Chapter 24

Her careful arrangement of designer-styled, blond-highlighted hair bounced as she leaned back on the gurney. Her hand, set aglitter by deep maroon fingernails, clutched a cell phone to her ear. Her lips stretched full and amorphous, blown out of proportion by collagen injections. Dark eyeshadow filled the hollows beneath her eyes, where long-vanished tears had deposited it.

"Oh yes," she said into the phone, in a socialite's singsong cadence, "it's been awful. I tried to kill myself this morning… Um-hmm. Prozac, codeine, and a bad Bordeaux. Threw it all up by the time the paramedics arrived. You'll never believe where they brought me. The UCLA emergency room. I was terrified. Thought I'd get doused with alkali on my way through the doors." She picked at a cuticle. "What's that, darling?" She glanced up at the resident at the bed beside hers, drawing blood from another woman. "One of them is, I suppose, in a Billy Baldwin sort of way."

Carson looked up from his chart and nudged David. "Welcome to West LA."

"Think compassion, Dr. Donalds. Where else do you think a lonely, depressed woman could get this much attention?"

"On Jerry Springer."

David coughed to cover his smile.

Dashiell Nwankwa suddenly filled the wide doorway to Exam Ten. "You rang?" he asked, his booming voice causing Carson to drop the chart he was holding. David walked over to greet Dash as Carson crouched to gather the scattered papers.

Dash had to duck slightly to get through the doorway. At 6'8", 280 pounds, Dash's was an imposing presence. His face, so dark it diffusely reflected the lights of the room, was partly blocked by an overflow of thick-braided dreadlocks. Like most psychiatrists, he wore a dress shirt and tie, but during medical school he'd had to slit the already-wide sleeves of his scrub tops a good two inches to get his arms through.

Dash's appearance was so remarkable that several psychiatry programs had rejected him on that basis, claiming it would compromise his ability to interact with patients and put them at ease. After he failed to match in a fellowship program, Dash sued each of them in a widely publicized series of cases, winning admission to each department. The cases were decided in large part by his near-perfect grades through Columbia Medical School, and his excellent recommendations. The chair of UCLA's psych department had stepped in early in the proceedings and offered him a spot, and though he had not originally applied to UCLA, he'd elected to sign on. His performance through the four-year program had been so impressive that he'd been offered a teaching position immediately afterward, and he'd quickly become a prominent member of the department.

He was also a favored expert witness for the defense. He looked tough but spoke convincingly about mental illness-a good combination for winning the jury's trust. Most expert psych witnesses, thin-necked and bespectacled, were quickly painted as wimps soft on crime. Because of Dash's experience with violent patients and criminals, he'd been David's first choice to assess Clyde.

"What do we have here?" Dash's voice, so deep it found resonance in David's bones, was mitigated with a musical lilt-the faintest whisper of a Nigerian accent. He glanced over at the woman on the bed behind David and Carson, who continued to chat on the cell phone. "Suicide attempt?"

"How'd you guess?" Carson said.

"Carson, why don't you take over," David said. "Dash, our guy is in Fourteen."

As they moved toward the door, the woman's purse, just beyond her reach on a metal tray, began to vibrate.

"Is that your pager?" Carson asked, reaching into the purse. The woman froze, silent for the first time, her mouth a lipsticked O near the phone's receiver.

Carson withdrew an eight-inch vibrator and stared at it, mortified. Dash's laughter, even choked down, made the light casings rattle overhead.

As they reached the end of Hallway One, David shot a nervous glance at the two officers guarding the door to Clyde's room. He turned to Dash, lowering his voice. "It was all I could do to slide you past the cops. Everyone's on edge. Anyone asks, you're assessing his need for antipsychotic meds."

"Got it."

"And keep tight-lipped. Some tabloid schmuck faked a concussion this afternoon just to get in here and poke around."

David breathed evenly and deeply as he approached the room, gathering himself. His stomach churned, a morass of yet-unidentified emotions-fear, anxiety, duty of some ill-defined sort. Anger was in there as well, he realized, in no small amount.

He nodded to the officers and paused for a moment, hand on the doorknob, searching for compassion. He fought past Nancy's face, and Sandra's, past the blue liquid that burned and ate flesh, past the disgust that caked the edges of his perception-the disgust that sprang, innate and full-formed, when he pictured Clyde's acne-scarred face. When he turned the doorknob, he felt calmer, more detached.

He was ready to see his patient.

He swung the door open quietly, and he and Dash entered. Clyde lay on the gurney, bound, eyes closed, drawing deep breaths. David and Dash approached him and stood a few feet back from the gurney rail. "Hello, Clyde. It's Dr. Spier again."

"Spier," Clyde murmured. "Like the building."

"Yes, but spelled differently. I'm here with Dr. Nwankwa from the Neuropsychiatric Insti-"

Clyde's eyes opened, a ripple of terror transforming his features from placid to violently agitated. He screamed, straining with his limbs against the restraints, bucking and thrashing. Dash calmly took a step back and signaled David to do the same.

"You said!" Clyde bellowed. "You said you'd help me!"

"I'm trying to," David said.

Clyde's frantic eyes flickered to Dash. "Get him away."

"Dr. Nwankwa is here to help y-"

"Get him away!"

Dash took another calm step back and sat down in a chair against the far wall. Clyde stopped thrashing and lay flat on the gurney, his chest heaving.

"Don't let him near me," Clyde said. He tucked his chin to his chest, hunching his shoulders, his eyes turned to the wall.

"I won't come near you," Dash said softly. "I'm just going to sit right here."

Clyde flopped over, his eyes darting to David and then quickly away. "Where were you? You went away. You said you would help me, but you didn't. Why is he still here? Have him go away. You said he would-"

"Dr. Nwankwa is here to try to help you. There are just a few-"

With renewed strength, Clyde thrust his torso at the ceiling, his arms bent back like wings. "Don't let him near me!" Veins stood out on his neck as he let forth a forceful, lengthy scream. His entire body strained. David waited for him to stop to catch his breath, but he only sucked in air and screamed again. His eyes were scrunched shut; his face was turning red.

Dash rose and stepped forward, touching David on the shoulder. He had to put his mouth to David's ear for David to hear him over Clyde's continuous, wavering scream. "I don't think we'll make much headway now." He tilted his head, indicating the door, and David followed him out. The officers outside regarded them with raised eyebrows.

Dash and David walked silently down the hall and into the empty doctors' lounge. David closed the door behind them. Dash sat heavily on one of the couches, resting his hands on his knees, and David took a seat opposite him.

David said, "Maybe he's got an aversion to psychiatrists."

"Or to black people," Dash said. "I got that reaction in a Denny's once."

David laughed. "Maybe it is race-based. But if we assume he's venting some hostility toward the hospital or its employees with his attacks, it's also relevant to see which staff members agitate him the most. He was largely cooperative with the ER staff-the first real fear and anger I've seen from him was directed toward you."

Dash pushed his fingertips together, musing. "He's too agitated right now for me to push him. It's unfortunate we don't have the luxury-or the opportunity-to wait for him to settle a bit so I can attempt a prolonged interview or formal assessment."

"Any guesses?"

"Obviously, I can't glean much from that little exchange, on top of which the environment is less than conducive to interpreting his behavior, but I'll throw around a few hypotheses if you promise not to quote me." Dash settled back on the couch. "Deterioration of hygiene could indicate depression or schizophrenia, and means he's probably not well assimilated into a peer environment. Low-set ears might be a red flag for developmental problems or might not-at some point, one might check for spacing between his first and second toes. He seems to be fixated on you."

"Why do you think that is?"

"Maybe in light of what happened this morning, he views you as a savior."

"I barely interacted with him."

"Yes, but for all we know, you're the first person in his life to show him kindness in the face of opposition." Dash swept a stray dreadlock off his forehead. "He appears to be terrified of eye contact-he looks away almost constantly. That could be linked to insecurity resulting from his general unattractiveness-that he's afraid to be seen-but I think it's a bit more complex. I'm thinking his fear is linked to the nature of the crimes."

"How so?"

"He attacks women's faces. Their eyes." Dash smiled. "What do staring eyes represent?"

Despite the fact that Dash was nearly ten years David's junior, David didn't mind being treated like a resident. "Intense intimacy, usually hostility," David answered.

"Why hostility?"

"Because staring eyes presage an attack?"

Dash shook his head, dreadlocks swaying. "No. Because for those with low self-esteem, for those who are painfully insecure, staring eyes are the wellspring of shame. Think about it-Delilah blinding Samson, Oedipus putting out his eyes, Adam and Eve hiding themselves beneath fig leaves-all these acts took place after the real harm had already occurred. They are a reaction to the awful act, not the awful act itself. When we dream of shame, we're naked before others, caught with our pants down. A person who feels shame wants to turn away the eyes of the world, so they can't see his exposure, his vulnerability."

"Magical thinking. If you can destroy the eyes of those who look upon you, you can destroy shame. And your feelings of vulnerability and exposure."

"An oversimplification, of course, but yes." Dash shifted, and the couch creaked and groaned. "Clyde throws alkali in women's faces. It destroys their eyes so they can't shame him, destroys their beauty so they can't appear superior to him, destroys their mouths so they can't say bad things about him or laugh at him. The most efficacious way to keep someone from laughing at you is to make her weep."

"Well, he's certainly succeeded at that," David said.

"Yes. I'd guess that inflicting fear is one of his primary motivations. Replacing his own fear with that of someone else."

"I suppose it explains what seem to be motiveless crimes."

The first notes of Dash's laugh startled David in his seat.

"I've been on the stand enough to know there's no such thing as a motiveless crime," Dash said. "All violence is an attempt to achieve justice. All violence stems from perceived self-defense. Most crimes are an attempt to replace shame with pride." His smile gleamed white in his dark face. "Violent crime and state-condoned punishment are remarkably similar when you think of it. They both aim to avenge injustices."

"In Clyde's case, he must be avenging some injustice that has to do with the hospital. Or psychiatrists."

Dash shrugged, dreadlocks swaying. "Or nurses. His victims were two women in scrubs. He probably believes he attacked two nurses."

"Do you think he's a psychopath?"

"I don't. Psychopaths are glib and superficial. He seems to have deeply felt emotions. Rapidly fluctuating emotions. He went from cooperative to scared to angry like a Porsche going zero to sixty. I wouldn't be surprised to find some guilty rumination, depression, internal conflict, chronic feelings of emptiness-you know the symptom cluster."

David nodded. "Differential diagnosis. Not Otherwise Specified."

"NOS. The psychiatrist's crutch. Until I can get more out of him."

"I'd like to turn him over to LAPD a bit more sorted out. He certainly won't be in the most sympathetic hands."

"He seems to have some sort of bond with you. Maybe you should see if you can get him to open up. If you lead him to talk about the fear behind his crimes, rather than the crimes themselves, he might be more likely to talk. Zero in on his sense of injustice."

David stood, squeezing his fist so his knuckles cracked. "Well, I need to check in on him anyway. See if he's ready to ship out." He rested a hand on Dash's massive shoulder on the way to the door. "Thanks for the input."

Dash drew himself to his feet and glanced down. "Hey, David?"

One hand on the doorknob, David turned, an eyebrow raised quizzically. Looking at Dash's face, he could not locate the affability to which he had grown accustomed.

"Be careful."

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