her voice had dropped to the point it was hard to hear her. "He said it would be worse this time, much worse."

What did this guy do to her, anyway? It must be rape, but Jesus, what kind of rape? There were some grim possibilities: rapes with objects, rapes while the person was being strangled. I had one client who was raped next to the grave the perp made her dig for herself.

"How could it be worse?" I asked. It is amazing how well you can carry on a conversation when you have no idea what the other person is talking about. Maybe it helps not to know; you lead less and listen better.

Camille didn't answer. I'm sure she didn't know. She had ceased paying any attention to the tears, and they were running freely down her face. Her nose was running too, and she was only sniffling to stop it. If she got any more panicky she wouldn't pay attention to that either. There is a level of panic where the social niceties —even hygiene —disappear.

I spied a Kleenex box on the table and reached over to give one to her. She ignored my outstretched hand as though it weren't there and started compulsively rubbing her wrists. A chill ran up my spine; I knew what that meant.

I didn't know how far I could go, but I kept on. I couldn't ask her how long it lasted, she wouldn't have any idea, so I started at the other end. "Where did they find you?" I asked.

"Nobody found me," she said. "I prayed to God over and over, but He didn't help. Nobody helped."

I tried again. "When it was over . . ."

Camille interrupted, and it was the first time I'd seen even a flash of anger. "It wasn't over," she said. "It's never been over."

I was silent for a moment trying to figure out how to ask. "Where did you go?" I asked. "When you got away?"

"I never got ... oh ... ," she said as she realized what I was trying to ask. "To a kennel," she said, finally. "I crawled over the fence and hid with the dogs. I was too scared to go to a house and I ... I didn't have any clothes. I thought I'd be safe with the dogs." She paused. "No, I didn't," she said, flatly. "I didn't think I'd be safe anywhere." I was starting to put things together—but there were still about a million things I didn't know.