When Susan arrived at Sharicka’s room, she found the girl sitting on her neatly made bed. She wore her wavy hair in a thick ponytail, oiled and pulled back from her plump brown face. The dark eyes looked larger than Susan remembered, almost pleading, and the demonic sparkle had left them completely. For the first time, she truly looked like a little girl to Susan, a four-year-old with issues even most adults could not handle.
Susan stepped inside and closed the door behind her. “What can I do for you, Sharicka?”
The girl looked up suddenly. Her hands lay in her lap, worrying at each other. “Fix me,” she said without a hint of the childish lisp she had used the first time she had spoken to Susan. Her eyes developed a glaze Susan did not, at first, recognize as welling tears.
As the room had no chairs, Susan sat beside Sharicka on the bed. “I don’t know what you mean, Sharicka. Tell me.”
The words tumbled out; and, with them, the tears. “I miss my mommy and daddy. I miss Rylan. And Misty.” She sobbed. “I want to go home.”
Susan did not know what to say. For the first time since she had come on service, she believed Sharicka actually spoke the truth. The instinct to gather the child into her arms and hold her while she cried was strong, but Susan resisted it. “Sharicka, you tried to kill Misty.” She said nothing more, leaving the ball in the child’s court. The seriousness of Sharicka’s intentions would come through in how openly she spoke about the crime.
“I know,” Sharicka said, so softly Susan had to strain to hear. “I don’t know why I do things like that.”
Susan did not accept that explanation. “If you’re going to get better, you’re going to have to dig deeper than that. You do bad things, Sharicka. Horrible things.”
“Yes.” The girl continued to sob. “I did horrible things. I hurt Misty.”
“Why? What are you thinking when you do these things?”
Sharicka finally got specific. “I was wondering . . . what it’s like to drown. I wanted to see.” She shook her head, probably tapped out for descriptions given her young age.
Although it did not make sense from her worldview, Susan gave Sharicka credit for trying. “Didn’t you think that if you killed your sister, you would no longer have a sister?”
“No.” Sharicka gazed at Susan through the tears. “I just wanted to see . . . what would happen. I didn’t . . .” She clearly struggled to find the right words, and Susan had to remind herself the girl was not yet five years old. “I didn’t . . . think . . .” She changed her tack. “When I’m not on my meds, I don’t think that far ahead.”
Susan shook her head. “You’re on your meds here, Sharicka. Yet you put a piece of balloon in a peer’s cup. You hit people. You even attacked a member of the staff.”
Sharicka pursed her lips. For an instant, Susan thought the demon light would reappear in her eyes. Instead, she rose and gestured for Susan to do the same.
Susan stood up.
Sharicka grabbed a corner of her mattress, lifted it, then groped beneath it. She brought out a small jar that had once held fish food and handed it to Susan. She kept her head down as she did so.
Susan held the plastic jar up to the light to reveal white mush that probably represented wet pills and several bits and pieces of capsules. She stared at it, stunned. Psychiatric patients had been known to hide or spit out their meds for as long as these medications existed. She could scarcely believe this could still happen. “You haven’t been taking your pills?”
“Not always, no.” Sharicka raised her head. Her eyes still appeared normal, aside from the tears. “I’m showing you because I’m going to take them now. Always.”
Susan put the jar into her pocket. “Always?”
“Always,” Sharicka said firmly. “Always always.”
Susan realized Sharicka had a point. If she was lying, trying to manipulate Susan, she did not have to reveal such a secret. If Sharicka had not shown her the bottle, Susan and the nurses would never have known. “Why now? What’s changed?”
Sharicka grimaced; at least it appeared that way to Susan. A moment later, she recognized it as a smile. “When I heard you fixed Diesel and Starling, I thought you might help me, too.”
Susan remembered. “When the nurses prepared them for discharge, you asked me to ‘fix’ you. But you didn’t mean it then, did you?”
Sharicka hesitated. For an instant, Susan thought she saw something less than innocent cross her features. “I . . . did, but I wasn’t on my meds. Since then, I’ve swallowed them every day. Then, you got Monterey to talk.” She shook her head, her gaze distant. “Anyone who can get Monterey to talk is amazing. If you could fix her, you could fix anyone.” Now her lips clearly bowed upward. “Even me.”
Susan met Sharicka’s gaze. She could feel her gut recoiling as she anticipated the demonic sparkle, the evil expression. This time, it did not come. Susan saw only a little girl with an advanced vocabulary and real insight. For the first time, she could see Sharicka the way the nurses saw her: a little girl with massive problems who needed her help.
Susan sighed. She knew better than to get drawn in by a manipulative patient. “Sharicka, I didn’t fix anyone. Those others . . . wanted to get better. They just didn’t know how. All I did was guide them in the right direction.”
“Guide me,” Sharicka said.
“The hard work is yours,” Susan continued. “Staying on your meds is a great start, but it doesn’t end there. You have to want to change. You have to think before you act, to consider the effect of your actions on other people before you gratify your own curiosity. You have to consider other people’s safety, other people’s feelings, and truly understand them.” Susan shook her head, wondering why she took the time to explain things a psychopath could never really comprehend. She switched to something she knew they could. “You have to know right from wrong. And choose right.”
“I do.” Sharicka sat back on the bed. “I know I did bad things, and they were wrong. I wanted to do things, and I just did them. By the time I realized they were bad, they were already done.” Sharicka gestured feebly, as if having trouble putting her point into words. “The meds give me time to think. I still want to do stuff, but I have a chance to think about it before I do it. Like, right now, I want to kick you in the leg. Without meds, I’d kick you. Now, I can think it would hurt you, so I don’t kick you.”
Susan appreciated that. “You wouldn’t want me to kick you.”
“No,” Sharicka said with great sincerity. “And I won’t kick you, either. It would hurt.”
“Yes.” The conversation seemed to have come to a natural conclusion.
“Can you watch me?” Sharicka said. “I won’t do any bad things. I’ll take all my meds.” Childish desperation touched her tone. “I want to go home.”
After the conversation Susan had had with the Ansons, she wondered whether they would ever take Sharicka home again. What’s different this time? What can I tell them has truly changed? What guarantees do I have? Susan had no answers to her questions, but one thing seemed clear. This time, Susan believed, Sharicka really did plan to get better. Whether the attempt proved successful was another matter.
Susan marched resolutely down the sidewalk to the hospital entry, ignoring the signs and shouted slogans of the protestors. The summer sun beamed down upon them, striking brilliant glimmers from some of the metallic lettering. Susan wondered idly if they purposely chose reflective material to catch the eye of hospital workers and passersby. If so, it worked only if the intent was to cause temporary blindness.
Susan had once asked Stony Lipshitz why the staff did not have pass-protected, private doors. Stony had reminded her that all of the many entrances and exits from the hospital were monitored; and, as long as the protestors remained peaceful and did not block the sidewalks, they had a right to make their voices heard. Preventing protestors from clotting smaller, more enclosed staff entries required enormous amounts of security, maintenance and repair of the scanners had become prohibitively expensive, and hospital clientele had complained that, when the staff “sneaked” into the building, the protestors turned their venom on the patients and their already overstressed families instead.
Susan had nearly reached the entrance when a hand seized the sleeve of her dress polo and a voice hissed into her ear, “Dr. Calvin?”
Susan glanced sideways at a man in his thirties with spiky light brown hair, the style a throwback to his parents’ youth. He had a narrow face, a prominent Adam’s apple, and an odd, predatory look in his pale eyes. “Yes?” Assuming him a patient’s relative, Susan spared him a moment.
“Get out while you can.”
His words seemed nonsensical. “What?”
“The cyborg experiment, Dr. Calvin. Get out while you can.”
Susan tried to disengage politely. “I have no clue what you’re talking about.” She attempted to walk around him.
But the man stepped directly into her path. “Goldman and Peters and USR. They’re tricking you. They’re creating cyborgs from mental patients.”
Susan had no idea how this man knew about the nanorobot experiment, but she remembered the first-day admonitions about talking to protestors and revealing details of experiments, as well as her father’s overstated but understandable concerns about the Society for Humanity. Worried this could spark into something violent, Susan moved forcefully leftward. “You’re way off base. Our only goal as doctors is to help the sick and injured become healthy again. Nothing else.”
The man moved with Susan, but she managed a quick spin that opened the way, then ran into the sanctity of the building.
Just what I need this morning. Morons leaping to horrific conclusions from bits of misinformation. Susan already battled a tough mood. The excitement of her first week had waned, and she desperately wanted some time to herself. She had returned to Manhattan to spend time with her father; yet she had barely managed a significant conversation. She had the best boyfriend of her life, and she had already broken their second date. She drew some solace from realizing Remington understood and shared the rigors of her schedule. I love my chosen life; I just need some time off. Susan knew she would get her wish tomorrow, but only after she had dedicated another full day and night to Manhattan Hasbro.
Rounds went swiftly, as even Dr. Bainbridge had Sunday plans. Susan finished out the morning with the little tasks that would keep the patients on par until the new week started. Things coasted on the weekends. No new treatments or approaches were considered; no procedures or meetings that could wait until Monday were conducted. Once the morning frivolities ended, the unit worked on autopilot and the nurses would not bother Susan with details unless they affected her own patients.
Monterey’s current nurse, Saranne, caught Susan daydreaming at a palm-pross. “Monterey is asking for you.”
Susan sat up. “Asking? As in . . . asking?”
Saranne smiled. “As in speaking your name with a question mark at the end.”
Susan nodded. “Well, I can hardly pass that up, can I?”
“You cannot,” Saranne agreed, gesturing toward the staffing room exit. “She’s at the door to her room.”
Susan found the girl exactly where Saranne had said, surprised to find Sharicka standing beside her. “Dr. Susan,” the younger girl said, “Monterey wants to see Nate again. Can I go with you?”
Susan forestalled Sharicka with a raised hand. “If Monterey wants something, she will have to ask me herself.” She turned her gaze directly on Monterey, her brows rising in slow increments.
Monterey was up to the challenge. “I want to see Nate again.”
Susan noted with satisfaction she had used a full sentence, and it surprised and pleased her when Monterey continued.
“You promised you would take me today.”
“I did.” Susan could barely contain her joy. Monterey is talking. The realization of another success filled her with more warm pride than she expected. She tried to remain professional but could not help remembering how long Monterey had suffered, how little hope anyone had had for her until Susan had come on service. The idea she might save Sharicka as well overwhelmed her. Pride goeth before a fall, Susan reminded herself, but she could not shake the feeling of satisfaction that assailed her. I’m great at this. I really am. “And I will. Can you walk this time?”
Monterey nodded vigorously.
Sharicka looked longingly at Susan. She seemed afraid to open her mouth again.
Susan had already set things up with Nate the previous evening, and he had promised to make himself available in the charting room. She felt certain he would not mind adding another child. “Of course you may come with us. As long as your nurse gives us permission.”
“He will! He will!” Sharicka said excitedly.
Susan knew she was right. Shaden had already proven himself the young girl’s staunchest supporter. “All right, then. You two get ready. I’ll let the nurses know where we’re going, get Shaden’s permission, and meet you here at” — Susan looked at her Vox — “exactly eleven oh eight hours.”
Sharicka got into the game, examining her bare arm with the same intensity Susan had her Vox. “Should we sinkonize?”
Impressed a four-year-old could come so close to correctly pronouncing “synchronize,” Susan rewarded her efforts by joining in. She consulted her Vox again. “It’s exactly eleven oh five and forty seconds.”
“Check.” Sharicka pretended to fine-tune a Vox, though such was unnecessary as they all self-adjusted to the world clock. She must have gotten the whole synchronicity routine from an old show or movie.
Monterey giggled at the interaction.
Susan turned and marched off, trying to appear as competent as an old-time spy whose very life might depend on how well she “sinkonized” with her partners.
When they came back together, Saranne keyed the three through the massive, confining doors of the PIPU and out into the main portion of the hospital. The girls remained silent as they walked with Susan, focused on anything and everything. Sharicka paid so much attention to the key locks that old fears resurfaced and Susan worried the little girl might attempt escape. She made a vow to keep a close eye on the child, to never once let Sharicka out of her sight or beyond a few steps. She felt certain she could outrun the chunky preschooler, so long as she did not give Sharicka too large a head start.
Both girls studied the walls of the regular part of the hospital, nudging each other and pointing to some of the more colorful or unusual paintings. People flowed through the corridors singly or in small groups, discussing everything from family members to duties, from hopes to sadness, from lunch to vomit. Gurneys rumbled past with clipped IV lines and personal charting screens that appeared blank to anyone who might glance at them from the hallway and required passwords to read. At last, the three arrived at the charting room. Susan had discussed bringing Monterey back sometime this late morning or early afternoon, and Nate had promised to do his best to be there when they arrived.
When Susan opened the door, N8-C was sitting in one of the plush chairs tapping away at a palm-pross. As they entered, he looked up and smiled. Susan wondered idly if he found the softer chairs more comfortable or if he simply emulated the things he saw humans do. The very thought struck her as odd. Usually, she found herself forgetting his origins, thinking of him as just another colleague/friend, like Kendall or Stony. “Good morning, Nate,” she called as she ushered her charges inside and closed the door.
Nate rose to meet them. “Good morning, Susan. Good morning, Monterey.” He gave Sharicka a quizzical look. “Hello, little girl I’ve never met.”
Sharicka dashed forward, took his hand, and shook it. “I’m Sharicka. Nice to meet you, Nate.”
Monterey waited until Sharicka had finished before sliding in and capturing Nate in an embrace.
Nate hugged Monterey back, but his gaze found Susan.
Susan just smiled and waited.
Monterey held on longer than would be considered appropriate in most situations, and Sharicka nudged the other girl’s arm with an elbow. “Let go, now. You don’t want to break him.”
Nate’s closeness muffled Monterey’s response. “Can’t break him. He’s a robot; he can’t die.”
Susan felt a smidgen of guilt for her deceit, but she had no intention of correcting the misconception she had started. If believing Nate indestructible spurred Monterey to talk, Susan would not disabuse her of the notion.
Monterey finally pulled away. “Thank you,” she said.
Nate merely smiled. “For the hug? I give those away to anyone who wants them.”
Sharicka cut in. “She means for fixing her. For helping her start talking again.”
Susan realized Sharicka might become a problem for Monterey. Like a well-meaning older sister who did all the talking for a toddler, she might delay Monterey’s verbal development.
“Is that what you mean, Monterey?” Nate asked.
Monterey nodded briskly.
Nate dropped to crouch at her level. “Because I didn’t do anything, really. You fixed yourself, Monterey. We just reminded you of your problem, and you worked through it.”
Susan could not take her gaze from the interaction, though she could feel Sharicka staring directly at her.
“I wanted to see you again,” Monterey explained. “Can you . . . take me to a park, sometime? With . . . Mommy?”
Susan considered Monterey’s words, expressing so much more than they said. Her use of the term “Mommy” instead of “Mom” or “Mother” or the trendier “Mym” that came from shortening “my mom” in text messages suggested she operated at a level far younger than her actual age. She had stopped speaking, and mostly interacting, at six. Passive exposure to movies, maturation of her brain and body, and the conversations from her mother and the medical staff would probably help her catch up quickly. But, for now, it made sense she might befriend a precocious four-year-old rather than another preteen. It also confirmed that her issues stemmed from her feelings about her father and their relationship to the accident.
Nate shook his head. “I’m sorry, Monterey, but I’m not allowed outside the hospital.”
The look on Monterey’s face showed more than disappointment. She looked scandalized. “Why not?”
Nate sighed. His gaze trickled upward from Monterey to Susan. “I’m not human, Monterey.”
“I know that.”
Susan thought she detected some defensive anger. This was not going to go well.
“I’m a tool, created to perform a service, like an MRI scanner. My work is inside the hospital. I’m not comfortable outside; and, worse, people are not comfortable with me.”
“I am.”
Nate grinned. “And I’m so glad you are.”
Susan intervened. It was easy to forget Nate had no actual training when it came to handling children or psychiatric cases. “Monterey, visiting Nate is a special reward you’ll get when you work hard at getting back to a normal life. We need to work on your relationship with your mother.”
Monterey froze in place. Sharicka stared at her, as if hypnotized by what the older girl might do next. Susan suspected she might actually lapse back into silence or, perhaps, fling an explosive temper tantrum. It surprised Susan to realize that she preferred the latter. In Monterey’s case, it seemed the healthier response.
But Monterey only turned Susan a partially suppressed smile. “I have to learn to sass her and slam doors?”
Susan could not help laughing as the words of their first meeting came back to haunt her. “You were listening.” That boded well. If Monterey had not completely shut out the world during her extended silences, she might have matured mentally during her six years of self-imposed isolation.
The girls spent the next hour romping with Nate and plying him with questions. The interaction amazed Susan, even though she knew how much like a normal human Nate generally acted. He could easily have passed for their uncle, tirelessly providing them with horseback rides, startling them with a sudden ankle-grab that sent them tumbling, or allowing them to catch their breath in the crook of his all-too-human lap. Had Susan not kept reminding herself, she would have forgotten he had no childhood of his own, that he never aged, that he had no precedent on which to base his play and answers other than what he had read or watched. According to her father, the programming for positronic brains was minimal, a language chip, the Three Laws, and a basic idea of primary function. All else came to Nate from personal learning.
The hour ended too soon for everyone. Susan had a scheduled meeting with Goldman and Peters, and she wanted to make sure she handled any potential issues on the PIPU before she left. Better to address things that might never need her input than to leave them festering and risk getting called away. “All right. Fun time’s over. We need to get back to the unit.”
The girls made loud, disappointed noises.
Susan explained without apology. “Nate needs to go back to work, so he doesn’t get in trouble.” She suspected assisting a doctor with two psychiatric patients counted as part of his job, but the girls did not need to know that. An hour of playtime with two unrelated youngsters was enough for any adult. “And we need to get back to the unit before your nurses and parents start worrying I kidnapped you.”
“No one will miss me,” Sharicka said, almost proudly. “I could stay all day.”
Susan ushered the girls toward the door. “That won’t work for the rest of us.” She opened the door and gestured them through it, watching Sharicka closely, still worried the child might try to break for freedom. Without taking her eyes from the girl, she threw a friendly wave back over her shoulder toward Nate. She would get together with him later to compare notes; but, for now, she dared not remove her gaze from Sharicka.
Monterey fairly skipped the whole way back, though she lapsed into silence. Sharicka took the same dense interest in everything she had on the way to Nate. She studied the details of the walls and floors, the locks and keys, with a fanaticism that bothered Susan, though she could not quite say why. In the end, both of the girls hugged and thanked her, then trotted off together to the television room.
When the nurses pressed her, Susan had to admit the whole affair had gone off well.
When Susan arrived at room 713 on the seventh floor of Hassenfeld Research Tower, she found Ari Goldman pacing furiously between the metal desks and his own, clutching a pencil in his hand, the eraser savagely chewed. The willowy Cody Peters sat in one of the chairs, head clamped beneath his long arms. They both looked up as Susan entered, and Ari stopped in his tracks. “He’s not here,” he grumped.
Susan let the door spring closed behind her with a faint whoosh. Having no idea what Ari meant, she glanced at Cody, whose presence was obvious. “Who’s not here?” Alarm trickled through her. Is he upset about Nate? Was he supposed to be here instead of cavorting with my patients?
Cody’s answer put her mind at ease for a moment. “Payton Flowers. Our first subject.”
Discomfort flared anew. “The schizophrenic patient?” Susan remembered his parents’ anguish at losing their brilliant future attorney to madness. She knew every subject had a check-in routine, but she did not know all the details. Goldman and Peters involved her as much as possible but tried to accommodate her ward schedule as well.
Cody explained, “He was supposed to be here an hour ago. We called his family. They don’t know where he’s gone, either. He took off during the night, apparently.”
Susan could feel her heart hammering in her chest. A man with schizophrenia wandering off was not usually a frightening or terrifying event. People with psychoses who took their medicines as prescribed posed no threat, and even those who skipped doses or went undiagnosed rarely caused problems that required concern. The media played up those one-in-a-hundred-thousand cases where a patient with paranoid schizophrenia murdered someone he mistook for the devil.
Ari explained, “If something bad happens to him, or anyone around him, we’ll have a hell of a time keeping the study quiet. And once it’s out, everyone will blame the nanorobots rather than the disease.”
Susan could not argue. Once someone posted an accusation, no matter how false or corrupted, others with an agenda would cling to it even after its debunking. Cody shook his head, turned his gaze to Susan, and rolled his eyes. “Nothing bad is going to happen just because a man who happens to have schizophrenia decides to lose himself for a day or two.”
Ari growled something wordless. He cleared his throat and spoke again. “Why did it have to be our man with schizophrenia? We should have admitted him for the week.”
Cody heaved a deep sigh. “Were you planning to pay for weeklong hospital stays for all our study patients out of your own pocket? Or do you have some magic words to allow them to stay for free?” He shook his head. “And how many of our patients would willingly allow us to coop them up? Would you hold them against their will?”
Ari had no answers. He continued to grumble to himself but did not speak aloud again.
Uncertain what to say, Susan shuffled her feet. She could understand Ari’s concerns. Although Cody made sense and spoke the truth, she could not throw off a vague feeling of dread. Her thoughts went back to the protestor. He had known about the study and her role in it, which meant the study was not wholly secret. She could not imagine him snatching a grown man from his bed, but coincidences did not sit well in those circumstances. “Is there anything I can do?”
Cody winced and glanced at Ari. He clearly did not want to speak of anything negative with his partner already in a snit. “We had another patient for you to inject, but he backed out. We’re scraping the bottom of the barrel for possible replacements. Do you have any suggestions?”
Susan shrugged. “I’m the wrong person to ask. It’s my first rotation, and I’m on the PIPU. I’m only working with children.”
Ari said softly, “We’re cleared for children.”
That surprised Susan. She had little knowledge of research, but she had always heard safety and efficacy had to be proven on adults before the administration allowed children to participate.
Cody nodded. “Special exemption for time and need.” He did not go into details, which relieved Susan. She did not need to hear a recitation of hundreds of rules governing medical research. These two knew them backward and forward. If they said children could participate, it was the truth.
“Hmm.” Susan considered the possibilities. “Let me think about it for a bit, and I’ll get back to you.”
“Sooner is better than later,” Ari said. “The quicker we finish and get the data out there, the less chance the SFH has to interfere.”
Susan would have liked to wait until she found Ari Goldman in a better mood, but she realized not speaking now would make it look as if she had hidden something later. “You should know I got accosted on the way into work this morning. Nothing violent or dangerous, but this man knew enough about the study to call it” — she tried to remember his exact words — “‘making cyborgs from mental patients.’ And he warned me to ‘get out.’ ”
Now, even Cody’s smile vanished. “Did he say why? Did he threaten anything?”
“No,” Susan said. “They trained us to ignore protestors, and I disengaged as quickly as I could.”
“Good job,” Cody said, arousing a pang of guilt. Susan could not help remembering her first day and the conversation she had held with one of those protestors. She shook away the thought with the knowledge that the conversation had had nothing to do with robots or research. At the time, she did not even know the study existed.
Ari’s frown deepened. It seemed to permanently score his aging features. “Making cyborgs from mental patients. Now I’ve heard everything.”
“Oh, I’m sure I could say a few things you haven’t heard yet,” Cody teased his partner, running a hand through his unkempt hair and leaving it mostly standing on end.
Ari ignored the taller, leaner man. “But wouldn’t it be cool if we had that technology?”
Cody shrugged. “We do, depending on how you define ‘cyborg.’ There are people with functioning, robotic limbs with neural connections.”
Ari dismissed him with a brusque wave. “I mean mental cyborgs. Positronic brains in human bodies. Toss out the old, malfunctioning head and replace it with working wire coils that can think and learn.”
The thought seemed chilling to Susan, and Cody must have had a similar instinct. “Don’t say that where the Society for Humanity can hear you. They’d have a field day.” He rolled his gaze toward Susan again, indicating with a glance not to take certain musings of Dr. Ari Goldman seriously. “Isn’t it the intellect that makes the man? I mean, somewhere, there are freezers full of cryogenically frozen heads waiting for replacement bodies.”
“Where?”
“I don’t know. I thought I read that somewhere.”
Ari defended his idea. “I’m not really suggesting we toss some human’s thinker into the garbage and put Nate’s in. I’m just saying we might replace a section of brain, say after an accident or stroke, with positronic circuitry. If we can map the brain down to the molecular level, perhaps we could replace a misfiring synapse or two and cure all mental illnesses.” He gave Cody a pointed look that probably passed for return humor. “Maybe even your arachnophobia.”
“Hey! That’s a carefully guarded secret.”
Both men looked at Susan, who made a zipper motion across her lips.
The casual speculation convinced Susan her encounter with the protestor would neither get her banned from the study nor essentially killed, as Dr. Bainbridge had suggested in his initial lecture to all of the incoming residents. “If you don’t need me for anything today, I’m going back to the PIPU.”
Ari waved a gruff good-bye. Cody shrugged. “Without Payton Flowers, or the newest patient, your schedule has completely opened. We’ll call you if anything else comes up.”
That suited Susan just fine. She turned to leave.
“Oh,” Ari added, “I’m serious about letting us know if you find another subject. Someone desperate with nothing to lose.”
“Desperate with nothing to lose.” The phrase hung with Susan long after she left Hassenfeld Research Tower and headed back toward the unit. She could see how that phrase would make people worry about becoming a part of the study, but she also knew anything new and different required such a warning. In some ways, it harmed the research process, because medications and procedures that might help people in mild circumstances seldom got tested. In other ways, it helped, because it ensured that any new medication or procedure had to work on even the most extreme cases to get notice and approval.
Susan realized if they had asked her the first day for patient suggestions, Monterey would probably have nanorobots circulating through her cerebrospinal fluid right now. The breakthrough with Nate had made even the controversial electroconvulsive therapy unnecessary. She wondered how the protestors would feel when the hospital and mother gave up the battle. Would they use Monterey’s improvement without ECT as an I-told-you-so victory for their agenda, or would the loss of a rallying point disappoint them? Would they savor their win and head for home, or would they channel their energy into a new cause, energized by their success?
Susan shook those thoughts aside. She had no real interest in the political aspects of medicine, other than simple curiosity. Her job was to see the patients, diagnose them, and make them better, to ease the burden on the children and parents in her charge. The journalists, protestors, and politicians could go to hell for all she cared. They mostly just got in the way of the practice of competent, proper medicine.
As Susan trotted down toward the bowels of the hospital, she studied her Vox to make certain she had not missed any pages or messages. Only one flashed up on the screen, a shorthand from her father wishing her a quiet, peaceful day. Susan smiled at the sentiment, touching the Kwik-key sequence to relay an “All’s well” in return. In fact, thus far, the powers that be seemed determined to keep her world quiet.
By the time Susan arrived on the PIPU, however, her streak appeared to have ended. As Saranne keyed her through the first of the doors, she said softly, “The Ansons are here.”
Susan did not know whether to smile or grimace, so she simply nodded. She appreciated that the Doctors Anson had not given up on their wayward daughter, or her caretakers; but the poor family had surely suffered enough. “Please tell me Shaden’s not pressuring them for discharge.”
“Not discharge,” Saranne assured her. “Just a simple home visit.”
Though it pained her to do so, Susan gave the suggestion serious consideration. When she had brought up the possibility of institutional care at rounds the previous week, the nurses, Stony and Clayton, and even Dr. Bainbridge had laughed. Few enough places accepted any patient for lifelong care, and none would consider a child, especially one so young, particularly a female. That had led to a discussion about inpatient psychiatry protocol, reasonable expectations, and ultimate objectives.
Susan had always understood that the eventual goal for every patient was discharge to home as quickly as possible. No one wanted to stay in the hospital longer than necessary. The intrusiveness, exposure to superbugs, and 24/7 noise were bad enough; but most patients could envision their bank accounts emptying as the hours ticked past. Third-party payers, especially the government, allowed set amounts of hospitalization time for specific diagnoses. Keeping patients longer required a ream of paperwork that brought every administrator, from the charge nurse to the CEO, down on the doctors’ heads. Inquiries often seemed more like inquisitions. Denials occurred frequently, forcing the choice between premature discharge and personal payment, which few people could afford.
Patients such as Sharicka made life especially difficult for physicians. Unlike most of the other PIPU patients, she had no evidence of psychosis or dementia. Personality disorders, even the antisocial type, were not justified diagnoses for inpatient therapy. Her youth further hampered them, as they could not even officially use the ASPD designation until she reached the age of majority.
They had to settle for ADHD, ODD, and conduct disorder, none of which sufficed for inpatient care, especially long term. Sharicka had serious and permanent issues; weeks, months, even years on the PIPU could not change her underlying problem. The treatment for her, and other children on the conduct disorder spectrum, was to medicate them to some tolerable baseline of comportment, teach the parents behavioral modification techniques, and wait for the future. Concern for imminent criminal actions was not excuse enough to interfere with anyone’s freedom, especially a child’s, whether with prison, an institution, or long-standing hospitalization.
Susan finally understood why the PIPU staff had discharged Sharicka to a therapeutic foster home after her first couple of weeks on the unit. Ultimately, everything the care team did had to bring, or at least attempt to bring, each patient one step nearer to discharge. So far, the Ansons’ insurance company had proven reasonable, but Sharicka only had to go a week or two without a violent incident for them to refuse further payment. It seemed inevitable given that Sharicka did seem truly determined to change this time. All too soon, Susan would have no choice but to discharge her, if not to her parents, then to another foster home.
Susan realized that refusing any type of visitation, then dropping Sharicka on the Ansons the day of her discharge did not serve anyone’s best interests. The purpose of home visits was to ease the patient back into everyday life as well as prepare the family for the future in gradually increasing increments. A single overnight would also reward Sharicka for trying and, with any luck, rekindle the hope her family had all but lost. “Does Sharicka even want a home visit?”
“She’s practically pleading.”
Susan walked down the hallway with Saranne, pausing to glance in the open doorway where Sharicka snuggled on her mother’s lap, her father hovering like a guard dog. He looked up as doctor and nurse walked by and gestured silently to Susan.
Susan held up a finger and nodded to indicate she would return shortly, then continued to the second massive iron door with Saranne. The nurse unlocked it, and they walked onto the unit and straight into the staffing area. Saranne could barely wait to ask, “What do you think?”
Susan found herself nodding quietly for too long. From the corner of her eye, she saw Shaden coming to join the conversation. “I . . . think . . . ,” Susan started without a clue as to how she intended to complete the sentence, “. . . it might be . . . possible.”
Shaden jumped right in, easily guessing the topic of the conversation. “She hasn’t done anything wrong in a while, Dr. Calvin.”
Susan wondered if Shaden even remembered that, earlier the same week, Sharicka had put a piece of a latex balloon into another child’s medication cup.
“Since she started taking her meds faithfully, she’s been so different.”
Susan had to admit Shaden made a good point. Sharicka did seem to have made a miraculous change in the last couple of days. “Maybe we should demand a full week of positive behavior before we inflict her on the world.”
“It’s just a home visit,” Saranne reminded Susan. “It’s routine. Most kids start those a week after they’re admitted.”
“Besides,” Shaden added, “the Ansons are going away next weekend. It’s today, or they have to wait two weeks.”
The nurses seemed so earnest and eager, and both had excellent reputations on the unit. Susan sighed. “I do believe Sharicka is making an honest effort. But do you really think she’s ready?”
Shaden made an important point. “If she were on some of the older antipsychotics, no. They can take weeks or months to really work. But she’s on hefty doses of Antoladol and Vilyon.”
Susan knew the second-generation neurotransmitter stabilizers did act quickly. Some psychiatrists started at subtherapeutic doses and worked their way up slowly, but Sharicka was already at the maximum dose for her size. Her previous R-1 had raised it, not knowing that Sharicka had been hiding her medications. “You’re sure she’s swallowing them?”
Shaden could have taken that as an insult. It implied, and quite rightly, the nurses had not acted thoroughly and properly in the past. Providers assumed people took their medication; and, under most circumstances, would not bother to check. It was a patient’s prerogative not to fill a prescription or take a medication, even one he required to live. But an underage mental patient in a locked unit ought to have better than usual attention paid to such details. “Sharicka is taking great pains to prove to us the meds are going down her throat.”
Susan doubted she wanted the specifics. “I’ll talk to the Ansons,” she promised, “but I’m not going to push them. If they decide they can’t handle her, we wait at least a week before presenting the possibility again.”
Shaden bobbed his head, clearly finding the conditions reasonable. “I’d like to come with you.”
Susan bit her lower lip. She was not the sort of person to squash conflicting opinions, and he was Sharicka’s most frequent caretaker. Although he had a soft spot for the girl that did not always seem logical, he was a competent professional with far more PIPU experience than she. The Ansons had run into people like Shaden many times. They would understand his point of view. Just maybe, Shaden would learn to value theirs as well. “All right. When do you want to do it?”
Shaden smiled. “They’ve had a solid forty minutes together. How about now?”
“Now suits me fine.” Susan swallowed her misgivings, turned toward the door, and they headed for the conference room together.