“Probably. But tenure, as it turns out, comes from the med school, not the hospital. So they’ve still got their titles. Salaries are a whole other story. Quite a revelation for those of us who thought we had job security. Not that anyone fought for Hardesty. Everyone thought he and his guys were deadwood.”
“No more Psych department,” I said. “No more free coffee. What else?”
“Oh, plenty. Does it affect you, there being no Psych department — in terms of your staff privileges, I mean?”
“No, my appointment’s in pediatrics. Oncology, actually, though it’s been years since I’ve seen any cancer patients.”
“Good,” she said. “Then there won’t be any procedural hassles. Any more questions before we go up?”
“Just a couple of observations. If it is Munchausen by proxy, there’s some time pressure — the usual picture is an escalating pattern. Sometimes kids die, Steph.”
“I know,” she said miserably, pressing her fingertips to her temples. “I know I may need to confront the mother. That’s why I have to be sure.”
“The other thing is the first child — the boy. I assume you’re considering him a possible homicide.”
“Oh, God, yes. That’s really been eating at me. When my suspicions about the mother started to gel, I pulled his chart and went over it with a fine-tooth comb. But there was nothing iffy. Rita’s ongoing notes were good — he was perfectly healthy before he died and the autopsy was inconclusive, as so many of them are. Now here I am with a living, breathing child and I can’t do a thing to help her.”
“Sounds like you’re doing everything you can.”
“Trying, but it’s so damned frustrating.”
I said, “What about the father? We haven’t talked about him.”
“I don’t really have a good feel for him. Mother’s clearly the primary caretaker and it’s her I’ve been dealing with most of the time. Once I started to think of it as a possible Munchausen by proxy, she seemed especially important to focus on, because aren’t mothers always the ones?”
“Yes,” I said, “but in some cases the father turns out to be a passive accomplice. Any sign he suspects something?”
“If he has, he hasn’t told me. He doesn’t seem especially passive — nice enough. So is she, for that matter. They’re both nice, Alex. That’s one of the things that makes it so difficult.”
“Typical Munchausen scenario. The nurses probably love them.”
She nodded.
“What’s the other?” I said.
“The other what?”
“Thing that makes it so difficult.”
She closed her eyes and rubbed them and took a long time to answer.
“The other thing,” she said, “and this may sound horribly cold-hearted and political, is who they are. Socially. Politically. The child’s full name is Cassie Brooks Jones — set off any buzzers?”
“No,” I said. “Jones isn’t exactly memorable.”
“Jones, as in Charles L. Junior. Hotshot financier? The hospital’s primary money manager?”
“Don’t know him.”
“That’s right — you don’t read your newsletters. Well, as of eight months ago he’s also chairman of the board. There was a big shake-up.”
“The budget?”
“What else. Anyway, here’s the genealogy: Charles Junior’s only son is Charles the Third — like royalty. He goes by Chip — Cassie’s daddy. The mom is Cindy. The dead son was Chad — Charles the Fourth.”
“All Cs,” I said. “Sounds like they like order.”
“Whatever. The main thing is, Cassie is Charles Junior’s only grandchild. Isn’t that wonderful, Alex? Here I am with a potential Munchausen by proxy that could explode in everyone’s face, and the patient’s the only grandchild of the guy who took away the free coffee.”
3
We got up from the table and she said, “If you don’t mind, we can take the stairs-up.”
“Morning aerobics? Sure.”
“You hit thirty-five,” she said, smoothing her dress and buttoning her white coat, “and the old basal metabolism goes to hell. Got to work hard not to be lumpy. Plus, the elevators still move on Valium Standard Time.”
We walked toward the cafeteria’s main exit. The tables were completely empty now. A brown-uniformed maintenance worker was wet-mopping the floor, and we had to step gingerly to maintain traction.
I said, “The elevator I took to your office was converted to key lock. Why the need for all the security?”
“The official line is crime prevention,” she said. “Keeping all the street craziness out of here. Which to some extent is valid — there have been increased problems, mostly during the night shift. But can you remember a time when East Hollywood didn’t get bad after dark?”
We reached the door. Another maintenance man was locking it and when he saw us, he gave a world-weary look and held it open for us.
Stephanie said, “Reduced hours — another budget cut.”
Out in the hallway, things had gotten frantic. Doctors blew past in boisterous groups, filling the air with fast talk. Families traipsed through, wheeling doll-sized veteran journeyors to and from the ordeals wrought by science.
A silent crowd was assembled at the elevator doors, clumped like human droplets, waiting for any of three lifts that had settled simultaneously on the third floor. Waiting, always the waiting...
Stephanie moved through deftly, nodding at familiar faces but never stopping. I followed close behind, avoiding collision with I.V. poles.
When we entered the basement stairwell, I said, “What kind of crime problems have there been?”
“The usual, but more so,” she said, climbing. “Car thefts, vandalism, purse snatchings. Some muggings out on Sunset. And a couple of nurses were assaulted in the parking lot across the street a few months ago.”
“Sexual assaults?” I said, taking two steps at a time in order to keep up.
“That was never made clear. Neither of them came back to talk about it. They were night-shift floats, not regular staff. What I heard was that they were beaten up pretty badly and had their purses stolen. The police sent a community relations officer who gave us the usual personal safety lecture and admitted that, bottom line, there was little anyone could do to guarantee safety unless the hospital was turned into an armed camp. The women on the staff screamed a lot and the administration promised to have Security patrol more regularly.”
“Any follow-through?”
“Guess so — you see more uniforms in the lots and there’ve been no attacks since then. But the protection came with a whole bunch of other stuff no one asked for. Robocops on campus, new badges, frequent hassles like the one you just went through. Personally, I think we played right into the administration’s hands — gave them an excuse for exercising more control. And once they get it, they’ll never relinquish it.”
“C students getting revenge?”
She stopped climbing and looked down at me over her shoulder, smiling sheepishly. “You remember that?”
“Vividly.”
“Pretty mouthy back then, wasn’t I?”
“The fire of youth,” I said. “And they deserved it — talking down to you in front of everyone, that ‘Dr. Ms.’ stuff.”
“Yeah, they were a pretty cheeky bunch, weren’t they.” She resumed the climb, but more slowly. “Banker’s hours, martini lunches, sitting around shmoozing in the caf and sending us memos about increasing efficiency and cutting costs.”