“This is Maria. She’ll be here whenever you need anything. Maria is well trained in handling our difficult patients. And her English is getting much better. Isn’t that so?”
"Si,” Maria said. Pockmarked skin stretched across darkly plump cheeks. Her expression was inscrutable, but her eyes darted nervously back and forth. “Gracias, thank you.”
They entered a corridor lined with solid metal doors on either side, each of them with an eye-high, centered window. The air smelled damp with the slightest hint of lemon cleanser.
Jess could hear noises from behind the walls, thumps and muffled shouting. She concentrated on Wasserman’s back as he spoke over his shoulder.
“Most of our patients are assigned a counselor and a team that works together to ensure that things are progressing. I’ve taken a personal interest in Sarah, and in this instance you’ll be working directly with Maria and myself. Often you’ll be alone. Sarah tends to react badly to crowds.” Nearly at the end of the corridor, he stopped at a door and turned to her. “Are there any more questions before you have a look?”
About a million of them. Jess squared her own shoulders and faced him. “I have to admit here, Dr. Wasserman, I don’t feel comfortable with what you’ve given me. Really it would be better if I could study the file. I need to know what tests she’s been given, what sort of diagnoses have been made—”
“Sarah has a schizophreniform psychotic disorder. She was diagnosed at age six. As I’m sure you’re aware, diagnoses of this sort prior to six years of age are extremely rare. Sarah was always difficult, but by her sixth birthday she was showing signs of marked withdrawal, looseness of association, and a breakdown of reality testing. There were hallucinations—”
“I understood that those didn’t start until early adolescence.”
“Not in this case.” Wasserman paused and seemed to choose his words carefully. “Sarah began to believe… still believes… that she could influence people. That she could bend things to her will. Fantasies of omnipotence are not uncommon—again, this stems from early childhood—but in Sarah these fantasies extended far beyond the normal stages. And then the phobias and the suicide attempts began. Recently she has grown so uncontrollable that we’ve had no choice but to confine her to the basement for good portions of the day. She fought us by withdrawing in her therapy sessions and refusing her medication. She hasn’t spoken a word in over three months now.”
Wasserman’s gaze kept slipping from the tiny window in the door, to Jess’s face, to some point in the corridor beyond her head.
“What about her parents?”
“Sarah has no surviving relatives, as I believe I told you. That’s the case with so many of the children here, unfortunately. They’ve been either orphaned or abandoned, and the foster care system is simply not well equipped to handle those with more severe mental disorders.” Wasserman glanced at his watch and then dug a set of keys out of the pocket of his white lab coat. “Now, Jean and I agreed that your first contact with her should be alone. Our intent here is to shake things up, draw her out, expose her to someone she might eventually be more comfortable with and who is not associated with me or my staff.”
“I’d still like to see her file.”
Wasserman blinked at her from behind his glasses. “You’re persistent, I’ll give you that. I’ve made my decision. If you need assistance there’s a button on the wall. Maria will let you out.” Wasserman fumbled the key into the lock as if he couldn’t get a handle on it. Then the key turned and the metal door swung open.
—3—
The girl crouched in the middle of a padded room. The restraint jacket that pinned her arms over her chest seemed to swallow her slender, boyish frame. Her black hair hung down far enough that Jess could not get a good look at her features.
If Sarah heard the door open, she gave no sign. Her breathing came slow and deep. A thin line of spittle hung trembling from a strand of hair to the floor.
Jess stopped just inside the door and listened as it swung shut behind her. The noise was enough to make her jump, but she caught hold of herself inside like the clenching of teeth.
“Hello, Sarah,” she said firmly. “My name is Jess Chambers. I’d like to visit with you for a while, if that’s all right.”
There were two ways to go about this: pretend to be occupied with something fascinating, and see if she became curious, or try to engage immediately. Either way it could take days, weeks, to break through. Both options assumed that Sarah was even reachable at all.
The girl had not reacted to her presence, and Jess found herself staring. Were the restraints really necessary? How violent could a ten-year-old possibly be? Perhaps she had tried to harm herself; Shelley had mentioned that she was suicidal. Jess had heard of psychiatric patients tearing at their faces, pulling out their own eyes, digging out their throats. It was difficult to kill yourself with your bare hands, but that didn’t stop some of them from the attempt.
She did not want to appear threatening and so she sat down on the floor against the wall, keeping a good distance, but getting into the girl’s line of sight. She had worn loose clothes specifically for this, a soft suit in neutral colors that covered her wrists and left only her hands and part of her neck bare. She wore contact lenses, her hair held up by a plain, white-cotton Scrunchie.
Remember what you have learned. Finding the real world too much to bear, Sarah had formed her own. It was up to Jess to interpret it. She would be a translator of sorts. To do this she would have to form a bond, allow herself to let the girl in and hope that Sarah would trust her enough, be lucid enough, to let her in too.
She opened her briefcase and removed a lined notebook and pencil. At the top of the first page, she wrote interpersonal contexts, and then, under it: Interaction with peers? Foster homes? Teachers? As she did this she spoke quietly, repeating her name, and why she was there.
It was like talking to herself. When she was a small girl her grandmother Cheryl had a stroke, and the family visited her at the Maine Medical Center in Portland. It was a place she was already well familiar with from various visits with Michael. They had gathered around Grandma Cheryl’s bed, and everyone spoke as if she could hear them, as if at any moment she would sit up and answer their questions. Her grandmother died three days later, having never uttered another word.
But this is different. Obviously Sarah was in a catatonic state, but that did not mean she had always been that way, or that she would not come out of it again. Studies indicated that catatonics were often aware of their surroundings and simply unable to respond. Jess had to believe the girl was listening, that whatever barrier she had erected in her mind did not entirely cut her off from the world.
After a few minutes of note-taking on her observations of the surroundings and Sarah’s condition, she risked a glance, saw that the girl had not moved. The buckles must be hurting her. She thought about loosening the jacket, decided against it. She did not know exactly what Sarah was on. Tranquilizers, Wasserman had said. Neuroleptics.
“I wonder if you could help me come up with some fun things to do,” she said, scribbling on the notepad. “We could try painting. I used to paint a lot when I was your age. I still do, like sometimes when I’m feeling sad or lonely. It’s like I’m putting those feelings down on paper where they can’t hurt me.”
Had the girl moved her head? This was silly. Damn you, Wasserman, for leaving me in here alone. She continued, feeling like a fraud, forcing the anxiety from her voice. This was a familiar, unsettling discomfort. Sarah is not Michael. She was much older than her brother when he died. The two were nothing like each other. Just keep going.