If only I could control my life like that, she thought, stepping on the welcome mat and watching the doors glide open. Simple.
Inside, she greeted the security guard, Bruce, a friendly guy with a clean-shaven face and a hangdog expression, who ushered people through the metal detectors with all the grace of Fred Astaire. He waved his magic wand and said, “Have a blessed day, Doc.”
“You too, Bruce.”
Kate caught a crowded elevator to the psych department on the second floor, and used her pass key to open the double doors of the Children’s Psych Unit. Across the hallway, through another set of locked doors, was the Substance-Abuse Treatment Center. Upstairs on the third floor was the Adult Psychiatric Intensive Care Unit, accessible by private elevator or locked stairwell—for hospital personnel only. Admission to all three programs was voluntary, but the exit doors were locked so the hospital wouldn’t be held liable if a patient escaped the premises without being properly released.
The smaller of two conference rooms had been reserved for today’s interview. Kate’s attorney was already there, along with the Risk Management representative, a stout woman in a cashmere pantsuit who sat with her fingers laced together.
Russell Cooper was an intimidating presence in his Armani suit, Bulgari watch, and gold cufflinks. “Kate, this is Felicia Hamilton from Risk Management. Felicia… Dr. Kate Wolfe.”
“Nice to meet you.”
“Same here.”
They shook hands.
Kate settled into a vinyl-padded chair next to Russell and studied Felicia Hamilton. She appeared to be in her mid-forties, with intelligent gray eyes and short sleek hair. A professional with a permanent poker face. Felicia opened her briefcase on the table and took out a digital recorder, a fountain pen and a clipboard. She placed the recorder on the table and said, “Do I have your permission to record this interview?”
“Yes.” Kate glanced at her attorney for approval. Russell nodded. Her heart wouldn’t stop racing. There were several bottled waters on the table, and Russell slid one over to her.
“Thanks.” She twisted off the cap and drank. Then came the questions. She reminded herself to keep it brief and truthful.
“On June 2nd of last year, Nicole McCormack came to the hospital for emergency psychiatric treatment and was admitted for observation,” Felicia said in the blandest of tones. “Why did you release her four weeks later?”
“Traditionally, lower-risk patients are treated on an outpatient basis.”
“So she was no longer suicidal?”
“She was working on healthier ways to express her negative feelings. I decided that her risk of suicide wasn’t high at that point.”
“When you say ‘wasn’t high,’ what do you mean?”
“Nikki came to regret what she’d done. Her psychological state had improved significantly, and her depression had lifted. After four weeks of treatment, I concluded she was no longer at risk of self-harm.”
“And what was the outpatient treatment plan?”
“She was to continue medicating and see me once a week for talk therapy.”
“And how was that going?”
“Very well. She was fully engaged in working through her emotional issues.”
“What was her mental state before her death?”
“She was doing very well, like I said. She wasn’t acting out or skipping school. She hadn’t reported any suicidal urges for months. She wasn’t giving away any of her personal possessions, except… well, that’s not important.” Kate caught Russell’s wince in her peripheral vision. Don’t volunteer unnecessary information.
“Let me be the judge of that,” Felicia said.
“She gave me a few things she’d found at the beach,” Kate explained. “I had to remind her, we can’t accept gifts from our patients. Hospital policy.”
“I see. What sort of things?”
“Just a…” How did you explain a skirt weight? “A few seashells,” Kate lied.
“And how was her family situation?”
“She and her mother were still arguing quite a bit,” Kate said. “Nikki thought her stepfather was too controlling. However, she was learning to communicate her needs and concerns to them.”
“Were there any other suicide attempts in her past?”
“Just the one that brought her to us to begin with.”
“I see. And what was the method?”
“She overdosed on aspirin.”
“And more recently, was she drinking alcohol or taking drugs?”
“I’m confident she was no longer doing drugs. However, it’s possible she wasn’t entirely forthcoming about her alcohol intake.”
“Okay. But did she display any of the symptoms of addiction?”
“None whatsoever.”
“Any history of mental illness in the family?”
“Not according to her mother.”
“Did she have any phobias?”
“Just that she was afraid of people’s tongues.”
“People’s tongues?”
Kate nodded. “The tips of people’s tongues bothered her. Also, she was afraid of the plumbing… old pipes in the house, the noises they made at night.”
“In your opinion, did this constitute cause for concern?”
“No. A lot of people have strange phobias. Those were separate issues from her main illness, which was bipolar disorder.”
They talked about medication and discussed Nikki’s state of mind during her last session with Kate. Felicia spoke in a monotone, conferring little emotion one way or another. Finally, she concluded the interview by saying, “Is there anything else you’d like to add?”
“Only that I consulted with my supervisor on the case. Dr. Ira Lippencott.”
Felicia nodded politely. “Thanks for your cooperation, Dr. Wolfe.” She packed up her briefcase and stood up. “You’ll be hearing from us in a few weeks. In the meantime, here’s my card.”
“We’ll call you if we have any questions, Miss Hamilton,” Russell said. As soon as the door closed behind her, he turned to Kate. “You handled that very well.”
She excused herself and rushed to the bathroom. She fought off a wave of disorientation as she studied her face in the mirror. She could feel the strain accumulating behind her eyes. She splashed cold water on her face and grabbed a paper towel. She hated her own vulnerability.
In psychiatry, a person’s core vulnerability was the emotional state that was most terrifying for them—fear of harm, fear of shame, fear of isolation. Kate’s was her sense of failure at not being able to help her sister, and by proxy, her young patients. It kept her working long hours. It made her struggle to become a better doctor. She had failed to protect Nikki. She would not fail again.
14
KATE FOUND MADDIE WARD alone in her room.
“Good morning,” she said. “How are you feeling?”
The girl rubbed her tired eyes. “Okay, I guess.”
“Your tests all came back negative. Which is a good thing.”
“Why is negative good?”
“It means we can rule out brain injury or other neurological causes.” She didn’t add that they still had to find out where the aural hallucinations were coming from, why Maddie was cutting and biting herself, and what combination of family dysfunction, psychological factors and chemical imbalance was causing her depression. “How do you feel in general?”
Maddie shrugged listlessly. “I don’t know.”
“Been a rough couple of days, huh?”
This morning, she looked different—older. More like a fourteen-year-old, and less like a twelve-year-old. The nurses had confiscated her gold stud earrings, leaving little holes in her earlobes. Her long blond hair was out of its ponytail and fell across her shoulders in swirly loops. She sat cross-legged on the hospital bed and gazed forlornly out the window. Her eyes had grown-up sorrows in them. Usually, when you walked through a psych ward during visiting hours, the rooms would be packed with family members bearing gifts. But Maddie Ward had been alone for forty-eight hours. No cards. No flowers. No phone calls. No visitors. That in itself constituted neglect, in Kate’s mind.
“Have you been getting along with your roommate?”
“Yeah.”
The roommate’s bed was made. She was probably in the day room. A sixteen-year-old anorexic—one of their frequent fliers.