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Chapter Three

Cassandra and I sat together at the table, examining the drawing she had done of her family.

“That’s really quite an elaborate picture. Can you tell me more about it?”

“There I am. Up in the sky,” she said. “I look down on everyone. I can see everyone. I can see everything from the sky.”

“That sounds interesting, being able to see everything.”

She nodded. “I like being an alien.”

“If I were an alien, I think I would feel lonely,” I said, “because I’d feel I was different from everyone else. I’d feel like an outsider.”

“No, not me. I like it,” she replied. “Because I can travel in a rocket ship.”

Cassandra was a rather wriggly little girl, squirming around in her seat, bending her head down and around in a way that allowed her to look up at me while I regarded the picture. There was something coy about her behavior. This made me wonder if she had chosen to draw herself as an alien because she genuinely felt like an alien or if she had chosen to do it as a way of engaging me, as a sort of savvy assessment of what she’d thought a therapist would be interested in.

“And here we have your family,” I said. “Yes? Your mother, your stepfather, your two sisters – ”

“And the fish. The fish, too,” she interrupted and pointed to them.

“Ah, I thought they were leftover from when you were experimenting with shapes …”

“No, they’re living in the sky like it was an aquarium. Goldfish. Really, they’re a family, too. That big one’s the dad. And that’s the mom goldfish. And those are the babies. They belong to my other family.”

“I see.”

“Those are my other family there. Remember, because I told you already. They’re outside the aquarium, looking in. That’s why they’re small.” She pointed to the snakes. “Really they’re not snakes. They got snake costumes on.”

“They’re not snakes?”

Cassandra laughed at this. “Silly! They’re people!” She laughed again. “That’s Daddy Snake and Mama Snake and the kid Snakes. And there’s the Minister Snake. And that’s Cowboy Snake. And that’s Fairy Snake.”

“I thought you just said they were people,” I replied, a little confused.

“They are,” she said cheerfully. “‘Snake’ is their last name. That’s because they dress up in snake costumes all the time, so that’s why people started calling them that. And really I’m Cassandra Snake when I live with them.”

“Why do they dress up in snake costumes?”

“Ding-dong, willy-nilly, Peter Pan!” she replied in an unexpectedly loud, singsong voice.

I sat back.

She laughed shrilly.

I sat quietly without speaking.

“Ding-dong, willy-nilly, Peter Pan!”

She laughed again, writhed in her seat, and fluttered her hands. Then taking up a black marking pen, she drew strong black lines across the picture in a random, rather frenzied manner. The lines didn’t color over anything or appear to be there to cover up anything. The way she did them, they appeared to be just marks, slashes across the page, as if her inner environment had become too much to control and these marks simply exploded forth like lightning strikes.

Saying nothing, I just sat, waiting.

This outburst lasted about three minutes. Then slowly Cassandra came back into herself and grew quieter. She was still laughing in a rather peculiar way. It was almost what I’d describe as a lascivious, sleazy kind of laugh. Certainly it implied sexuality to me, which, I suppose, given the “snakes” and the outburst regarding “ding-dong,” “willy,” and “Peter,” was perfectly possible.

Still I said absolutely nothing. I kept my expression as bland as possible so that she would not interpret my silence as disapproving, but I continued to sit motionless.

At last Cassandra fell completely quiet. The interesting thing about this episode, to my mind, was that not once did she take her eyes off me during the whole course of it. Her eye contact was quite extraordinary, but it also implied to me that my reaction was very important to this whole little drama. I sensed she was doing it for me, that she was expecting me to behave in a certain manner as well and she had to keep a close watch in order to see what I was going to do or, possibly, to adjust her own behavior as necessary.

When she was finally reduced to sitting quietly again in the chair beside me, her great dark eyes still fixed on my face, I said, “You know, I think you did that as a way of getting away from what we were talking about. Sometimes magicians do that trick. They say, ‘Look over here,’ because they want your attention over here so that you aren’t paying attention to over there and they can hide something away without your noticing.”

There was a long, long silence. She pressed her hands together prayer fashion and pushed them down between her legs on the chair. Straightening her elbows, this pushed her shoulders up, like a frozen shrug. Her eyes were still locked on mine.

There was a flicker. She looked away for just a very brief moment, then back at me. “Can I go now?” she asked. “I’m tired. I’m done with this. I want to go back to the dayroom.”

The children’s psychiatric unit was on the seventh floor of the hospital. When one first came off the elevator and turned left, there was a long corridor that contained administrative offices, many of which were not affiliated with our unit. At the far end were the two sets of double locked doors through which one entered the unit itself. Immediately beyond the doors to the left was the nurses’ station, and to the right, the dayroom where the children gathered to relax and play when they weren’t in the unit classroom, attending therapy sessions, or participating in activities. The sleeping rooms were down two short corridors that branched off the opposite side of the dayroom from the nurses’ station. Most accommodated two children each, although there were four single rooms. All locked. In all, the unit could accommodate twenty-eight children between the ages of three and eleven.

Beyond the dayroom, to the left of the nurses’ station, was a third short corridor, and it was here where the two therapy rooms were, plus a miscellany of utilitarian rooms – an examination room, a med room, a walk-in linen room, and an odd little room that was about twenty feet long but only about six feet wide. Various kinds of technical equipment, like video cameras, recorders, and monitors, were stored just inside the door, whereas at the far end, there was a teeny, tiny kitchen, narrow as a boat’s galley.

It was down among these rooms that I had my office, which I shared with Helen, a clinical social worker, whose main task was liaising with children after they had left. Consequently, she spent only a small amount of time each week actually on the unit, and I normally had the office to myself.

The room was a curious mixture of the industrial and the macabre. A set of cast-iron pipes went through the room. This would have been ordinary enough, had they been in the corner of the room or ordinary-sized pipes, associated with something like the central heating. These, however, sprung up about three feet in from the near-side wall and varied in size between three and six inches in diameter, so it was like having a stand of trees in the office. Iron trees. Or rather, just their trunks, passing through the room.

Moreover, in the old days, the room had been used for electric shock therapy. This had long since been discontinued, but the evidence was still there in the form of odd knobs and disconnected wires and the indentations of long-since-removed equipment on the walls. These things had since been painted over, indeed, many times, giving them a blobby, indistinct form.

Midst this, Helen and I had managed to squeeze in our two desks, a large table, and two sizable bookshelves. As always, Helen’s side of the room was a triumph of order and organization. My side looked, as Helen succinctly put it, as if the condemned-building notice was overdue.

I had just returned to my desk from the session with Cassandra when there was a quick rap at the door, and it opened. Nancy Anderson stuck her head in. She was the charge nurse on the unit during the weekdays. In her fifties, a tall, strongly built woman of African American origins, Nancy had made a career of psychiatric nursing. She loved the job; she loved the kids, and decades of experience had given her a clear understanding of life’s absurdities, which meant her reaction to most things was a good laugh.

“This one’s for you,” she said, waving a piece of paper.

“What is it?” I asked and reached over for it.

“He’s asked specially for you. Read your research on elective mutism. Saw that article in the paper. Wants you.”

“Oh, good,” I muttered sarcastically.

I hated these – cases where the parents wanted a specific therapist or therapy – because they often came with wildly unrealistic expectations. Many were looking for miracle workers, nothing less, and it seldom worked out that miracles were in the cards.

“Harry’s looked it over,” Nancy said. “He says why don’t you arrange an opportunity to see the child sometime this week. There’s a space in his schedule to interview the parents next Friday, if that works for you. If they want to go ahead with something, if it looks right, there’s a space coming open on the unit a week next Wednesday.”

I took the paper from Nancy. “Geez. This is out in Quentin. Did Harry notice that?”

Nancy lifted her eyebrows in a “no idea” expression.

“That’s almost two hundred miles. It’s going to take over three hours of driving just one way. It’ll use up my entire day just to observe the kid for forty-five minutes.”

“I think that’s why they’re thinking of inpatient.”

“Surely they’ve got services in Quentin.”

“Well, they want you.”

I started reading. It was a personal letter from a man named Mason Sloane. He was the grandfather of the boy in question and the letter was written on the letterhead of a well-known regional bank.

Oddly, to my mind, the first thing Mr. Sloane established was his family business pedigree. They were majority shareholders in the bank, which had been founded in the late 1800s by his grandfather. Ownership and operation of the bank had passed from father to son through the generations and was now managed by Mr. Sloane’s son, who was a prominent businessman in Quentin, a small city of about thirty thousand.

What drew Mr. Sloane to me was an article he had read in the city’s Sunday newspaper about my research into elective mutism. He had a four-year-old grandson named Drake, his only child’s only child. The boy did not speak outside the home. Mr. Sloane said he was an exceptionally intelligent and lively boy; however, he had always refused to speak to almost everyone. The family had taken him to various specialists locally with no success. When Mr. Sloane read about my work, he knew here was Drake’s problem. And I was the solution. Drake had elective mutism and if he came to see me, he would be cured.

The rest of the letter outlined how money was no object nor was distance or effort. They’d do anything to see Drake had the help he needed and I was it. All I had to do was name my price and make the arrangements.

Sitting back in my desk chair, I sighed. The article he was referring to in the newspaper had been one of those things that had seemed like a good idea at the time I did it. This was before I’d gained any insight into how important it was to journalists to write dramatic stories, even if there wasn’t actually any drama in your work to write about, and how, if you did get suckered into talking about your favorite bit of research, a reporter desperate to prove to his boss he can write something more exciting than this week’s round of society weddings was not the best guy to open up to. What I had hoped would be an article providing general information on this surprisingly common childhood problem metamorphosed into pop psychology sound bites that not only had never come out of my mouth but also diminished my treatment methods, making them sound effortlessly, almost arrogantly effective, as if there were no margins for error at all.

There was more to worry about in Mr. Sloane’s letter, however. It was clear from the tone that he had already made several sweeping assumptions: that Drake was a perfectly ordinary boy just waiting to be cured, that “cure” was just a matter of finding someone with the magic to do it, and that enough money could fix anything.

The way the hierarchy was set up at the hospital meant each child who entered the unit was assigned his or her own team of specialists, which would include nursing and care staff, psychologists, occupational or physical therapists and educators from the unit, plus liaison people, who would continue to work with the child when he or she returned to the community. Each such team was always headed by a child psychiatrist. Even if one of us in an allied position had been responsible for referring a child to the unit with the intention of working more intensively on a problem ourselves, nonetheless, the case leader was still one of the psychiatrists. This was because the unit was, first and foremost, a medical facility. The child psychiatrists, by virtue of also being medical doctors, were thus always at the top of the pecking order. Moreover, it was they alone who were able to prescribe drug treatment in addition to the other forms of therapy.

I wasn’t known for being a natural team player, certainly not back in my teaching days, when I’d rather relished the “outsider” status provided by being in special education, and I had always been inclined to rebellion. However, I found this hierarchical approach worked well in the tightly structured hospital setting. I was grateful not to be in a position to make the ultimate decisions, which were often very gray and, thus, very difficult, and frequently had grave consequences. Even more, however, I enjoyed the intellectual stimulation provided by regular interaction with professionals whose background and training were very different from my own.

We had five child psychiatrists, four men and a woman, and they were, all of them, sharp, erudite individuals. My favorite among them was Dave Menotti, who was affable and witty and most likely to come down from “Heaven” – our term for the corridor on the floor above where the psychiatrists’ offices were – to fraternize with us. Harry Patel, however, was the psychiatrist I most looked forward to leading my team. He was a quiet man who seldom socialized, so it was hard to get to know him personally. A native of New Delhi – indeed, a fairly recent immigrant – he often gave the impression of not quite having a command of English, and this contributed to his slightly aloof nature. But this wasn’t true. Harry just didn’t waste words if none were needed. And Harry was stunningly good at what he did. I would have expected the difference of cultures to work against him, but this hadn’t happened. Indeed, perhaps it was this that gave him such astute powers of observation, because I found he could see depth even in the most ordinary of situations. Faint nuances of behavior, fleeting expressions, sighs, silences. He took them all in. He worked with incredible delicacy, never pushing the children, never leading, only following. I loved watching him in action, and I loved even more the chance at his guidance.

So, even though I had qualms about Mr. Sloane’s letter regarding his grandson, if Harry suggested we observe the child, I was happy to do so. Thus, I cleared my schedule, packed up my “box of tricks,” and set out for the long journey to Quentin.