“IT’S A PIECE OF CAKE, I’M telling you.”
Nearly a week had passed since the cat head discovery, and there were no more intimidating incidents. Whatever Nick had done was working. Also, Brenda Flowers, attorney for CommCare, had called René to prep her on her disposition scheduled for the following Monday.
“Unlike a courtroom trial, a deposition isn’t cross-examination; it’s just a vacuum cleaner for information—lots of broad, open-ended questions and follow-ups. All they want are the facts, and the strategy is to answer the questions as straightforwardly and narrowly as possible.”
That’s when René felt her stomach leak acid. And she could hear her father’s voice:
The softest pillow is a clear conscience.
Flowers also said that the Zuchowsky lawyer’s name was Cameron Beck, and don’t be fooled by his baby face. He could be a little pushy.
But Ms. Flowers had grossly understated Cameron Beck. He was a pit bull disguised as a cherub.
Flowers met René the following Monday at Beck’s office on the twenty-eighth floor above State Street. She was in her forties and a pleasant woman with a sincere blue business suit and reassuring manner. “Don’t be nervous,” she said. And instantly René’s heart rate kicked up. “You’re going to be fine.”
After a few moments, Cameron Beck came out to lead them to a conference room with a large shiny table, artwork on the walls, elegant designer furniture, and a million-dollar view of Boston Harbor—all of which conspired to remind René that there was a much larger world outside of wheelchairs, bedpans, and pills.
Also in the room was a stenographer with a dictation machine. She asked René to take an oath that everything she said was the truth. René nodded, thinking that she would throw up. But she didn’t and took the oath.
In his early thirties, but looking about fourteen, Beck was a soft and cheeky man with a thick head full of auburn ringlets. He had a sharp, thin nose and intense blue eyes that projected a predatory cunning. As Flowers had said, Beck began with some neutral questions about herself—René’s education, job
history, her role as consultant to Broadview. René explained in minimal terms, as instructed.
Then Beck asked about the people she worked with at Broadview—their responsibilities to residents, what their jobs were, who their superiors were—boring stuff that helped Beck understand how the CommCare pharmacy operated and what its relationship was with the nursing home. This lasted for nearly an hour. All went well until Beck started to ask about Clara Devine. “Did you know her?”
“Not personally.”
“As I understand it, this was the first time that Broadview has ever had a patient escape. Is that your knowledge?”
“That’s what I’ve been told.”
“I see. Then maybe you can tell me how you think she got out of a locked Alzheimer’s ward.”
“I don’t know how she got out.”
There! It was out, and on record, and under oath.
Officially she had crossed the line.
Sorry, Dad. Just made myself a cement bag.
Apparently Beck sensed the psychic shift because his eyes locked onto René’s. He glared at her for several moments without blinking, probably hoping she’d crack under the strain and fill the dead air with confession. But René held firm and held his gaze.
“Well, Ms. Ballard, maybe you can speculate. Did she go out the door? Or perhaps the window? Or maybe she went up the chimney?”
Brenda Flowers cut in. “Counsel, I don’t think this line of questioning is fruitful. It’s clear that Ms. Ballard doesn’t know how Clara Devine escaped.”
“We’re trying to establish how a lockdown security system failed, apparently for the first time. So I’m sure that Ms. Ballard, an educated professional familiar with long-term-care facilities, has a theory she could share with me, don’t you, Ms. Ballard.” And his eyes snapped back to René and dilated in anticipation.
Didn’t I see you in The Silence of the Lambs?
she thought. “I don’t have a theory.”
“Then guess.”
“Mr. Beck, please. This is a fact-finding exercise, not a courtroom.” Flowers tried to sound pleasant, but the lilt of her voice had a serrated edge.
René responded. “My guess is that the door lock system failed, and she just pushed her way out.”
“She just pushed her way out. I see, as opposed to somebody letting her out.”
“Nobody would let her out.”
“How do you know that?”
“I don’t.”
“How familiar are you with Broadview’s security system? To your knowledge, how does it work to keep patients in?”
“A security code pad.”
“I see. So you press a certain code and the door opens.”
“Yes.”
“And it closes behind you and locks automatically.”
“Yes.”
“And the only way out is to press the code on the keypad.”
“Yes.”
“So you’re saying that something in that system failed.”
“If I had to guess.”
“If you had to guess. Is it possible that Clara Devine knew the code and let herself out when nobody was looking?”
A prickly rash flashed across René’s scalp. And in her head she saw the video of her escape. “Clara Devine was suffering dementia, and such patients don’t have the cognitive powers to remember codes or operate a code pad.”
And now you’re falling behind slippery wording.
“But she did get out and go down the stairs or elevator and slip out the front door past the main desk where staffer members were supposedly on duty, is that not correct, Ms. Ballard?”
“Yes.”
“How do you explain that?”
“That the security door malfunctioned.”
“Have you heard of it failing any other times?”
“No.”
“Have you ever known the security system on the Alzheimer’s ward to ever fail?”
“No.”
“Then how do you explain it failing this one time?”
“I can’t.”
“What about the front desk? Did she suddenly turn invisible, or did she turn into a bird and fly out?”
“Mr. Beck, you’re bullying my client and I won’t stand for it.”
But he disregarded Flowers. “Well?” Again he bore down on René as if trying to stun her in his glare. But the more hostile Beck turned, the more resistant René became. It occurred to her how easy it was to lie, to maintain a kind
of Orwellian doublethink—holding two contrary thoughts in your head at the same time. And with every question, she felt a separation from her more real essence—like a retreating doppelgänger. To justify the growing split, she kept reminding herself of the “higher good”—of Lorraine Budd recalling her high school friend from 1940-something and Ernestine spelling her nurse’s name and Louis Martinetti remembering his army days. “I don’t know.”
“You don’t know. Is it possible the front desk attendant maybe left for a few moments to go to the restroom or get a coffee, and while she did Clara slipped by?”
“It’s possible. But I really don’t know.”
“And where exactly were you when she got out the door?”
“At home.”
“You say your job is to monitor patients’ medications, correct?”
“Yes.”
“And you have a pharmacy degree?”
“Yes.”
“So you understand the medications that are prescribed to patients?”
“Yes.”
“Good. So if a patient is taking anything that might be harmful to themselves or others, you would know?”
“Yes.”
He opened up a folder and pulled out a sheet.
“Was Clara Devine on any medications that would cause her to become violent?”
Maybe.
“No.” She heard the syllable rise easily out of her throat but imagined that her eyes were blinking red polygraph alerts.
“Are there any she was taking that could have such violent side effects?”
“No.”
He opened a file folder and removed a sheet. “The medication sheets on file at the nursing home lists Atenolol. What’s that?”
“A beta-blocker. It reduces heart rate, blood pressure.”
“What about Aricept?”
“That’s for her dementia.”
“No possible side effects?”
“No.”
“What about Paxil?”
“That’s for her depression and general anxiety.”
“How does it work?”
Brenda Flowers tried to protest the line and manner of questioning, but he persisted as if he were on some slightly manic autopilot.
René could see that Beck was enjoying his schoolroom inquisition, but she would not crack as she shot back the answers as if she were taking her orals back in pharmacy school. “Paxil is the brand name of paroxetine, a class of drugs known as selective serotonin reuptake inhibitors. It affects the activity of neurotransmitters in the brain, in particular serotonin and norepinephrine, which help regulate one’s mood.”
“You’ve done your homework, I see. So have I,” and he whipped out a file card from his folder. “Did you know that Paxil can cause delirium, irrational talk, and hallucinations, irritability and hostility, even manic reactions including ‘great excitement and psychotic rage, followed by depression’—all of which this drug is supposed to prevent? Is that not so, Ms. Ballard?”
“All drugs have side effects, and a small percentage may be adverse.”
“But are these not side effects that could have led to Mrs. Devine’s attack on Edward Zuchowsky?”
“That’s remotely possible.”
“Remotely possible? Well, did you know that England has recently banned the use of Paxil for children and teenagers under the age of eighteen because the drug has been linked to suicide, suicidal behavior, and violent outbursts? Did you know that?”
“I had heard that, yes.”
“And yet your home still prescribed the drug to her.”
“Clara Devine was seventy-six years old.”
He made wide-eyes. “Oh, so it only adversely affects people under eighteen? How is that possible? Brains are brains, no?”
“No. Childhood depression is different from adult depression, probably because children’s brains are still developing. So antidepressants may not have the same effects—beneficial or adverse—in children as in adults or geriatric patients. While it’s difficult to weigh the risk-versus-benefits of any medication, Clara Devine had been on the same doses of Paxil and her other medications for many months. So I’d say that it’s very unlikely that any of those meds caused such a dangerous impulse.”
“So you’re saying that nothing she was on could have accounted for her violent behavior.”
“Not to my knowledge.”
“But how would you know if you’ve been on the job for only eight weeks?”
“Because I saw her medical charts, and because there’s no report of psychotic rage, hostility, or combative behavior that would point to her killing of Mr. Zuchowsky.”
Beck rocked back in his seat and looked down at this list. “Once again, are you certain there were no drugs she was on that could have led Clara Devine to kill Mr. Zuchowsky—some kind of stimulant or antipsychotic drug that produced the opposite effect?”
In a flash she saw the nurses’ notes: “More alert.” “More verbal.” “Remembered his granddaughter’s name.” And Louis Martinetti’s swearing, “We’ll get them back is all.” And she heard her father’s exasperation:
I can feel the holes.
Besides, she really didn’t know if Memorine had anything to do with the killing. That was the truth. And that’s what the purpose of this deposition was. Furthermore, this Cameron Beck was a royal prick. “Not to my knowledge.”
Beck snapped closed his file folder. “Thank you, Ms. Ballard. That will be all.” He stood up and shook her hand. “Good day.”
When they left the office, Ms. Flowers said, “Sorry about that. But he can get a little intense at times. You should see him in the courtroom. How do you feel?”
“Fine,” she said.
Piece of cake
? René felt as if she had just eaten a slab of suet.
FOR THE BETTER PART OF A WEEK, René pored through the various nurses’ reports of residents enrolled in the Memorine trials, hearing the nasal persistence of Cameron Beck’s voice—“any adverse side effects?” What she discovered was a marked increase in cognitive tests scores of nearly fifty percent of the subjects as well as improvement in their basic daily functions. In fact, Louis Martinetti had progressed twenty percent on his Mini-Mental State tests. That statistic particularly delighted René, as if the demon was being vanquished for both Louis and her father.
But in about a quarter of the reports, nurses had noted spells of “regressive behavior” and of “odd spells” when patients would become dissociated from the moment and lapse into past-time hallucinations—like Louis Martinetti thinking he was back in the army—or “childhood delusions.”
Flashbacks.
According to her time line, those residents were part of the first trial group.
“Her mood would suddenly change, like that,” Alice said when René asked about Clara Devine. “Suddenly she’d start talking in rhymes. Or she’d have conversations with people who weren’t there. That’s not unusual for dementia residents.” Then she added, “But the thing is these spells could last a long time, and they were pretty coherent. It was kind of weird.”
The notes also indicated that flashback spells had been observed in Mary Curley, who, like Clara Devine, was being treated with antipsychotic drugs and tranquilizers. So was Louis Martinetti.
“It’s what we did if they became too disruptive or when the families visited.”
The medication orders had been signed by Jordan Carr.
Of course, Clara Devine was at McLean’s Hospital for psychiatric evaluation and would not be back for weeks or months—if ever.
During his rounds one afternoon, René approached Jordan Carr about his medication orders when he became defensive. “That’s what’s used for treating psychotic delusions. Do you have a problem with that?” His face had taken on the rashlike mottling again.
He clearly did not like the implication of her question: that they were burying a potential adverse side effect of Memorine. His manner also reminded her of the professional divide that separated them. “No,” she said.
“Good.” Then to clear the air, his manner changed. “I hear your deposition went well.”
“It’s not something I’d like to go through again.”
“Well, you won’t, I’m sure.” Then out of his shirt pocket he removed two concert tickets. “By the way, I’ve got two tickets to the symphony next Friday night.
Mnemosyne
by the Hilliard Ensemble.”
She thanked him but said she was busy, which was a lie. It was also the second time she had turned down a date with him. Jordan Carr was handsome, charming, brilliant, rich, and accomplished—a real catch in most women’s books. His interest in her had not gone unnoticed by some nursing home staffers who wondered if her relationship with Jordan had transcended the professional. It hadn’t, and René did not want to encourage that. She was not comfortable dating a professional colleague. Nor was she ready for another boyfriend. All she wanted was to continue carving out her career without complications.
From the upstairs window she watched Jordan leave the building. A couple of weeks ago he had purchased a second Ferrari, a silver 1999 Maranello. Out of curiosity, the other night she went online and looked up the model. She came up with one hit from Atlanta with the same red with tan interior. The asking price was $240,000.
As he pulled out of the parking lot, her eye fell on her little blue Honda Civic with the dented front fender. She felt like the member of a different species.
“Did Dr. Carr leave?” Alice asked, as René returned to the nurse’s station.
“Yes.”
“Oh, well. A fax just came in for him.”
Just then one of the aides called her to help with a patient. “Here, hon, slip this in Dr. Carr’s mailbox for me like a good kid, okay?” And she handed René the sheets and scurried away to the aide. Even Alice was beginning to perceive René as Jordan’s girl.
René walked over to the mailboxes and happened to glance at the sheet. It was from Massachusetts General Hospital Emergency Department, Archives. It was a blood assay made back in August.
She glanced at all the chemical analyses, but what caught her eye was the
name of the patient. It struck her as odd since he was not one of Jordan Carr’s patients. In fact, when she had mentioned her visit a few weeks earlier, Jordan had said that he was unfamiliar with the case of Jack Koryan. Never heard of him.