He wore a short white coat over a blue oxford shirt, burgundy print tie, and dark gray trousers of a subtle check. His shoes were black calfskin loafers. Very proper, very tasteful. But clothes didn't make the man. He would have looked patrician in double knits
"Dr. Delaware? Will Towle."
"Alex."
I stood and we shook hands. His grip was firm and dry. The fingers that clasped mine were enormous and I was conscious of abundant strength behind them.
"Please, sit."
He took his place behind the desk, swiveled back and threw his feet up on top, resting on a year's back issues of the Journal of Pediatrics.
I responded to his question.
"It is a beautiful shot. Somewhere in the Pacific Northwest?"
"Washington state. Olympic National Forest. We were vacationing there in fifty - one. I was a resident. That was my wife and son. I lost them a month later. In a car crash."
"I'm sorry."
"Yes." A distant, sleepy look came on his face; it was a moment before he shook himself out of it and came back into focus.
"I know you by reputation, Alex, so it's a pleasure to get to meet you."
"Same here."
"I've followed your work, because I have a strong interest in behavioral pediatrics. I was particularly interested in your work with those children who'd been victimized by Stuart Hickle. Several of them were in the practice. The parents spoke highly of your work."
"Thank you." I felt as if I was expected to say more but that was one subject that was closed. "I do remember sending consent forms to you."
"Yes. yes. Delighted to cooperate."
Neither of us spoke, then we both spoke at the same time.
"What I'd like to - " I said.
"What can I do for - " he said.
It came out a garbled mess. We laughed, good old boys at the University Club. I deferred to him. Despite the graciousness I sensed an enormous ego lurking be hind that white forelock.
"You're here about the Quinn child. What can I do for you?"
I filled him in on as few details as possible, stressing the importance of Melody Quinn as a witness and the benign nature of the hypnotic intervention. I ended by requesting that he allow her to go off Ritalin for one week.
"You really think this child will be able to give you information of substance?"
"I don't know. I've asked the same question. But she's all the police have got."
"And your role in all of this?"
I thought up a quicky title.
"I'm a special consultant. They call me in sometimes when there are children involved."
"I see."
He played with his hands, constructing ten - legged spiders and killing them.
"I don't know, Alex. When we start to remove a patient from what has been determined to be an optimal dosage we sometimes upset the entire pattern of biochemical response."
"You think she needs to be on medication constantly."
"Of course I do. Why else would I prescribe it for her?" He wasn't angry or defensive. He smiled calmly and with great forbearance. The message was clear: Only an idiot would doubt him.
"There'd be no way to reduce the dosage?"
"Oh, that's certainly possible, but it creates the same type of problem. I don't like to tamper with a winning combination."
"I see." I hesitated, then continued. "She must have posed quite a problem to merit sixty mgs."
Towle placed a pair of reading glasses low on his nose, picked up the chart and flipped through it.
"Let me see. Ah, yes. Hmm. "Mother complains of severe behavioral problems." " After thumbing through a few more pages: " "Teachers report failure to complete school assignments. Difficulty in maintaining attention span for more than brief periods." Ah - here's a later notation - "Child struck mother during argument about keeping room clean." And here's a note of mine: "Poor peer relations, few friends." "
I was certain that the argument had something to do with giving away the giant walrus, Fatso. The gift from Daddy. And as for friends - it was easy to see that M and M Properties wouldn't truck with that kind of nonsense.
"That sounds pretty severe to me, don't you think?"
What I thought was that it was horse shit. There'd been nothing resembling a thorough psychological evaluation. Nothing beyond taking the mother at her word. I looked at Towle and saw a quack. A nice looking, white - haired quack with lots of connections and the right pieces of paper on his wall. I longed to tell him so, but that would do nobody - Melody, Milo - - any good.
So I hedged.
"I can't say. You're her doc." Faking the comradely grin was an exercise in moral self - control.
"That's right, Alex. I am." He leaned back in his chair and placed his hands behind his head. "I know what you're thinking. Will Towle is a pill pusher. Stimulants are just another form of child abuse."
"I wouldn't say that."
He waved away my objection.
"No, no, I know. And I don't hold it against you. Your training is behavioral and you see things behaviorally. We all do it, settle into professional tunnel vision. The surgeons want to cut everything out. We prescribe and you fellows like to analyze it to death."
It was starting to sound like a lecture.
"Granted, drugs have risks. But it's a matter of cost - risk analysis. Let's consider a child like the Quinn girl. What does she start out with? Inferior genes - both parents somewhat limited intellectually." He made the word limited sound very cruel. "Lousy genes and poverty, and a broken marriage. Absent father - although in some of these cases the children are better off without the kind of role models the fathers provide. Bad genes, bad environment. The child's got two strikes against her before she leaves the womb.
"Is it any wonder then that soon we're seeing all the telltale signs - antisocial behavior, noncompliance, poor school performance, unsatisfactory impulse control?"
I felt a sudden urge to defend little Melody. Her genial doctor was describing her as some kind of total misfit. I kept silent.
"Now a child like this - " he took off his glasses and put down the chart - "is going to have to do moderately well in school in order to achieve some semblance of a decent life for herself. Otherwise it's another generation of P.P.P."
Piss - poor protoplasm. One of the quaint expressions dreamed up by the medical profession to describe especially unfortunate patients.
Playing straight man to Towle wasn't my idea of a fun afternoon. But I had a hunch it was some kind of ritual, that if I held out and let him smilingly browbeat me he might give me what I came for.
"But there is no way a child like this can achieve with her genes and her environment working against her. Not without help. And that's where stimulant medication comes in. Those pills allow her to sit still long enough and pay attention long enough to be able to learn something. They control her behavior to the point where she no longer alienates everyone around her."
"I got the impression that the mother was using the medication in a haphazard way - giving her an extra pill on days when there were lots of visitors at the apartment complex."
"I'll have to check that." He didn't sound concerned. "You have to remember, Alex, that this child does not exist in a vacuum. There's a social context here. If there's nowhere for her mother and her to live, that isn't exactly therapeutic, is it?"
I listened, certain there was more. Sure enough: "Now you may ask, what about psychotherapy? What about behavior modification? My answer is: What about them? There is no chance of this particular mother developing the capacity for insight to successfully benefit from psychotherapy. And she lacks the ability to even comply with a stable system of rules and regulations necessary for behavior mod. What she can deal with is administering three pills a day to her child. Pills that work. And I don't mind telling you, I don't feel a damn bit guilty about prescribing them, because I think they're this child's only hope."