Do No Harm

Chapter 42

David headed over to the Neuropsychiatric Institute, exiting the elevator on the sixth floor. He hit the buzzer to the side of the locked white door. A moment later, the door swung open, Dash all but filling the frame, arms folded across his massive chest. "There's been some whispering on the wards about the way you've been acting. Then you call me with this?"

"Did the cops come through here yet?"

"Yes. Filled me in on this DaVella business. Of course, they were pissed off when I didn't let them in. As you know, we don't disclose most patients' names." Dash eyed David, as if to make sure he'd caught the implication.

"I need your help, Dash."

"My shift is over. I'm on my way to my workout."

"This isn't trivial."

Dash sighed, a deep rumble. "You're looking for a patient with polydactyly, huh? On both hands?"

"Do you have a person fitting that description?"

Dash's head tilted in a half nod, half shake. "We might."

"I need to speak with him," David said.

"How do you know it's a him?"

David sighed. "You know what they say, Dash."

Dash's lips twitched, but did not form a full smile. "What's that?"

"Internists know everything and do nothing. Surgeons know nothing and do everything. And psychiatrists know nothing and do nothing."

Dash's booming laugh echoed a ways up the cold corridor.

"I'm asking you to do something here," David said. "If there was anyone who would ever respect patient confidentiality, it's I."

"You looked like an asshole, David. After the escape."

"I know," David said softly. "I know." He waited patiently for a verdict.

"Don't make me regret this," Dash finally said. He turned and entered the ward, gesturing for David to follow. They walked down the long corridor toward the reception desk encased in reinforced glass. Behind windows to their left, patients congregated in a recreation area.

A cluster of patients sat together, following a low-impact stretching workout on TV. The busty woman on-screen leaned forward in a hamstring stretch, grabbing both feet. Most of the patients could barely get their hands to their ankles. An attractive woman in her twenties shuffled aimlessly through the room, her paper slippers shushing on the tile. An older man with tardive dyskinesia sat alone at a table, his lips popping out in a rapid series of puckers, his fingers making choreic movements, as if playing the piano.

A nurse sat down across from him and engaged him in a game of cards. His straining lips loosened into a momentary smile.

Dash steered David past the reception desk down another locked corridor lined with seclusion rooms. The seclusion rooms were always kept lit, so staff members could observe the enclosed patients through the small sliding windows in the doors.

Dash paused outside a door and tapped it gently with a knuckle. "Give a holler if you need me," he said. "I'll wait out here." He walked a short distance up the corridor and leaned against the wall.

David gripped the knob and slid open the tiny window. The room, no larger than eight by ten, was entirely white. A wiry man paced along the far wall. He paused, his head snapping up at the sound of the window sliding open, his tight, close-set features quivering. He swept his hands through his hair with deft, quick gestures.

David stepped inside and eased the door almost shut behind him. The white walls reflected the overhead light harshly. David folded his hands out before him, keeping them clearly in the man's view. "Hello, I'm Dr. Spier. I work over in the emergency room."

"I'm Dean Lograine," the man said. He offered a six-fingered hand, which David shook cautiously. "My friends call me Mouse. My enemies too."

His gown was patterned with snowflakes, as had been the one Elisabeth had worn on her final day. David found the similarity unsettling. Over each of Mouse's nipples, a stain had spread through the fabric, the size of a quarter-breast discharge, a side effect of some psychiatric meds.

"I came by to follow up on a complaint you made a few months ago, against a Douglas DaVella."

"So you believe me that guy came in here was harassing me something awful and I told him to go stuff it. Stuff it I said but he kept on and kept on about my meds like he was asking everyone and he seemed scared really scared and angry just to be there."

"Where did this take place?"

"Out in the rec room. Arts 'n' crafts. We were doing arts 'n' crafts. Popsicle-stick men. Ever make those?"

"Yes," David said. "Though I'm not much of a craftsman."

Mouse threw back his head and laughed. And kept laughing. Finally, David interrupted him. "Do you remember any specifics of your conversation with him?"

"He saw me taking my morning meds and he came over and asked me what they were for. And I told him I'm manic, a bit manic, but there's a downswing to that, you know, not just all high flights of fancy, and so I get depressed and sometimes, only sometimes, I've been known to get agitated and the meds keep me from getting agitated or anxious or violent." He flashed a toothy grin. "Don't worry. I won't get violent now."

"I'm not worried," David said. "If you don't mind my asking, what medications are you on?"

Mouse spat in the corner. "Do you have any Tic Tacs?"

"I'm afraid not. If you don't mind my asking," David repeated slowly, "what medications are you on?"

"I don't mind, not at all. Not at all. That's what he asked too. I'm on risperidone and Cogentin and lithium."

"And what happened? Between you and Douglas DaVella?"

"He tried to steal my pills. But I fought him I didn't want him to I need those pills to keep me glued together you know that's what they're for to arm against delusions and hallucinations and… and

… and… "

"I can understand why that would be upsetting," David said. "Did he say why he wanted your pills?"

Mouse regarded David, and his close-set eyes glowed with a sudden clarity. "He said he didn't want to be violent."

If Clyde had in fact given Mouse a reliable answer, the ramifications were fascinating: Clyde was self-medicating to try to cure himself. And poisoning himself by overdosing.

"But I bit him," Mouse continued. "And then the orderlies came and tackled me. But I wasn't lying. He tried to steal my meds."

"But no one believed you."

"Of course not." Mouse's words trembled with indignation. "They told me I was delusional."

"Thank you so much," David said. "You've been a tremendous help."

He backed up to the door until he felt it against his shoulders, then he reached behind himself for the handle.

"Hey, Doctor?"

David paused halfway out the door. He leaned back in the room. Mouse pulled his gown down tight across his chest, and David noticed for the first time that he had gynecomastia, increased breast tissue pushing out two bumps in his thin gown. Another side effect. Mouse released the gown and regarded David with a piercing stare.

"We take medications and do these things to ourselves, to our chemistries, to be well. It's courageous of us. We are willing to tamper with… tamper with… "

David nodded at him, a brief, sad tilt of the head, and closed the door.

He followed Dash back to his office. "There is definitely something going on with Clyde and the NPI," he said. "Remember how agitated he became when you were introduced by title, and then there was this incident with… Mouse… and Mouse reported that Clyde seemed scared and angry when here."

Dash closed his office door and unbuttoned his shirt. Beneath, he wore a tank top that barely stretched across his torso. He retrieved a gym bag from the corner, which he hefted with some exertion. "I'd agree-he probably has some phobia about the place."

"Maybe Clyde witnessed something here when he worked at the hospital," David said, following Dash back out to the main hall. "Something traumatic to him."

Dash leaned forward and hit the elevator's down button. "Doesn't explain why he'd go to all that trouble covering himself with a fake name before he worked here." He readjusted the bag's strap across his shoulder as the elevator dinged and opened.

"Diane's following the prescription trail as we speak. I'm checking medical records this afternoon. Any way you could check NPI records?"

Dash's hesitation showed in the four lines that momentarily etched across his forehead. "I'm only playing with a half deck here. You want to bring me up to speed?"

By the time David finished filling him in, the elevator had hit the ground floor and Dash's face was far less placid. They walked in silence through the lobby. Stepping out into the warm afternoon, they headed for the track.

"Is there any chance someone like him could be rehabilitated?"

"What are you trying to do here, David? Assimilate him back into society?"

"What's the prognosis?"

"Not good," Dash said. "Delinquency problems, withdrawal, bad history of adjustment. Expunged juvie record would indicate early age of onset. Add the gender bias to that, and it don't look pretty."

"I think he's striking out against rejection, abandonment. As you said earlier, he perceives he's protecting himself."

"Of course he does," Dash said. "But there's more. Assaulting women gives him a satisfaction he doesn't achieve in any other aspect of his life. It's an accomplishment, David. It allows him to replace chronic feelings of inferiority with feelings of empowerment and pride. He's ugly, stupid, and profoundly asocial. He never knew what having control felt like until he seized that alkali and let fly."

"So maybe if he's given some control in his life… " David said. "If he doesn't feel like he's constantly threatened… "

"And how about when he is?" Dash asked. "I had a teenager call me a nigger at the grocery store for taking the last carton of orange juice. We live in a routinely hostile world."

David eyed Dash's bulging arms. "Brave kid."

They reached the field and Dash threw down his weighty bag and began to stretch out his arms.

"So you believe he has deeply ingrained psychopathology and his prognosis is bad," David said. "Sounds like a candidate for an insanity plea if he's brought to trial."

"There are a lot of people with severe mental and emotional problems who can still distinguish right from wrong."

"Which means?"

"Which means he might be psychologically insane, but in his case, that probably won't translate to legal insanity. The courts present us with two options-drooling psycho or nutcase-and they rarely if ever fit. If a violent person pleads insanity, it reduces them to a status of nonpersonhood, a passive victim of brain disease, whose behavior is senseless and unintelligible. This is facile and despicable, and unfortunately, the better option. But it's probably not open to Clyde. He's insane and criminal. No get-out-of-jail-free card."

"It doesn't matter if he's in legitimate need of psychiatric care? He can't go to a high-security hospital like Patton?"

"There are eight times as many mentally ill people in prisons as there are in state mental hospitals. Does that answer your question?" Dash took note of David's expression. "I'm just being realistic. If he's captured, it becomes a legal game. Has he shown goal-oriented activity? Yes. Has he attempted to avoid detection? Yes. The M'Naghten Rule still holds, and Clyde fits both criteria to be sentenced harshly-he knew the nature and quality of the acts he was committing, and he knew they were wrong. If memory serves, he made both of these facts abundantly clear in your conversation with him in the ER. So yes, he will, in all likelihood, wind up in prison. And you'll be the prosecution's star witness." He regarded David with a tilt of his head. "Unless you decide to take up perjury."

"No, I think I'll pass on that one."

"This case has all the elements for a good scapegoating. Heavy press coverage, benevolent victims, an inarticulate, unattractive assailant. He'll be locked away as soon as they can jam him through the courts."

Dash crouched, removing a discus from his bag. He was still the Nigerian record holder in the discus, though David had never been certain of how noteworthy that distinction was.

Dash entered the discus circle and practiced a few rapid pivots, his feet shushing over the concrete. The sun lent the surrounding grass a metallic sheen. Dash paused, breathing heavily, and faced David again. "And since I'm already on my soapbox, let me whine a bit about our lovely prison system. Rape is an institutionalized practice. Massively underreported."

"I'm aware that prisons aren't a good place to summer, Dash."

"My point is that someone like Clyde is particularly ill equipped to handle it. The acute deprivation, the constant abuse-he'll be ripped apart. Look what happened to Jeffrey Dahmer."

"What did happen to Dahmer?"

"Bludgeoned to death with a metal bar." Dash hurled himself into the spin, his enormous body moving quick and graceful, and unleashed the discus with a grunt. It shot from his grip, arcing across the clear blue sky.

David let out a long, weary sigh. "Well, odds are the cops'll shoot him anyway."

Dash stood, hands on his hips, and watched the discus hit the grass and skid to a halt. When he turned back to David, his eyes were deeply sorrowful. "In some ways," he said, "that might be more humane."