Cassia, p.4
CASSIA, page 4
It was no mystery to Jack why more and more of the patients were assigned to him. He was the only one who cared about the hard-core cases, especially the penal code ones, the compulsive rapists, the psychotic murderers. He knew if he could treat them effectively, make them human again, he could treat anyone. They would provide the final and best test for any new pharmacological treatment regime.
Finally, the group approached the last cell on the corridor, its door locked tight. The Jane Doe. Dr. Fielding entered a security code. The door swung open to reveal a young woman standing in the cell’s center. Her palms were thrust outward, chin tilted toward the ceiling, eyes rolled back, fluttering constantly. A wild mane of dirty blonde hair spilled along her shoulders. She whispered, softly and frantically.
Jack was struck by her pure primal beauty, embarrassed that his own primitive instincts were asserting themselves. He couldn’t help notice how her full lips quivered, how her breasts trembled beneath her gown. He had lusted after women from time to time. All married men did, he figured. It was in their genes and in their jeans. You can’t turn off a million years of instinctive behavior by taking a vow. No matter how devoted he was to Wendy—and he was absolutely devoted to her—primitive instincts sometimes took over, but he had never lusted after a patient before.
Yet, there she was. Vulnerable. Needy. Crazy beautiful.
“Your case, Dr. Temple.”
Jack snapped from his reverie when he realized Dr. Fielding had spoken and was handing him the patient’s chart. He quickly reviewed the preliminary patient history.
“We have a new Jane Doe,” Jack began. “Age unknown. Probably mid-twenties. Tried to hang herself from the swingset of a school playground this morning. No ID.”
He strained to make out what she was whispering. It was hopeless. The few phrases he could understand were scattered, meaningless.
“The patient presents a form of catatonic schizophrenia,” Jack continued. “We’ll put her on Risperidone, then see what we can do for her.”
Lillian pushed in to inspect some odd scarring on the left arm.
“We think her name might be Cassia,” Dr. Fielding told the group. “Receiving reported a crude scar on her forearm with that name.”
Jack and the others pushed in close to see. It looked to him as if the flesh had been repeatedly scraped away to spell Cassia. Each letter was sloppier and more jagged than the last, a graphic barometer of a deteriorating mental state, the last couple letters hard to read.
“Probably self-inflicted, maybe with her fingernails,” Fielding continued. “Of course, we don’t know for sure that Cassia is her real name, so please don’t call her that if you try to talk to her. Although, as you can see, she doesn’t seem to respond to anything anyway.”
To Jack, the name Cassia seemed to fit, and it was far better than Jane Doe Number whatever. He had lost count of how many Jane Does they had brought in over the last couple years. Usually, fingerprints could identify them, but Receiving said the authorities had turned up nothing.
“Are the police trying to identify her?” Lillian asked Fielding.
“Trying? Of course. Hard? They have a lot of other things to do.”
“Any idea what she’s saying?” Lillian asked, as she and the others strained to make out what Cassia was whispering.
“I’m guessing it’s not about the latest advances in quantum physics,” Jack quipped, hoping the lame joke would somehow refute his attraction to Cassia, or hide it at least. No one laughed.
“I think we’re done,” Fielding said, leading the group from the cell.
“Can I videotape her?” Lillian asked, lingering close to the door. “Maybe I can play it back and figure out what she’s saying.”
“I doubt that’ll reveal much,” Jack replied. “In cases like this—”
“I don’t see why not,” Fielding cut in. “With your Kyronane project winding down, Lillian should have free time in her schedule. The patient appears harmless enough.” She turned to Lillian. “Just don’t play her own whispers back to her.”
Fielding shut the cell door and led the group back along the hallway. Jack remained outside the cell and peered at Cassia through a small cell door window.
“Your wife.”
At first Jack didn’t respond, then realized it was Bess calling to him.
“What?”
“She’s on the phone,” Bess explained from down the hall. “She said she couldn’t get through on your cell. You can take it at my station.”
#
Wendy cradled her phone on her shoulder as she kept an eye on her lunchtime art therapy group at the downtown Taverton Community Center. There were a dozen adult IWA students—Individuals with Autism—mostly middle-aged or older. They were painting, or not as the case may be, at their respective easels.
“Jack?” Wendy asked again, her patience fading.
As she was just about to hang up, he answered. “Hi Wen,” Jack’s voice buzzed through the phone. “Hope your day’s been better than mine.”
“What happened?”
“I’ll tell you tonight, at the auction.”
“I thought you might have forgotten,” she said.
“Not a chance.”
“Great, I’ll meet you there.” Wendy then got to the real point of her call. “Jack, did you get a new patient out there today? One who tried to hang herself from a swingset?”
There was a long pause. “Yeah, how did you know?”
“That swingset was at Scofeld Elementary!” Wendy exclaimed.
“No kidding, you saw her?”
“I stopped her, Jack. Me and a couple of other teachers. Is she okay now?”
“Hard to say. We have her in a seclusion cell. She’s clearly quite disturbed. I don’t know what the prognosis is.”
“Take care of her for me. Protect her. She needs help.”
“Of course, Wen. We always do our best. You know that.”
Wendy wanted to tell him she felt she had somehow been meant to encounter the poor girl, that fate had designs on her, on both of them. Yet she didn’t want to sound too crazy herself.
“Wen? Still there?”
“Yes, I … ” She noticed that one of the more domineering students of the class—a middle-aged woman named Dixie—was starting to critique the painting of another student. She evaluated the other’s work in the same manner, and with the same colorful language, that one longshoreman might use to critique another’s misbegotten tattoo.
“Windows. Always with the fucking windows,” Dixie blurted as she eyed the latest painting by a pudgy forty-ish man named Lanny, who hunkered close to his easel, as if it somehow gave him protection, a little shield against the threats of the world.
“Wendy?” Jack asked.
“Sorry, got to go. I’ll see you tonight at Andrew’s.”
Wendy stowed her phone and moved to break up the altercation. She wasn’t worried Lanny would retaliate. He was too timid for that. She worried he might react by painting over his work, ruining it.
“Don’t be crude, Dixie,” Wendy chided. “Lanny can paint whatever he wants.”
Wendy looked at the painting. It was a rendering of a window, opening onto an otherworldly landscape. Lanny had somehow brought a unique life to that other world, using colors not often found in the real world. Wendy usually discouraged her students from painting with acrylics, always preferring more natural oils, telling anyone who’d listen that acrylics stole the soul of a painting. Yet Lanny’s acrylic works were both dazzling and soulful. His latest was excellent and could easily hang in any fine art gallery here in town, or one in New York for that matter.
“I think it’s perfect, Lanny,” Wendy said, putting a calming hand on his shoulder. “Just the way it is. Maybe you’ll let me auction it off tonight.”
Lanny nodded, weakly.
“Can’t we just auction off Lanny?” Dixie asked as she settled back at her own easel, snickering.
Wendy rolled her eyes. It would be a long day. She looked again at the painting of the window and the inviting world that lay beyond. She wished she could slip through for an hour or so of peace and quiet within that other realm, all worries left behind.
CHAPTER EIGHT
“Don’t get your hopes up,” Jack told Lillian later that afternoon as he led her back to the Jane Doe’s cell, the one they called Cassia. “I’ve never been much for linguistic psychotherapy.” He spoke those last words as though it were something one might step in.
He regretted sounding so disapproving. He admired her initiative. Too many of his assistants over the years had, whenever possible, done as little as possible. Worse, they had as little contact with patients as they could, either through laziness or fear of the patients themselves, as if they might catch their affliction, as if schizophrenia were infectious.
Lillian, though, had surprised him. She had rolled up her Skidmore College sleeves and got to work with even the most heartbreaking of patients. She was a puzzle, though. Her clothes, for example. Dowdy outfits. At first, he thought it was just finances—a young woman struggling on a low salary. Then he’d met her parents, The Andersons, and they were not wanting for wealth. No, something else was going on with those “librarian” clothes, something Lillian was reluctant to talk about. He had once gently teased her about her attire, but a chill had darkened her mood.
“You were talking about linguistic psychotherapy?” Lillian prodded as they approached Cassia’s cell.
The orderly Derrick was already there, waiting patiently outside the door with the videocamera and its tripod brought from the clinical lab.
“Look, I think it’s important to listen to patients,” Jack explained to Lillian. “To let them talk. To let the words come out. But linguistic analysis—trying to find meaning in ramblings—is often pointless. There can be many causes of psychological disorders but, within the brain, they are usually manifest either as chemical or structural problems.”
As they reached Cassia’s cell, Derrick keyed in the code for them.
“If chemical, we address the problem with psycho-pharmaceuticals,” Jack continued. “If structural, there’s less hope. Neurosurgery can benefit some patients, of course, depending on the structural deficit, but not many. In my view, schizophrenia is mostly a structural problem caused by inadequate synaptic connections in the cerebral cortex. For some reason, synapses, you know what they are, right?”
“Of course, the connections between neurons in the brain.”
“Synapses are ‘pruned,’ especially during late adolescence. That’s part of how we learn. Unneeded neural connections are eliminated, leaving only helpful ones. With schizophrenia, the pruning just keeps going. Of course, there’s much debate. Put ten psychiatrists together, you’ll get ten different theories. Still, most research indicates that, one way or another, the wiring of the schizophrenic brain is compromised.”
Jack opened the cell and he and Lillian entered, as Derrick waited outside. Cassia stood in the center of her cell, eyes fluttering, whispering like mad. Jack was struck again by her wild beauty.
“Unless there’s a way to remedy those synaptic wiring problems,” Jack continued, “and no techniques have yet been effective, there’s little we can do with a patient like this one. Medication can help manage symptoms but will not truly cure her. And linguistic psychotherapy? Too often, that just vexes and confuses the patient, making things worse.”
“You don’t agree with Freud that—”
“Freud’s been in the ground for a long, long time now. Most of his theories should have been buried with him.” He grinned as if it were a joke but realized he probably just sounded mean. He was far too young to sound like a crotchety old doctor. He thought of Wendy and wondered what she’d think of his rant about psychotherapy. So close-minded, she’d tell him.
“So you think it won’t do any good to figure out what she’s saying?”
“I suppose it can’t hurt to learn what she’s whispering, but it won’t make sense. It’ll be disorganized. Acutely disorganized.”
Jack lifted one of Cassia’s arms, then let it go. For a few moments, it remained suspended, then relaxed to its previous position, palm outstretched. Throughout, Cassia continued to whisper, oblivious.
“Waxy flexibility,” Jack said, noting the common symptom of catatonia. “Keep your distance. Derrick will be outside if you need him.”
“What did Dr. Fielding mean about not playing her whispers back to her?”
“Those with schizophrenia often hear voices in their minds. They don’t imagine them. Those neural problems I mentioned cause them to hear their own subconscious thoughts as if they were external voices. Like I said, the wiring is compromised.” Jack paused at the door. “So if she were to hear those same voices coming from a videocamera she might—”
“Freak out a little?” Lillian asked.
“You never know.” Jack spun and headed back along the corridor.
#
“I’ll be fine, Derrick, really.” Lillian motioned the orderly away from the cell door, annoyed no one trusted her alone with patients, although she’d been working on the ward for six months already. “I don’t think she’d hurt a flea. I doubt she even knows we’re here.”
“Doctor’s orders.” Derrick remained stationed at the door.
Lillian shrugged and readied the videocamera. It was a clunky older model, but it would suffice. She zoomed in on Cassia. In the viewfinder, her face was hard to follow. Perpetually whispering, she tilted her head slightly left and right, as if hearing voices from different directions. Lillian took a close look at Cassia’s throat. Earlier, she’d been so intent on the crude scar on her forearm she hadn’t noticed the bruising. It was probably from the noose she tried to hang herself with early that same morning. The contusions weren’t bad, but they were there nevertheless.
Lillian shuddered at the thought of how close Cassia might have come to ending her life. Or maybe it was one of those so-called cries for help, too often ignored by others.
“I don’t know whether you can understand me,” she said to Cassia. “But my name is Lillian Anderson.”
No response.
“I hope you don’t mind. There was a time when I hated being videotaped. Drove me nuts.” She squeezed Cassia’s forearm gently, and the camera captured a single tear as it trickled along Cassia’s face.
Lillian dabbed a tear from her own eye too.
#
As Jack returned to the clinical lab, he hoped he hadn’t sounded too discouraging to Lillian. Her new project didn’t really bother him. What annoyed him was Dr. Fielding’s cavalier dismissal of his own research project, that it was “winding down.” She must have heard he’d stretched the original test protocols for Kyronane, and she disapproved. He’d probably be called into her office soon enough. Yet there was nothing unethical about it. Earlier studies by Ryker had already shown the drug to be safe at standard dosages. Now, it was just a matter of determining whether the drug was effective for particular psychiatric conditions.
Side studies of efficacy were common and often encouraged by pharmaceutical companies, tacitly or otherwise. It took forever to get approval to test new drugs, especially on the mentally ill. Once a new compound was approved by the FDA for efficacy tests in human subjects, it was wise to perform collateral experiments to see if there were other beneficial effects. Often, the intended use of a new drug proved ineffective, but researchers discovered other benefits. A medication that might have been tossed aside found a useful purpose. Even Viagra was originally misunderstood. That little blue “miracle pill” was initially intended to treat hypertension and angina pectoris.
The reps from Ryker Pharmaceuticals had been coy about where Kyronane came from, Jack recalled, saying something about ongoing “internal research protocols” and “trade secrets” and other nonsense. He figured it was just another drug stumbled upon in the lab with no obvious clinical application. The subsequent discovery it mitigated obsessive-compulsive disorders might have been unexpected.
They put Jack on the clinical trials list knowing he could be trusted to find still other uses. He had a reputation. He could be relied upon to find “off label” applications for new drugs. Some, like Dr. Fielding, found that troubling, but there were just too many patients for whom psychotherapy was pointless. If they were to have a better quality of life, he knew, it would be with drugs like Kyronane. Jack thought of it as a little blue miracle, his little blue miracle. He’d find as many uses for it as he could. He’d prove to Dr. Fielding, and Ryker, and anyone else who’d listen, that Kyronane was the next miracle drug. He already had a marketing catchphrase.
What can blue do for you?
CHAPTER NINE
Wendy was thrilled by the turnout.
The art glitterati of Taverton—such as they were—had all come out. Her friend Andrew’s loft was packed. The paintings for auction were displayed on easels arranged around the expansive space. Loud music thumped, shaking a row of stylish mannequins that stood along the wall. The mannequins nonchalantly took in the scene, each adorned with a different colored wig, bold colors. A bank of large TVs covered another wall, at least twenty of them. Abstract images splashed across the screens in synch with the music. Andrew certainly loved his audio-visual gadgetry, Wendy thought.
She didn’t much like the DJ, though. Too loud, and too “hipster” for her tastes. She would keep her eye on the balcony, which jutted over the street. She could always tell when the music became too annoying by the number of people shivering outside, trying to get away from it. She had managed plenty of auctions. She understood the patrons with enough money to make a real difference were generally older and easily driven away by irritating music or cheap drinks.
She would talk with both the DJ and the bartender. Sheesh, Wendy, how can you be so uptight? She asked herself. Isn’t that Jack’s job? She spotted him pushing his way in through the front door. At least he’d gone home and changed from his dorky work clothes into a casual suit. He was looking around wearily, probably hoping to see a friendly face.
