The Girl Without a Name

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W
e call her Jane, because she can't tell us her name.

Can't or won't, I'm not sure. She lies in a hospital bed, a strangely old expression upon her teenaged face. We don't know her age either. Twelve, fourteen maybe. A navy-blue hospital blanket sits across her knees in a neat square like a picnic blanket. A picnic in a hospital room, with a stained white ceiling for a sky and faded blue tiles for grass.

Dr. Berringer lifts the patient's arm, and it stays up, like a human puppet. “What do you think?” he asks.

“Catatonia,” I answer. “Waxy catatonia.”

“Bingo, Dr. Goldman,” he says, his voice encouraging, with just a hint of New Orleans, where he's from. His voice doesn't match his face. He looks like a Kennedy, with sandy, wind-blown hair as if he just walked off a sailboat and blue eyes with lashes so long he could be wearing mascara. He is, in a word, handsome. He is also, in a word, married, much to the disappointment of the entire female staff at the Children's Hospital of Buffalo. Let's just say the nurses perk up when Dr. Tad Berringer hits the floor.

Jane's arm drifts back down, her eyes still focused on the wall.

“But
why
is she catatonic?” I ask.

“That's the million-dollar question, isn't it?”

Jane Doe is our mystery. A police officer brought her to our doorstep this morning like a stork dropping off a baby. A few days ago, she was found wandering the streets of Buffalo, dazed and filthy, clothes torn, but apparently unharmed. No signs of bruising or rape. But she wouldn't speak. They coddled her, gave her hot chocolate (which grew cold in the mug), brought in a soft-speaking social worker, and Jane sat and stared. So the police canvassed the neighborhood, fingerprinted her, ran her image through Interpol, put up missing posters adorned with her unsmiling, staring face.

NAME: UNKNOWN. RACE: AFRICAN AMERICAN. DOB: UNKNOWN.

No one claimed her. They brought her to Children's and ran some tests. The ER said there was nothing wrong with her physically. So they sent her up to the psych floor. So we can figure out who she is and what's wrong with her.

“Schizophrenia maybe?” I ask.

“Could be.” His eyes crinkle in thought. “But we also have to rule out other, less obvious causes.” He leans over the bed and shines a penlight into her eyes. Her pupils contract, then bloom. “You ever hear of the hammer syndrome, Zoe?”

“No,” I say, jotting this onto the back of my sheet.

“It goes like this: When all you have is a hammer, everything looks like a nail.”

I stop writing, and he drops the penlight into his black doctor bag, smiling at me. “What can we establish here?” he asks, more a statement than a question. “Our patient has catatonia; that's all we know. So let's start with that. What's the differential for catatonia?”

“Schizophrenia.”

“Okay, that's one.”

“Right.” I wait for the list to scramble into my head. That's the one good thing about ADHD. Alongside the scattered, ridiculous thoughts that pop up relentlessly (and which you have to keep banging down like a never-ending game of whack-a-mole) sprout elegant, detailed lists. Such as differential diagnoses. Lately that hasn't been happening for me, though. I don't know if my Adderall is working too well or not well enough. My dopamine isn't cooperating in any case, which is inconvenient, seeing as I'm on probation. My brain grinds on in slow motion with no list anywhere in sight, so I plow through the old standby mnemonic for the differential diagnosis of any disease. Something medical students learn the first day they step on the wards: VITAMIN D. Vascular, infectious, traumatic, autoimmune, metabolic, iatrogenic, neoplastic, degenerative.

“Status epilepticus,” I say.

“Excellent thought. Did we order an EEG?”

“I will,” I say, writing it in her chart.

“What else?”

A list crawls into my brain by inches. “Encephalitis?”

“Okay. Does she have a fever?”

I pull off the vital sheet hooked on the bed frame, scanning the blue, scribbled numbers from this morning. Vitals normal. “No fever, but it's still possible. Her labs are pending.”

“Get neurology to see her. They can decide on a lumbar puncture. She'll probably need it, though, if the EEG is negative.”

“They said she didn't need an LP in the ER.”

He doesn't look impressed. “Just means the on-call didn't feel like it.”

“We could get an MRI,” I suggest.

“Fine. What are you looking for there?”

“Less common causes for catatonia…stroke, lupus, Hallervorden-Spatz,” I say, cheered as the differential diagnosis list starts to soar in. “That could show up on MRI. PET scan, too.”

“Let's start with an MRI,” he says, tamping down my overenthusiasm. “Let Neurology decide on the PET.” Jane blinks, grimaces, then stares again. I hand Dr. Berringer her chart, which he balances in his palm, adding a couple of lines under my note then signing it with a flourish. He hands it back to me. “Onward and upward?”

We exit the quiet oasis of Jane's room, emerging into the hallway awash with hospital noises: the overhead speaker calling out, food carts rattling by with the malodorous smell of breakfast that no one will eat, medical students scampering around the floor like lost bunnies. Dr. Berringer's phone rings, to the tune of “When the Saints Go Marching In,” and he picks it up as we head down the hall.

“Hello?” There is squawking on the other end. “She just showed up today.” He listens a minute while we walk. “I'm sorry. I don't know any more than y'all.” This is met with more squawking on the other end. “Right. Listen, I'll tell you as soon as I know something. I promise.” He hangs up with an eye roll, smiling at me. “Admissions wants her demographic info. Jane Doe, folks. That's all I got.” He strides in front of me into the nurses' station. Dr. Berringer has a jogger's body, long and lean, verging on skinny. He is tall, taller than me even, and I'm over six feet. As he leans in the door frame, a nurse, roundish in her lavender scrubs, openly gapes at him. “Any other consults come in overnight?” he asks Jason, who is sitting at the little brown Formica table, poring through a chart.

Jason adjusts his bow tie. He must have a hundred bow ties with matching shirts. I've never seen him repeat a color. “Three,” he says. “I have two, and Zoe's got the new girl.”

“And one more I haven't seen yet,” I add. “Just came in this morning.”

“So let's round later. Around two?” Dr. Berringer asks.

“That's good for me,” Jason answers. Jason is chief resident, so he's in charge of rounding. I was all but promised the job when Dr. A (the smartest in our threesome and also the one who saved my life) transferred into the neurovascular fellowship. But then I was put on probation, so that was the end of that. Jason calls me Probation Girl.

“All right. See y'all later,” Dr. Berringer says with a wave. His teeth are white-bright, bleached maybe, in perfect rows like pieces of Chiclets gum. My brother, Scotty, accuses me of having a crush on Dr. Berringer, claiming that “every sentence you say has his name in it,” but he's exaggerating. If anything, it's a minor crush. Minimal.

“You want to bed that guy so badly,” Jason says as soon as he's out of earshot.

“Please. That is beyond ridiculous.”

“Whatever you say,” he mutters, leaning over to grab another chart from the rack.

I crack open Jane's chart and finish off the orders. Neurology consult. IV fluids because she's not eating. DVT precautions because she's not moving. “Anyway, you're one to talk.”

He pauses to think. “Okay, empirically he's good-looking, I agree with you. But he's just so…white.” He pronounces the word with some distaste. Jason, being Chinese American, can say this.

“What about Dominic? Last I looked, he was white, too.” Dominic is a nurse at the hospital and Jason's on-again, off-again boyfriend. Mostly off-again.

“Yeah, but he's Italian. He could pass as Hispanic or something. He's not Mr. Ralph Lauren.”

“Sure, well, as long as he could
pass
as something ethnic.” I shove Jane's chart aside, leaning back in the stiff, metal chair. “So are you back to dating Dominic this week?”

“I don't know. That guy's so hot and cold,” he complains. “I see him at the bars and he's all over me. Then we come to work and he flirts with girls. I'm, like, just pick a goddamn team and play for it.”

“You should just dump his ass,” I say.

“Yeah, probably. Hey, speaking of dumping, whatever happened with that French dude? You ever hear any more from him?”

“Who, Jean Luc?”

“Yeah. That boy was smoking hot.”

Jason is right on that one. Jean Luc
was
smoking hot. Hotter than I am, that's for sure. I've always been a solid six, maybe seven on a good hair day. Jean Luc was more like an eleven, or a twelve. Still is, I imagine. “Not in a while,” I answer. “Still with Melanie,” I mention, before he can ask. Melanie, the model-beautiful girlfriend he left me for.

“Oh well. All's well that ends well,” Jason says, meaning Mike. And he's definitely right about that one.

Jason turns back to his progress note, and I stash Jane's chart back in the rack, ready to see my next patient. On the way down the hall, I pass by Jane's room and see Dr. Berringer standing by the bed, staring at her. He lays his hand on her head, tenderly. Like a father patting his child's head.

Or a priest bestowing a benediction.

I
t takes me a second to place him. A massive man in a saggy, black, windowpane suit, with his belly protruding over his belt, his hair in a thinning brush cut. He leans over Jane's bed.

“Detective Adams,” I say.

He spins around and sees me in the doorway. It takes a second for him to place me as well. “Dr. Goldman,” he returns. “I see your wound healed nicely.” He points to his neck, referring to the scar on my neck where my patient stabbed me. Detective Adams was the officer on the case at the time. “And how are you on this fine day?”

“Good,” I say, pausing to consider, then repeat, “good.” Overall it's true, and he probably doesn't want the full backstory anyway.

“Have you heard from…your patient?” he asks.

I can tell he's not exactly sure how to refer to her, my patient who tried to kill me. “No. I'm on the prison's do-not-call list.” That was after she left a fourth breathy message on my machine, sobbing about how sorry she was and begging me to please, please, please come and visit her. I let the first three messages slide. But the last one unnerved me a bit; she started talking about my birth mother. My brother called the prison to block her calls the next day.

“Good. Good to hear.” Then he turns to Jane. “So what do you think of this one?”

“I was just going to ask you that.” I walk over and take Jane's pulse, thready under my fingers. Her wrist stays elevated, then droops down. Jane is still Jane. Staring, unchanged.

Dr. Berringer comes into the room. “Hello.” He nods to us both, which tells me he's already met the detective. “Any news on Jane?”

The detective frowns. “Nothing. And believe me, we're out there. We got posters up. We canvassed the neighborhood a tenth time.”

Jane stares on in the silence.

“Do you think it would be any different if it were a white girl lying in the bed?” I ask. “I mean, there'd be TV crews and everything. I swear it's like nobody gives a damn.”

“We all give a damn, Zoe,” Detective Adams replies, sounding more tired than angry.

“I know. I'm not saying that you don't.” I soften my voice. “I don't even know what I'm saying.”

The detective stuffs his notebook in his breast pocket, the black stitching pouched at the corner. A tan, oblong coffee stain peeks out on the cuff of his sleeve. “Any idea when she'll start talking again?”

“
If
she'll start talking again,” Dr. Berringer says. “Early days yet. We're still waiting on the LP.” He looks to me to confirm.

I nod. “Neurology agreed to do it. And we have a few other tests pending.”

The detective takes one more good look at Jane and turns away with a sigh. “Pleasure as always,” he says to Dr. Berringer, then looks at me with an almost fatherly smile, like he would have tipped his hat if he'd been wearing one. “Good to see you, Zoe. You look great.”

“Thanks,” I murmur with some embarrassment. The last time he saw me, I was anemic in a hospital bed, tethered to an IV and hazy from pain pills. I would think, comparatively, I look like a billion bucks. Detective Adams leaves the room with the careful, bowlegged walk of knees that have played too much football. Dr. Berringer and I stand in silence broken only by the sound of the IV bag dripping.

He leans an elbow down on the bed in the small white space beside the lumpy outline of Jane's leg. The bed lets out a mechanical moan, moving to accommodate the new weight. This drove me crazy when I was in a hospital bed after my patient tried to kill me.

“Jane, Jane, Jane,” he says, his voice tender. “When are you gonna talk to us, girl?”

Jane blinks twice, in some indecipherable code, and stares off again.

Over the gaggle of neurology residents, I see Jane curled in the shape of a crescent moon, her cocoa skin taut over her vertebrae.

“Was she given a sedative?” I ask.

“No need,” answers Mary, chief resident of the neurology group. The first-year resident holds the test tube of clear spinal fluid, the finest tremor jostling the liquid. “But we numbed her up good,” she says. “All bones. One-two-three. Easy-peasy.” Mary has an odd, clipped speech pattern. The first-year switches tubes, a few drops of spinal fluid hitting the sheets in the transfer, and fits the tube into the holder with a squeak. The whole setup reminds me of my fifth-grade chemistry set, pouring one clear tube into another and watching when, like magic, an inky purple blooms. I don't envy the resident, though. I don't go anywhere near needles if I can help it. Psychiatrists and blood, we don't mix.

“Be done here in a jiffy,” Mary says, which is my cue to make haste. The first-year is labeling the tubes with stickers.

“And if she gets a headache?”

Mary looks up at me. She doesn't quite hit five feet, so it's a stretch. “Don't see her complaining about it. But if so, give us a buzz.”

“Okay.” I linger one more second over poor Jane, contorted on the bed with a three-way stopcock jutting out of her back. But there is no other way. If she has encephalitis, we have to find out. A positive spinal tap could be her saving grace.

I get back to the nurses' station with every intention of hitting the UpToDate review on catatonia, but first I decide to put my chin in my hand and rest my eyes for a second. I am just drifting off when I startle awake to the sound of Jason whistling “Jessie's Girl.” The tune bores a hole directly into my brain. I was on call last night, and between three new-onset deliriums and one acute psychosis, sleep was not in the cards.

“Bad night?” Jason asks, writing out a note.

I yawn. “You could say that.”

“I had a lo-o-o-ng night, too.”

“I so don't want to hear about it.”

“What about you? How's Mike?” Jason asks.

“Mike's good,” I answer.

“Good good? Or he's-a-bastard-and-I'm-not-talking-about-it good?”

“Good good. But seeing as I've been here since yesterday,” I grumble, “he didn't rock me all night long as you're implying Dominic did.”

“Honey, I'm not
implying
anything.”

Dr. Berringer appears in the doorway then, leaning one hand against the frame. His gold wedding ring glints in the sun. “Zoe, you look beat. Rough night, champ?”

This makes me think of a boxer dog we had when I was six years old, named Champ. My mom named him after some tearjerker boxing movie. Champ was forever sneaking into the laundry room and eating underwear, which is really all I remember about him. Until he was hit by a car a year later. So he's probably up in doggy heaven snacking on a roomful of undergarments.

“Zoe?”

We are halfway down the hallway, though I don't remember walking there. Night call and ADHD have never been a winning combination. “Sorry, I was just thinking.”

He smiles. “Anything interesting?”

“Not really. I once had a dog named Champ.”

He stares at me, bemused. “Congratulations. I once had a dog named Lacy.” He pauses. “She was an Alsatian. Lacy the Alsatian.” An orderly walks by us, whistling. (I swear it's “Jessie's Girl” but I'm probably having auditory hallucinations by now.) “All right, Jason, who do we got?”

“Let's start with Mr. Gonzalez.”

“Okay, what's the bullet on that one?”

“A nineteen-year-old Hispanic male with the known diagnosis of schizophrenia, brought in by his wife with an acute exacerbation.”

“Okeydokey. Let's go.”

As we enter the patient's room, the body odor is so overpowering that I have to breathe out of my mouth. He weighs in at 403 pounds, his blanket a mountain around him. The lines on his neck are caked with dirt, and his fingernails are tan with nicotine. “Daisy deals with daily deals, dozens of daily deals.” He pauses then, smiling, his eyes glittering with joy. “Don't dally. Don't dally. Daisy doesn't dawdle, does she?”

I have no answer to this. I don't know any Daisy or if she tends to dawdle.

“Mr. Gonzalez,” Dr. Berringer says, standing next to the bed.

The patient looks up like the doctor is in on the joke. “Name, game, same, game, shame. No shame in a name game. Can't tame the name game, said the same dame.”

Dr. Berringer looks delighted. “Okay, what type of speech is this?” he asks, turning to Jason.

“This would be clanging speech,” Jason answers.

“Clang-a-lang-a-ding-a-dang,” the patient answers.

“Mr. Gonzalez, have you been taking your medications?” Dr. Berringer asks.

“Dead meds, Fred said, no meds to the dead dread head.”

“Jason, get ahold of the wife. See what the pill bottles look like. I suspect our dear Fred hasn't been taking his meds.”

“Will do,” he says.

Dr. Berringer pats the patient's shoulder, and Mr. Gonzalez looks up at him with a convivial nod.

“See you tomorrow, Mr. Gonzalez.”

“The day has a way of making me say,” he answers as if this is his usual good-bye. We exit to the hall, able to breathe freely again.

“Wow, that was a good one,” Dr. Berringer says, clearly a man who loves his job. “What are his meds again?”

As Jason reels them off, my eyes wander to the window. The sun glimmers off the cars in the parking lot, tiny boxes in rows. Dew outlines a rectangle on the window.

“Earth to Zoe,” Dr. Berringer bellows with a good-natured grin.

“I'm sorry. What?”

“Top three in the differential diagnosis of mania, I was asking you.”

“Mania. Right, yes.” I swallow, pause, waiting for a list to lumber into my brain. “Hyperthyroidism.”

“Good, that's one.”

I wait. “Steroid usage?”

“Excellent. Another one?”

I try to think. The harder I think, the blanker my brain.

“Jason? Want to help her out here?”

Jason takes a sip of coffee that I actually want to steal from him. “ADHD,” he says.

“That's right, Jason. ADHD. Can be a tricky one.”

Alas, the bitter, bitter irony.

“All right,” Dr. Berringer says. “Let's see what our Jane is up to.”

Jane is unchanged, like she's stuck in a freeze frame. She sits staring on her throne, her toes sticking out of the blue T.E.D. stockings, which travel well above her thighs like a bad Pippi Longstocking costume. She blinks and twitches her nose like a bunny. Dr. Berringer lifts her arm up again, and again it stays there, a macabre party trick, until he gently pushes it back down.

“No change, huh?” he says, disappointed.

“No. But we did get some results at least,” I answer, lifting her growing plastic chart out of the rack.

“Okay, what do we got?”

“MRI was normal.”

“How about the LP?”

“Just done.”

He folds his arms. “Any stains sent out?”

“A few things,” I answer. “RPR, India ink, HSV, cytology. That'll take probably a week, but I can keep bugging the lab.”

“Yeah, do that, would you?” he says. “Tox screen was negative, right?”

“Negative,” I confirm. We stand there watching her. “I was thinking, what about a trial of benzodiazepines?” I ask.

“Which one?”

“Ativan, or Valium maybe? There have been reports on both.”

He drops his stethoscope into his bag. “What do you think, Jason?”

“I don't know. Maybe we should wait for the LP.”

Dr. Berringer lifts his hands, his fingers interlaced with his pointer fingers straight up against his lips like he's shushing someone. We wait for his decision. “Jason's right. I'm going to say hold off on the benzos for now. Let's wait on the LP and see what a tincture of time does for our Jane. Jason, got anyone else?”

“Actually, the rest of mine have all been discharged,” he answers.

“Okay, good. I'll catch up with you later then. Zoe, can I have a quick word? If you don't mind?”

“Of course.” My stomach does a somersault. I've been asked for a “quick word” many times in my life, and it's never a good thing. First off, it's never quick, and it's certainly never someone wanting to take a little time out just to tell you what a damn good job you're doing.

He motions toward the family conference room. He shuts the door behind us. Photos of baby animals of every ilk (puppies, kittens, baby seals, lion cubs, etc.) hang crookedly in cheap metal frames. The room smells musty, like it was just vacuumed with a bag that needs a change. We sit down side by side at the long table, my heart prancing in my chest.

“Just let me say, you're not in trouble or anything,” he starts. “I just want to check in with you. See what's going on.”

“Okay,” I say. There is a pause, but I'm unsure how much more to offer. Two psychiatrists reflectively listening to each other doesn't make for a sparkling tête-à-tête.

“
Is
there anything going on?” he asks.

“In terms of?”

“In terms of you. Your focus. You just don't seem…I don't know…all there lately. We all have off days. And you're post-call, I know. Maybe that's all this is. But if there's more, or if there's something I can help you out with, I want to know about it.” He leans back in his wooden chair, twisting the ring on his finger.

“I have ADHD,” I announce. I hadn't really planned on sharing, but my brain apparently had.

He nods slowly with a concerned smile. A possibly practiced concerned smile.

“It's been a bit of a problem lately. I'm working on it with…well, with my psychiatrist. I know I've been off lately, as you noticed. Just so you're aware. I'm aware of it.” I sound like an ass. Any more
aware
s and I'll be clanging.

He crosses his long legs and leans back farther in his chair, staring at the ceiling tiles. “I'm glad you told me, Zoe. I'm glad you were comfortable enough to do that.”