Authors: Neil McMahon
But the sense was inescapable that she was the one locked in a cell. The room was tiny, packed with books, paperwork, and files. The desk she kept clear, a last outpost of defense against the surrounding chaos. Her gaze moved across a shelf of videotapes on assault management and AIDS protection; a medication list, a reminder that most psychiatric treatment came in the form of tranquilization; her teaching schedule, with the world
assault
figuring again and again. On the
ward, she wore earth-toned clothing, pale lipstick, and no jewelry or scarf that could be grabbed.
She took out a compact, touched up her makeup, and paused with her hand on the doorknob. She could hear more patients in the hall now, word of her arrival having spread. Three-Psych had been built to house thirty, which meant in practice that the administration tried to hold it down to fifty. Most of the non-NGIs were public admissions from the community, comprising the full spectrum of mental illness. They gathered around her, and a part of her mind believed that this was the best healing she could give, just to be there.
She recognized most of the voices, not from what they said or how, but a peculiar quality beyond any ofthat, like vocal pheromones audible only to a tuned ear: Corinne, wrists and neck heavily scarred, who occasionally stripped naked and walked screaming down the hall; Lewis, who could get drunk on water and had to be restrained from bellying up to a toilet like a bar; Edward, who had ripped antennas off cars in a supermarket parking lot to keep them from broadcasting his thoughts to the world, and who now paced tensely, flipping the pages of a special Bible to keep demons away. Many of the patients reflected the vast range of subfrequencies known as thought insertion, hearing the voices of angels, demons, the dead, urging anything from suicide
to the sacrifice of a baby they pronounced evil; or sometimes voices just keeping them company. It was a major problem in maintaining schizophrenics on medications. Without those inner companions, they got lonesome.
When she stepped out of her office into the crowd that had gathered, some of the faces turned away with quick shyness, while other gazes clung like unseen nets, without social grace or remove, the straight blank curiosity of children or primitives.
“I need,” a voice said. She turned to the man who stood shuffling in a slow dance of agitation: Raymond Coolidge, recently arrived from the streets of Oakland, late twenties, Psychosis Not Otherwise Specified, which in practice meant heroin addiction coupled with HIV dementia.
“Some
pussy.”
Raymond had the habit of declaring himself to whatever female staff or patients happened to be around when the urge struck him. His face was sweating and earnest, grayish skin stretched tight, leaning toward her at an odd angle as if his neck was broken. The thin fingers of his right hand ceaselessly moved up and down his thigh, squeezing his penis, which hung visibly inside his loose pajama pants.
“I need some pussy,” he said again, more firmly now, as if she could not help but agree. “Now, baby. You got to understand.” His flexing fingers left his thigh and hovered imploringly in
the air between them. She considered the textbook response: explaining to this psychotic man, who stood before her massaging his cock, that his behavior was inappropriate.
“If you touch anybody, Raymond, you’re going to Seclusion.”
His face turned morose and he shuffled off, hand returning to its work. He was not known to be assaultive, but she decided to recommend increasing his Haldol dosage. Each four-person dorm slept eight, with patients close enough to touch each other and many unable to defend themselves or fully understand what might be happening.
The far end of the ward’s I-shape was commanded by the Nurses’ Station, which stood glassed-in like a gun turret on a raised dais. Past that were ten identical concrete cells, eight feet square, euphemistically called seclusion rooms. Furniture in each consisted of a one-piece stainless steel bed bolted to the floor. The windows in the steel doors were shock-resistant glass reinforced with wire mesh, too small for a human body to pass through if the glass were broken. Video cameras, recessed in the ceilings out of patient reach, broadcast twenty-four hours per day on a bank of monitors at the Nurses’ Station.
Only the plastic-covered bedding was vulnerable to assault. The thin mattresses and pillows occasionally got shredded or eaten, but it was the sheets, provided for patient comfort by California
law, that made the staff nervous. Before coming to Clevinger, Alison had not known that you could hang yourself—quickly—without your feet leaving the floor.
The Clevinger Administration Building was a different world from Three-Psych. Here the doors were not locked. Jephson’s outer office was spacious, with the luxury of a large and ungrated window.
Paula Rivinius, Jephson’s secretary, was on the phone. Mrs. R, as she was known on the wards, was dressed in a peacock-patterned sheath of lavender, purple, and cobalt. It was low-cut, slinky, laden with jewels, an outfit more at home at a Las Vegas dinner show featuring Tom Jones than in a hospital office. She was in her late forties, but worked hard to look ten years younger, and brought it off with fair success. Her longish hair was dark blond, the once black and now graying roots dyed and teased into careful disarray. Good legs and generous breasts allowed her to look Rubenesque rather than plump. Indigo eyeshadow and heavy jewelry lent an exotic, vaguely Eastern touch, as of a Hungarian gentlewoman in reduced circumstances.
She looked up over cat’s-eye glasses and held up two fingers for minutes. From the conversation, it was clear that she was trying to place a patient in a halfway house. Alison walked to the window, her suspicions widening again to include
Mrs. R among those who might know about the phony NGIs. Paula had been with Jephson since the program’s start. She was divorced, Jephson never married, and Alison was sure that Mrs. R would be only too happy to scratch whatever itches the great man might have.
The door to Jephson’s inner office remained closed as Mrs. R talked on.
After almost two years of working for the man, Alison knew almost nothing about him personally. He was aloof, distant, a behaviorist with a mechanistic model of therapy that combined drugs with behavior modification.
At least, that was the operative assumption. Since his therapy sessions with the NGIs were conducted privately, no one else really knew what took place.
But a scenario was taking shape in her mind.
Many psychiatrists were reluctant to perform court-ordered evaluations, for good reason. The pay was almost nothing and the time demands great. The work itself was depressing and thankless, with grim prison visits and human beings at their worst. Trials and hearings were likely to bring attacks from attorneys, seeking to belittle professional competence and even verging into the personal.
But Jephson performed dozens of such evaluations per year, usually on cases that received no publicity. These almost never went to trial. They were settled at hearings among overworked, disinterested, state-appointed attorneys and judges.
Jephson’s backup evaluations were usually performed by Vikram Ghose, a timid man from India who was on a continuously provisional status, without a license to practice independently in the United States, but whom Jephson had hired at Clevinger.
Suppose that, once in a while, the tumblers lined up to present low-profile cases, offenders with histories that suggested mental illness. These men screened by Jephson in private pre-hearing sessions. He then selecting, not the genuinely mentally ill, but sociopaths who might be keenly intelligent, especially in their own interest. Shading evaluations and obliquely coaching to present them as schizophrenic or bipolar.
Then guiding them through therapy, with information couched, coded, conveyed largely by emphasis, and absorbed by that instant, razor-keen intuition. The rules would be made immediately clear: act out once and you were in jeopardy; twice, and you went back to Atascadero or Vacaville, places that made Clevinger look like a Ramada Inn, to remain for years and maybe life. But stay in control, do twenty-plus months of soft time, and walk out free and clear. Therapy confidential. Negative feedback easily doctored and no central agency to correlate it. Especially if the men moved to other areas of the country, perhaps even changing identities.
“Sorry, dear,” Mrs. R said, hanging up. “They know how to complicate things.”
“Dr. Jephson asked to see me.”
“Yes?” Mrs. R drew the syllable out into a question. Vermillion lips compressed, she picked up the phone again. She said, “Dr. Chapley’s here,” then looked up and nodded.
Jephson’s private office possessed the flavor of a Cambridge don’s, with its supplied grandeur overcoming the cheap, textured drywall and aluminum windows. The desk was his own, a massive structure of antique oak with blotting pad, inkstand, and a silver tray of stationery. A small TV/VCR unit for educational videos sat on a rollered stand in a corner. Several diplomas and awards hung on the wall behind him, flanked by thick volumes on neurology, psychoanalytic theory, and behavior modification, sitting shoulder to shoulder on shelves like haughty authorities.
“Alison,” he said. “Please sit down.”
He swiveled to the side and leaned back in the chair, slender hands clasping each other with a relaxation that seemed imposed.
“From time to time something comes along that makes me realize my shortcomings. Such as the poor follow-up on those NGIs that you brought to my attention. My focus has always been on results. I’ve let other aspects suffer, bureaucratic details and such. Our system is imperfect, our resources limited. One does the best one can.”
He paused.
“It’s a very impressive best, Dr. Jephson,” she said. “No one would argue with that.”
“I’m afraid I’m not much good at delegating responsibility, either.”
This time she waited. Jephson’s fingers steepled.
“I’ve been thinking for some time that JCOG would benefit from an administrative director,” he said. “Someone to take over the day-to-day business, the hands-on operation.”
Her eyebrows arched with comprehension. So: become a team player—and acquire the position of administrative director of JCOG. Stay another year or two, blind to what was going on, then carry the weight ofthat credential to wherever she wanted to go next.
From threat to bribe.
She said, “I think that’s a wonderful idea. It would free you up for more important things.”
He waved a hand modestly. “Just putting other talent to good use.”
“Did you have anyone in particular in mind?”
Jephson swiveled back to her and smiled, a gift he bestowed rarely. “I shouldn’t think I’d need to look too far from home.”
“When would you be implementing this?”
“Oh, it will take a few months. We need a formal job description, funding, all that.”
Or else it was a stall. Nothing definite
promised—but a way to keep her quiet until he could come up with something damaging to her.
She said, “I wouldn’t call that poor follow-up a detail, Dr. Jephson. Those are dangerous men. No one knows where they are.”
His smile remained, but his pale eyes went glacial. “I
am
looking into it, Alison.”
She bit off the words,
So am I
, and stood.
“Keep me posted,” she said.
Mrs. R was busy over a stack of papers. She waved beringed fingers as Alison walked by.
Alison paused at the outer door. “Paula, is John Garlick’s release still on schedule?”
Mrs. R looked up, surprised. “As far as I know. Why?”
“I just wondered if any hitches had developed.”
“You’d have to ask Dr. Jephson.” Mrs. R’s gaze returned to the papers.
Alison’s gaze turned hard, anger flaring at being caught in this smug charade.
“Suppose Garlick stops reporting for meds?”
“The outpatient clinic would notify us,” Mrs. R said.
“But that’s that, right? Nobody else would know. Nobody’d go looking for him.”
“Social workers would try to contact him.”
“Meaning what? A phone call or two? What if he just disappeared?”
Mrs. R placed both hands flat on the desk and leaned forward.
“You wouldn’t go looking for those men either, Alison. It’s not like on the wards. You can’t just scream for help.”
Back on Three-Psych, Alison imagined a subtle shift among the staff she passed: gazes of curiosity or wariness. The patients looked different, too: sly and secretive instead of confused. She realized she was assessing them all in terms of:
Who might be in on this?
The answer kept coming back:
Anyone.
A few minutes before five
P.M.
, Alison let the heavy door of Three-Psych swing closed behind her and walked out into the damp twilight air. The afternoon had included a Dual Diagnosis Group meeting, for patients with both mental illness and drug problems from fortified wine to inhaling propane.
Garlick, a one-time heavy drinker and meth user, had put in a mandatory appearance. Today, there was no baiting of other patients. He had been quiet, polite, his gaze rarely meeting hers, as if he had known he was under her scrutiny.
Soon to be released.
She opened the Mercedes’ door and was swinging herself in when her mind registered what the car’s interior light showed:
A small white box, lying on the driver’s seat.
Her breath stopped. But a second later, she exhaled and managed a smile.
A return gift from Monks.
She left the door open for the light, and opened the box with her thumbnails. Under a layer of tissue paper lay a five-by-seven photograph. The setting was a forest clearing, with a thick growth of redwoods at its edges. The corner of a shed was visible, with a rusty corrugated iron roof.
In the foreground was the face of a man. He was looking over his left shoulder, his gaze fixed on the camera, his mouth slightly open. The sense was that he had been taken by surprise and was just realizing that the photographer was there. His eyes were shadowed beneath the bill of a baseball cap, but an ugly, unmistakable sense of menace emanated from them.