Do No Harm

Chapter 48

David stood at the counter in Medical Records, staring down at Clyde Slade's file. He'd spent about an hour at the station, filling in Yale but withholding the theories he wanted to flesh out more in his own mind. And of course, he'd made no mention of Ed. On the drive home, he'd received a page from Medical Records, informing him Clyde's file had arrived.

Again, the clerk was listening to the Dodgers game, staring at the radio as though that would enhance the experience. He broke off his intent focus to glance at the skimpy file. "Not much there, huh?" he said.

David flipped open the file, revealing a single sheet. The note at the top: Admitted 8/13/73 for NPI study under Dr. J. P. Connolly.

A tingling swept across David's body: the feeling of nailing a difficult diagnosis.

August 13. The day of Nancy's attack. Clyde had been admitted for the study twenty-eight years before-to the day. He would have been ten years old. The study was a likely source of his fear of the Neuropsychiatric Institute and of Dash as its representative. Maybe the date had been an unconscious trigger, a precipitating event for Clyde's assaults. Psychologists refer to the phenomenon as the anniversary syndrome-people entering depressions on the anniversaries of the deaths of their loved ones, post-traumatic stress victims feeling their anxiety escalate on the anniversaries of the original trauma.

The study's lead researcher, Dr. J. P. Connolly, had been a world-renowned psychologist. A close friend of David's parents, he had grown somewhat cantankerous in the final years of his life. He'd passed away about a decade ago.

David glanced down the page. The only other note indicated a respiratory infection Clyde had sustained in September of '73-the reason for the file's existence in Medical Records as opposed to the NPI's.

David picked up the phone and reached Dash at the office. He took a few steps away from the counter, lowering his voice, though the desk clerk seemed immersed in the ball game. "Hi, Dash. Did you look for that NPI file I asked you about?"

"Despite my better judgment. Nothing came up under either name."

"I found a peds file for Clyde Slade. Shows he was entered in a study run out of the NPI by Connolly in August of '73."

"That's odd. There's nothing here under Slade-I did a thorough search. Hang on a sec, I'm logged on right now." The sound of keyboard strokes. "Nothing about a Connolly study in August either. Of any kind."

"Why would files be missing?"

"I don't know. Restricted, maybe. Or Connolly could have kept his files at home. He did have funding from a variety of sources."

"But shouldn't there at least be copies at the NPI?"

"Yes. And the journal in which the study was published. But there's nothing."

"All right. Thanks for your help." David hung up, his enthusiasm undercut by the nagging sense of something askew.

The walkway was as David remembered it as a child, a thin path twisting through gardens to the front door. The gardens themselves, however, were hardly recognizable, so overgrown were they with weeds and patches of sourgrass. The trademark marigolds drooped in limp clusters, baked brown by the heat.

David had not been to the Connollys' house in over twenty-five years. He recalled dark leather furniture, thick carpeting, and the pervasive, comforting smell of a pipe. When he knocked on the front door, a distant, warbling voice sounded from within. "Just a minute, please."

Mrs. Connolly's estimate was overly ambitious; it took her nearly two minutes to get to the door. Clutching a tissue that had been worried to shreds, she gazed up at David. Old and quite frail, she wore a heavy cotton nightgown decorated with flowers. The skin of her arms draped in wrinkled sheets over her bones. "Yes?"

"Hello, I'm David. Janet Spier's son." David realized too late that he'd neglected to mention his father.

"Oh my goodness." The woman's eyes grew watery. Her hand described a fretful arc in the air with the tissue. "David, I haven't seen you since God knows. I just can't believe it. How handsome you are." She reached out and stroked the front of his white coat once, reverently.

"It's good to see you, Mrs. Connolly."

"I remember you used to run around wearing your mother's white coat. It would be down to your shins." A faint, sad grin etched itself on her face. "I was so sorry to hear about her."

"Thank you. My father too."

"Oh dear," Mrs. Connolly said. "Oh dear."

"And I'm sorry about your husband. I don't believe we've spoken since he passed. Dr. Connolly was a great psychologist."

"Yes." Her head bobbed with tiny nods, perhaps a Parkinson's tremor. She stepped back, opening the door. "Please come in. It's been so long since I've had a visitor. What prompted you to stop by?"

"I… I actually wanted to know if your husband kept any of his old files and records."

Her face fell with disappointment, and David could have killed himself for it. "Oh, of course. You stopped by on a work matter. You must be awfully busy."

She turned and shuffled slowly back into the musty interior of the house, steadying herself by setting her trembling hands on counters and the backs of chairs.

"My J.P. kept all his files and records. They're in his study, every last one of them, organized by date, color, size. He was very protective about them, but I'm sure he wouldn't mind Janet Spier's son having a look around." She raised her arm up in the air with a giggle, and David recognized, for the first time, the younger Mrs. Connolly he remembered. He followed her patiently down a long, thickly carpeted hall, gripping her arm gently from behind. She paused before a door. "You'd better open it, dear. It sticks. I'm afraid I don't have the strength anymore."

David found he had to throw a little shoulder into the door to get it open. Dr. Connolly's office sat virtually untouched. A magisterial desk and leather chair, a wall of filing cabinets, rows of meticulously organized medical journals. A thick film of dust covered everything, and the smell of pipe smoke that David recalled still tinged the air.

Mrs. Connolly stood in the doorway for a moment, taking in the room. "I haven't seen the inside of this room in some time." She shook her head once, as if throwing off sad thoughts, and forced a smile. "Take your time, dear," she said. "I'll be in the living room, watching the TV."

David waited to make sure she safely navigated the dark hall, then closed the door and surveyed the room. Dr. Connolly kept his office impeccably organized, and David located the relevant files in the cabinets in no time. Fear's Legacy-1973.

He pulled out the two general files and set them on the desk. Swirls of dust lifted from the leather blotter and refused to settle. The abstract sat at the front of the first folder. It was titled

FEAR'S LEGACY: SORROW,DISTRESS, AND ANGER.

Fear arousal can be obtained using several stimuli, including but not limited to: noise; sudden change in illumination; sudden unexpected movement; rapidly approaching objects; height; strange people; familiar people in strange guises; strange objects and strange places; threatening animals; darkness. Often, two or more of the above items can be combined to achieve a higher degree of fear arousal (i.e., darkness and the noise of a growling dog's rapid approach). When confronted with fear, children respond in three distinct and predictable ways: They grow immobile, or "frozen"; they increase their distance from one type of object (snakes, loud noises, flashes of light); they increase their proximity to another type of object (mother figures).

Twenty-seven boys between the ages of six and ten were selected from foster homes, orphanages, and delinquent holding facilities. Each subject was removed from his "home" for a period of six weeks and taken through a twelve-phase series of fear-arousal experiments, four trials a day, seven days a week, increasing in intensity. Each set of subjects lived together through the six-week trial, barracks-style, so the contagious effects of fear might also be analyzed. All trials occurred within a controlled environment.

Feeling a growing sense of nausea, David paused to rub some dust from his eyes. Dr. Connolly had chosen children without families. That way, there were no parents to complain. No one to notice if the children deteriorated emotionally as a result of the experiments, or developed abnormal attachment patterns. Further, the study evinced bad science. There was no control group-Connolly had selected children who already, in all likelihood, were emotionally fragile. The experiments were biased before they even got off the ground.

Remembering Dr. Connolly's kindly blue eyes and his well-trimmed white beard, David could not recast him as the perpetrator of these experiments. But his mother had told David cautionary tales about Dr. Connolly, who had deteriorated in his later years beneath the burden of tongue cancer and a rapidly diminishing reputation. He'd become reclusive, holing up in his house. For the last three years of his life, the professional community heard from him only in the form of his letters to psychology and psychiatry journals, angry diatribes decrying the work of more-renowned rivals.

David's mother, he recalled, had gone to great lengths to distance herself from the man. Now he knew why. The study had taken place during his mother's tenure as chief of staff-he was appalled and surprised she had permitted it. When he glanced back at the abstract, he felt the soothing glow of relief. Results were inconclusive, as the study was terminated on October 15, 1973. David's mother had, in fact, stopped the experiments. The paper continued:

However, several of the results are worthy of note, perhaps for incorporation into future studies. We found that once the subjects reached a state of acute distress, they were not easily comforted. In social workshops following the trials, they were permitted to role-play with dolls, interact with nurses, and draw pictures. We noted an increase in hostile behavior following each trial, particularly hostile behavior directed toward the nurses, who carried out the logistics of the experiments and acted as attachment (mother) figures. The subjects seemed to hold the nurses at fault. Those subjects who did not act out their aggression harbored a tremendous amount of latent resentment.

Through each six-week trial period, the subjects tended to develop along one of two distinct routes, either becoming intensely clinging and anxious, or growing increasingly emotionally detached. Those who became detached expressed three central beliefs: (1) The attachment figure would not respond to calls for support and protection, (2) They did not judge themselves to be the sort of person toward whom an attachment figure would respond in caring fashion, and (3) Their actions had no consequences on the external environment.

All three beliefs are reinforced by classic conditioning. As the subjects were rewarded randomly and punished randomly, they came to view themselves as powerless within their environment.

Some intense bonding occurred between subjects during off-hours between trials. When one subject perceived that another could offer comfort or respite from fear, an intense, almost obsessive relationship developed, reminiscent of collective confabulation, the shared fantasy worlds that sometimes develop between castaways and POWs. Through these relationships, the subjects attempted to wrest back some means of control over their lives.

The next few pages had been ripped out. Feeling slightly light-headed, David pushed back in the chair, sending up a miniature cloud of dust, and returned to the filing cabinet. The subsequent alphabetically arranged files were bulky and labeled by name-all males: JOSH ADAMS, TIMOTHY DILLER, FRANK GRANT. David scanned them, his finger coming to rest on the tab reading CLYDE SLADE.

He pulled the file, returned to the desk, and sat staring at it, gathering his courage. Katydids shrilled in the darkness outside the window.

He flipped open the file to reveal a bad Polaroid atop a stack of papers. Clyde, age ten, squinting into a background light. His posture was uncomfortable and defensive-head lowered, shoulders hunched, skinny arms dangling awkwardly at his sides. The points of his shoulders were visible through his threadbare T-shirt. David recognized the dark flat eyes and wide nose, but little else.

The top papers contained Clyde's history, most of which Ed had already told David about. Moved from foster home to orphanage to foster home. Beneath the history were Clyde's clinical results. He had grown increasingly withdrawn throughout the study, the document reported, displaying a fair amount of latent aggression toward the nurses. The experiments had been conducted against Clyde's will; he had begged repeatedly to be left alone, to be permitted to return to his last foster home. His requests were recorded merely as data. He had no parents to lodge more persuasive complaints or to demand that his rights be protected.

The following pages consisted of self-reports, clinical observations, and the results of physiological exams, including a precocious series of skin conductance tests. A few wrinkled drawings remained at the bottom of the stack. Drawn with the fat, simple lines of a coloring book picture, they all featured the same guideline figure: that of a nurse. The nurse's outline was clearly defined, right down to her patronizing smile and white cap. Clyde had used mostly red crayons, turning the simple sketches into gruesome depictions. Vicious slashes colored the nurses' faces, markings pressed so firmly down into the pages they left indentations and even tore the paper in spots. Their heads were covered with layer upon layer of color, until they resembled bloody blurs. Many of the nurses' breasts and genital areas were likewise ravaged with red.

Hurwitz, Gregg

Do No Harm (2002)

A note at the bottom read: Particularly fierce and impassioned. And below that: Film Reel #23.

Dread spreading inside him, David looked up and located the dusty old projector in the corner. The cupboard above the filing cabinets seemed to stare back at him. He opened it to find reel upon reel of sixteen millimeter film, labeled in black marker. He found Reel #23. A screen pulled down from the ceiling in front of the window, unleashing more billows of dust. The light switch clicked off loudly, filling the room with shadows.

David blew the top layer of dust from the projector, plugged it in, mounted the take-up reel, and threaded the film. He pulled a chair around beside the projector and, bracing himself, flipped the switch.

Ten-year-old Clyde Slade, brought into a seclusion room with a timer on the wall. He wears a child's hospital gown. A nurse sits in a chair centered in the small room, staring at the wall like a statue. He goes over to her and takes her hand, but she pulls it away, keeping her stoic stare leveled at the far wall. A loud wavering shriek sounds from hidden speakers, so sudden it startles David back in his chair. On the screen, Clyde begins to cry and attempts to pull himself into the nurse's lap. She moves only to repel him, shoving him off. Clyde sits on the floor, hands pushed over his ears, mouth bent wide, his cries not even audible beneath the shrieking. The noise ends. By the timer on the wall, it takes Clyde over three minutes to cease his frantic sobbing.

And then a loud mechanical voice intones, "Three, two, one. Step back from the door." The loud sound of the door's bolt being unlocked, and Clyde scrambles to freedom.

Clyde's ritualistic phrase, his private mantra, was actually the hard-conditioned cue given to him as a child that his fear was about to end. He used it still to alleviate anxiety.

The film cut out and David wiped the sheen of sweat from his forehead. Seconds later, the seclusion room appeared again on the screen, this time with the lights off.

The outline of the nurse in the chair is barely visible. Clyde is led in, though he pounds at the door as soon as it is closed behind him. "Please! Please!" He runs to the nurse, who again moves only to push him firmly away. The door opens and another nurse enters with a large rectangular box. She opens it and dumps what appear to be harmless garden snakes on the floor. Clyde shrieks and tries to run away but the snakes quickly spread out through the small seclusion room. The second nurse pushes them toward Clyde.

David closed his eyes for a moment, but Clyde's wails still came. "Please! I'll be good." And then: a final terrified strategy- "I'm sorry. I'm sorry."

When David viewed the screen again, his mouth was dry and sour. Clyde turns to the wall, burying his face in the corner as the snakes curl around his feet. He murmurs to himself, something inaudible, though David knew he was counting down from three over and over, anticipating. Finally, the second nurse collects the snakes and the mechanical voice sounds, "Three, two, one. Step back from the door." Clyde sprints for freedom.

At the beginning of the next trial, Clyde crosses immediately to the seated nurse and bites her leg. She rises and administers him a quick but vicious spanking before returning to her stonelike perch on the chair. When a series of blinding lights begin to flash in the white room, a wet spot spreads down the leg of Clyde's trousers.

Trial after trial followed on the reel of film. Experiments with animals, with people in threatening poses, with motorized contraptions that sprang open like jack-in-the-boxes, but with no warning. By the final trial, Clyde had resorted to sitting against the far wall, face blank and dazed. He made no attempt to approach the seated nurse. They brought in a snarling German shepherd on a chain and held it inches from Clyde's face. Clyde seemed hardly to notice it. The scene cut out and the end of the film flapped in the reel.

As the reel continued its mindless rotation, David sat in the darkness of the study, breathing dust. A long vacant block of time passed as the film slapped the reel and the katydids chirped. Finally, David peeled himself from the leather chair and clicked the lamp on the desk. With the quiet, precise movements of a priest, he put away the projector and the screen. He jotted down the names of the subjects and their dates of birth. Clyde's file, the general files, and a few reels of film he took with him.

The rest of the house was dark and smelled of mothballs and fragranced powder. Mrs. Connolly had fallen asleep in the living room, a quilted blanket at her side. Dr. Quinn Medicine Woman flickered across the TV screen, muted. David crossed silently and pulled the blanket up around her. She stirred as he reached the door.

Her voice was gentle, and it warbled slightly. "David?"

"Yes, Mrs. Connolly?"

"Did you find what you needed?"

"I did."

She smiled, though sadness found its way even into that. "We always appreciated what your mother did for us."

A quick flare of unease. "What do you mean by that?"

Her eyes gathered an acuity he had not before noticed. It quickly faded. David wondered for the first time if her usual demeanor was an affectation.

"He was a good man, wasn't he? My J.P.?"

David felt a slight tingling in his face at her avoidance of the question. "Yes, he was."

He closed the front door gently, leaving her to fall back into sleep.