Breakdown

Chapter 6

The building that housed LACBAR-I-SP resembled what it had once been: a discount furniture outlet in a homely section of mid-city.

The front was mostly windows painted chalky white. All that glass seemed unwise if you were dealing with seriously mentally ill people in a sketchy neighborhood. A sign warned the place was on twenty-four-hour video surveillance despite the obvious lack of a camera. A locked but flimsy door with a call button sent a ludicrous mixed message.

I got buzzed in without announcing who I was, stepped into an empty waiting area backed by another window. No paint on this glass, just dust clouding the image of an elderly woman pecking a desktop keyboard. To her left was a white door marked No Admittance. She was aware of me but kept working.

I tapped the glass and she slid open the partition.

“Dr. Delaware to see Zelda Chase.”

Closing the glass, she got on the phone, returned to her keyboard.

I stood around for a while before a skinny, white-coated young woman entered the booth and conferred with the receptionist.

The new arrival sported a basic-training brass-colored buzz cut tipped black. The coat was too large, parachute-billowing over a T-shirt and jeans. I’d never met her but I recognized her and knew plenty about her because she liked attention and had sprayed personal data all over cyberspace.

Kristin Doyle-Maslow was twenty-five years old, the possessor of a B.A. in urban studies from Vassar, the only child of a father who practiced gestalt therapy in Newton, Massachusetts, and a mother who lived in Brookline and taught bio-psychiatry at Tufts. She favored “farm to table” cocktails. The list of her favorite bands broke new ground in obscurity. She liked Ethiopian food, especially “the teff and the pumpkin,” and believed public policy was a “contact sport.”

For the past two years she’d worked as an intern at HUD in Washington, “conceiving and authoring position papers on community outreach.” No training in psychology or any other mental health field.

As she continued to talk to the typist, she turned and studied me. Young, but afflicted with the kind of severe, pinched face that gets old quickly. Steel-rimmed glasses of a style favored by corporate executives in the fifties didn’t help.

She checked a few papers on the typist’s desk, finally emerged through the white door.

The T-shirt under her coat was green and read — what else—

An oversized green plastic badge pinned to the coat’s breast pocket informed the world who she was, but she announced, “Kristin Doyle-Maslow,” in a voice that could intimidate a trombone.

I said, “Nice to meet you. How’s she doing?”

“By ‘she’ I assume you mean Ms. Chase.”

Stifling a flood of retorts, including references to Amelia Earhart and Marilyn Monroe, I said, “I do.”

“There’ve been no obvious problems.” She made a show of producing a ring of keys and unlocking the white door. Breezing through, she left me to catch the swinging panel.

I followed her into a drafty, unoccupied, white space partitioned into cubicles but devoid of furniture or office equipment. The sting of fresh paint was overwhelming. At the rear was another white door marked No Unauthorized Entry.

I said, “Your project has just started?”

“We’re in the development phase.”

“But you’re equipped to handle inpatients.”

She stopped, adjusted her glasses. “At this point in time, we have one patient. Yours.” Her forward march resumed.

I said, “Hold on.” Trying to keep my voice even but the vibes set off by those stifled retorts seeped in and raised the volume and hardened my tone.

Kristin Doyle-Maslow’s shoulders jumped but she kept walking.

I said, “I need you to explain what’s going on. Now.”

She stopped and half turned. “You’re the psychologist. Isn’t explaining your job?”

“What’s yours?”

“I’m executive director of LACBAR—”

“Meaning?”

“I conceptualize and organize.” Her jaw jutted but her voice had lost conviction and the pale eyes behind her glasses shifted uneasily.

“Okay, now please explain how a 5150 patient ends up here when there’s nothing else going on.”

“I don’t see why that’s relevant. She’s in distress, she asked for you, I liaisoned.”

“With who?”

“I told you. Ravenswood University Hospital. Networking with local caregivers is one of our primary mandates.”

“The U. punted to you.”

“We were considered ideal for the situation.”

I looked around at a thousand square feet of nothing. “I’m here because I evaluated Zelda Chase’s son five years ago and his welfare concerns me. Where is Ovid now?”

“No idea. The only reference to him is his name in Sherman’s transfer document.”

“What did he say about the boy?”

“Just that he existed. Now can we get going—”

“I’d like a copy.”

“It’s mostly dates — onset of providership, termination. You have never terminated.”

Making that sound like a felony.

I said, “I’d still like a copy.”

“I don’t have one. Everything’s e-filed at headquarters.”

“Where’s that?”

“Boston.”

“Should be easy enough to get.”

“Fine,” she said. “But there’s nothing in there.”

“What about your copy of Ravenswood’s chart?”

“No need for us to get that, she wasn’t treated there, just inputted. And furthermore, I don’t see how any of this—”

“Since Ms. Chase got here, she hasn’t mentioned Ovid at all?”

“She hasn’t talked at all.”

“You said she asked for me.”

“At Ravenswood,” she said. “How else would I know? Now can we proceed?”

“Once I’m oriented. I still don’t get why she was sent here when you’re a shell operation.”

“We are not a shell, we are fully operational.”

“Doesn’t look fully to me.”

“We are totally prequalified and authorized by the federal government and cooperating local governments to offer comprehensive mental health services and we’d be meeting our goals if getting things done in this city wasn’t the way it is.”

Pale eyes fluttered. So did pale hands.

Welcome to L.A.

I said, “Bureaucracy, huh?”

Without a trace of irony, she said, “It’s the worst.”

“I sympathize, Kristin. Wikipedia says you’re into the second year of a three-year grant, meaning you’re feeling pressure about your next NIMH site visit. Your mandate is primarily outpatient but for that you need to develop a ‘network of community referrals,’ and so far that hasn’t happened because it’s as if the city wants to make your life miserable. But don’t feel picked on, anyone trying to start a business in L.A. deals with it.”

“We are not a business, we are—”

“Same difference, Kristin. Let me guess: You leased this property only to encounter the building department, the zoning department, a whole list of ad hoc community boards and committees, the assessor, the health department — I’ll bet you’re getting lots of input from the health department. Because at some point you’ll need to feed staff and patients so they classified you as a restaurant and are making you jump through all kinds of hoops. How’re you handling nutrition in the meantime? Takeout?”

“High-quality takeout.” Her foot tapped. “What-ever. Now, can—”

“Because of the delays, you’re limited to ‘short-term crisis admissions’ and the best way to accomplish that is to take in 5150s because they’re not lucrative, meaning that local practitioners who you’ll need as referral sources don’t feel threatened.”

And with all the competition for NIMH money, if you don’t come through by the time the feds send in their savants to review you, you’ll lose the high-titled job you snagged because of your mother’s contacts with the congressman who got you the HUD position.

Kristin Doyle-Maslow said, “If you’re refusing to provide service, let’s terminate this, here and now.”

“I’ll provide, let’s go.”

Looking at me doubtfully, she resumed walking. When she reached the second door, I said, “What’s the name of the doctor who transferred her to you?”

“Nehru.”

I looked at her.

She said, “What?”

No room for world history in urban studies?

I said, “Thanks for the info, Kristin.”

The restricted area was wide but shallow and quartered into a nursing station and Inpatient Rooms A, B, and C, each bolted shut and equipped with miniature flaps over peep-spaces. I listened for sound, trying to figure out which room housed Zelda.

Silence.

The station was more homey than clinical: wooden desk in place of a counter, a couple of upholstered chairs, end tables, and a black leather couch that still bore plastic wrapping around its stubby legs. A white metal cabinet with a red cross in the center took up the right-hand wall. To the left, a man in a white uniform sat behind the empty desk reading a paperback. He gave a small wave that I returned, though Kristin Doyle-Maslow didn’t.

She said, “He’s finally here. Her doctor.”

The nurse got up and walked toward us. Thirty-five or so, balding, lightly mustachioed, nondescript. His badge was half the size of Doyle-Maslow’s but gave out real information.

Kevin Bracht, RN.

We traded names and handclasps.

Bracht said, “Happy to see you, Doc. She’s sleeping, that’s all she’s been basically doing.” Eyeing Door A.

Kristin Doyle-Maslow made her exit while talking. “In terms of billing, talk to Yvette out front. Your patient’s due to be released tomorrow morning, remittance should arrive within sixty days. If you need to extend the 5150, it can’t be here.”

“Why not?”

“That’s our mandate.”

“And she’s already been here for two out of three days.”

“One and a half days, it’s a forty-eight-hour hold, not a seventy-two.”

“That’s different.”

“Overall, she’ll be held for seventy-two but part of that was allotted to Ravenswood, which is fine, we’re only authorized to do two-day holds in line with our position statement emphasizing transitioning to comprehensive outpatient services.”

Which you’re not set up to carry out. Thank you, Joseph Heller.

Kevin Bracht’s eyebrows arched.

I said, “No prob, Kristin. Mr. Bracht and I will now liaise.”

The sound of the door slamming bisected the sentence. Bracht laughed and said, “Just Kevin’s okay. So now you’ve had the privilege of meeting The Hyphen.”

“Must be fun working for her.”

“Almost as fun as a sharp stick in the eye. Soon as Ms. Chase is discharged, I’m out of here.”

“Quitting so soon?”

“Not quitting, never hired. It’s a temp deal, the agency didn’t exactly explain things accurately.”

“You’re a freelance?”

“I’m a guy who needs to moonlight, Dr. Delaware. Three days a week I work at an applied behavioral analysis home for autistic adults. The wife and I just bought a house, so I do extra hustle. Mostly that’s taking care of old folks who need watching for a weekend when their regular caregiver’s away. Also some terminals at home and some hospice care.”

“Tough stuff but better than this,” I said.

“Death I can deal with, Doc. It’s normal, it’s expected. This, on the other hand, is a weird setup. The Hyphen has no clue about psychiatry or anything else for that matter. Once I realized I’d be stuck here by myself the thought of some crisis coming up began scaring the hell out of me. I mean I’m authorized to call the referring physician but what’s that worth? Stuff happens fast, no way am I going to bear responsibility if God forbid there’s a situation.”

He pointed to Door A again. “No problems so far, knock wood, but I still find myself checking all the time to make sure she doesn’t hurt herself. She’s wearing the clothes she came in with but I took these and put them away because there’s nails in the heel.”

From a desk drawer he removed a pair of flat shoes, once black, now gray. “I’ll grant you one thing: The room’s pretty well designed for psych patients. Can’t spot any easy way to get into trouble. But still...”

“Thanks for trying to keep her safe.”

His smile returned. “You and I would say ‘safe,’ The Hyphen would probably say it’s optimal injury resistance. Anyway, so far, Ms. Chase has been easy.”

“Any symptoms I should know about?”

“Not unless you count nonstop sleep. Which happens with acutes, right? They put out all that energy then they need to hibernate. She was kind of agitated when the ambulance brought her in — fighting the restraints, grinding her teeth, so I was expecting the worst. But I talked softly to her and she calmed down and soon she was out like a light. It was like she just needed to hear a human voice.”

“What time did she arrive?”

“Around eight yesterday morning. The agency calls me at six, my wife, she’s also an RN, is leaving for her shift at Kaiser, it’s my turn to get our boy off to preschool and the agency’s like ‘Right now, Kevin.’ And I’m like you’ve got to be kidding. Then they told me what I’d be getting paid and I said, ‘Son, you’re off to preschool early.’ ”

“Generous compensation.”

“Three times the usual, plus a great food allowance. But I’m starting to feel like I’m the one who got committed. I mean, look at this — talk about solitary confinement. I’m glad you’re here to take charge.”

“That food allowance is for takeout?”

“You see a stove or even a microwave? The neighborhood’s pretty ethnic and The Hyphen has charge accounts everywhere, so that’s cool. I had Moroccan for lunch, Korean for dinner, fresh rolls from a bakery this morning. I ordered extra for Ms. Chase but she’s stayed asleep and I ended up tossing it because there’s no fridge, who needs food poisoning? She changes her mind, I’ll get her fresh. I did manage to get some water into her — dribbled it slowly through her lips. It took a while, you know how flaccid they can get, I had to make sure nothing ended up in her trachea.”

“She drank without resistance?”

“She moaned a little at first but I kept telling her she was okay and, again, it seemed to help. I figured hydrating her was the right thing to do.”

“Good call.”

He seemed relieved. “I mean at some point I have to make decisions and if she got dehydrated, the only alternative would be to I.V. her and who wants to do that? Plus, do you see an I.V. setup anywhere? On order, claims The Hyphen. Same for syringes, tubing, the fridge, everything else that would make this place real.”

I pointed to the red-crossed cabinet. “What’s in there?”

Kevin Bracht walked over and tapped the metal door. It swung open. Other than a box of bandages and a packet of rubber gloves, empty.

I said, “No meds in stock?”

“Not even aspirin. Everything needs to be ‘patient-specific,’ meaning an M.D. needs to order even OTC stuff. Fortunately, she came in medicated, EMTs gave me her pills, they’re in my desk.”

He walked to the opposite end, retrieved a vial.

Ativan, 3mg, twice daily.

Bracht said, “EMTs said the doc at Ravenswood suggesting kicking it up to three times if she gets agitated but I haven’t been comfortable with a secondhand verbal order.”

“That could add up to a large dose,” I said. “Even twice a day is serious. Five years ago she didn’t have much body weight. She any heavier now?”

“Nope, real skinny. Maybe that’s why she’s still out of it. So you want that off the table?”

“I’m the wrong kind of doctor to ask.”

I showed him my card.

He said, “Psycholo — child psychologist? The Hyphen knows that?”

“She sure does.”

“No offense, Doc, but why?”

“She needs to build up brownie points for the government by documenting treatment, got me here by claiming Ms. Chase asked for me. You hear anything like that?”

“Haven’t heard a syllable out of her. How’d she find you?”

“I evaluated Zelda’s son five years ago. He’s eleven years old and his mother’s locked up and The Hyphen claims there was no mention of him in the chart other than his name. That’s what motivated me to show up.”

“This is messed up.”

“Did the EMTs give you any sort of history when they brought her in?”

“Nope, just the meds.” He walked over to Door A, unlatched the wooden flap, peeked through a mesh window, crossed his fingers.

“Still sleeping.”

I went over and had a look for myself. The opening was small, affording an attenuated view, but wide enough to reveal a blanket-covered form on what looked like a conventional bed. Buttercup-yellow walls, natural light streaming from a high, stationary window.

Kevin Bracht said, “What now, Doc?”

“I’m going in.”