"No," I said. "Jones isn"t exactly memorable."
"Jones, as in Charles L. Junior. Hotshot financier? The hospital"s primary money manager?"
"Don"t know him."
"That"s right-you don"t read your newsletters. Well, as of eight months ago he"s also chairman of the board. There was a big shake-up."
"The budget?"
"What else. Anyway, here"s the genealogy: Charles Junior"s only son is Charles the Third-like royalty. He goes by Chip-Ca.s.sie"s daddy. The mom is Cindy. The dead son was Chad-Charles the Fourth."
"All Cs," I said. "Sounds like they like order."
"Whatever. The main thing is, Ca.s.sie is Charles Junior"s only grandchild. Isn"t that wonderful, Alex? Here I am with a potential Munchausen by proxy that could explode in everyone"s face, and the patient"s the only grandchild of the guy who took away the free coffee."
3.
We got up from the table and she said, "If you don"t mind, we can take the stairs up."
"Morning aerobics? Sure."
"You hit thirty-five," she said, smoothing her dress and b.u.t.toning her white coat, "and the old basal metabolism goes to h.e.l.l. Got to work hard not to be lumpy. Plus, the elevators still move on Valium Standard Time."
We walked toward the cafeteria"s main exit. The tables were completely empty now. A brown-uniformed maintenance worker was wet-mopping the floor, and we had to step gingerly to maintain traction.
I said, "The elevator I took to your office was converted to key lock. Why the need for all the security?"
"The official line is crime prevention," she said. "Keeping all the street craziness out of here. Which to some extent is valid-there have been increased problems, mostly during the night shift. But can you remember a time when East Hollywood didn"t get bad after dark?"
We reached the door. Another maintenance man was locking it and when he saw us, he gave a world-weary look and held it open for us.
Stephanie said, "Reduced hours-another budget cut."
Out in the hallway, things had gotten frantic. Doctors blew past in boisterous groups, filling the air with fast talk. Families traipsed through, wheeling doll-sized veteran journeyors to and from the ordeals wrought by science.
A silent crowd was a.s.sembled at the elevator doors, clumped like human droplets, waiting for any of three lifts that had settled simultaneously on the third floor. Waiting, always the waiting . . .
Stephanie moved through deftly, nodding at familiar faces but never stopping. I followed close behind, avoiding collision with I.V. poles.
When we entered the bas.e.m.e.nt stairwell, I said, "What kind of crime problems have there been?"
"The usual, but more so," she said, climbing. "Car thefts, vandalism, purse s.n.a.t.c.hings. Some muggings out on Sunset. And a couple of nurses were a.s.saulted in the parking lot across the street a few months ago."
"s.e.xual a.s.saults?" I said, taking two steps at a time in order to keep up.
"That was never made clear. Neither of them came back to talk about it. They were night-shift floats, not regular staff. What I heard was that they were beaten up pretty badly and had their purses stolen. The police sent a community relations officer who gave us the usual personal safety lecture and admitted that, bottom line, there was little anyone could do to guarantee safety unless the hospital was turned into an armed camp. The women on the staff screamed a lot and the administration promised to have Security patrol more regularly."
"Any follow-through?"
"Guess so-you see more uniforms in the lots and there"ve been no attacks since then. But the protection came with a whole bunch of other stuff no one asked for. Robocops on campus, new badges, frequent ha.s.sles like the one you just went through. Personally, I think we played right into the administration"s hands-gave them an excuse for exercising more control. And once they get it, they"ll never relinquish it."
"C students getting revenge?"
She stopped climbing and looked down at me over her shoulder, smiling sheepishly. "You remember that?"
"Vividly."
"Pretty mouthy back then, wasn"t I?"
"The fire of youth," I said. "And they deserved it-talking down to you in front of everyone, that "Dr. Ms." stuff."
"Yeah, they were a pretty cheeky bunch, weren"t they." She resumed the climb, but more slowly. "Banker"s hours, martini lunches, sitting around shmoozing in the caf and sending us memos about increasing efficiency and cutting costs."
A few steps later she stopped again. "C students-I can"t believe I actually said that." Her cheeks were aflame. "I was obnoxious, wasn"t I?"
"Inspired, Steph."
"More like perspired. Those were crazy times, Alex. Totally crazy."
"Sure were," I said. "But don"t dismiss what we accomplished: equal pay for female staff, parents rooming in, the playrooms."
"And let us not forget free coffee for the house staff."
A few steps later: "Even so, Alex, so much of what we obsessed on seems so misdirected. We focused on personalities but the problem was the system. One bunch of C students leaves, another arrives, and the same old problems go on. Sometimes I wonder if I"ve stayed here too long. Look at you-away from it for all these years and you look better than ever."
"So do you," I said, thinking of what she"d just told me about trying for the division-head position.
"Me?" She smiled. "Well, you"re gallant to say so, but in my case, it"s not due to personal fulfillment. Just clean living."
The fifth floor housed children aged one to eleven who were not in need of high-tech care. The hundred beds in the east ward took up two thirds of the floor s.p.a.ce.
The remaining third was set aside for a twenty-bed private unit on the west side, separated from the ward by teak doors lettered THE HANNAH CHAPELL SPECIAL UNIT in bra.s.s.
Chappy Ward. Off limits to the hoi polloi and trainees, maintained by endowments, private insurance, and personal checks; not a Medi-Cal form in sight.
Private meant Muzak flowing from concealed ceiling speakers, carpeted floors instead of linoleum, one patient per room in place of three or more, TVs that worked almost all the time, though they were still black-and-white antiques.
This morning, nearly all twenty rooms were empty. A trio of bored-looking R.N."s stood behind the counter at the nursing station. A few feet away a unit clerk filed her nails.
"Morning, Dr. Eves," said one of the nurses, addressing Stephanie but watching me and looking none too friendly. I wondered why and smiled at her anyway. She turned away. Early fifties, short, chunky, grainy-skinned, long-jawed, sprayed blond hair. Powder-blue uniform trimmed with white. Atop the stiff hair, a starched cap; I hadn"t seen one of those in a long time.
The two other nurses, Filipinas in their twenties, glanced at each other and moved away as if spurred by a silent" code.
Stephanie said, "Morning, Vicki. How"s our girl doing?"
"So far so good." Reaching over, the blond nurse pulled a chart out of the slot marked 505W and handed it to Stephanie. Her nails were stubby and gnawed. Her gaze settled on me again. The old charm was still not working.
"This is Dr. Alex Delaware," said Stephanie, thumbing through the chart, "our consulting psychologist. Dr. Delaware, Vicki Bottomley, Ca.s.sie"s primary care nurse."
"Cindy said you"d be coming by," said the nurse, making it sound like bad news. Stephanie kept reading.
"Pleased to meet you," I said.
"Pleased to meet you." A challenging sullenness in her voice made Stephanie look up.
"Everything okay, Vicki?"
"Peachy," said the nurse, flashing a smile as jovial as a slap across the face. "Everything"s fine. She held down most of her breakfast, fluids and P/O meds-"
"What meds?"
"Just Tylenol. An hour ago. Cindy said she had a headache-"
"Tylenol One?"
"Yes, Dr. Eves, just the kid stuff, liquid, one teaspoon-it"s all in there." She pointed to the chart.
"Yes, I see," said Stephanie, reading. "Well, that"s all right for today, Vicki, but next time no meds-not even OTC stuff-without my approval. I need to authorize everything, other than food and beverage, that pa.s.ses between this child"s lips. Okay?"
"Sure," said Bottomley, smiling again. "No problem. I just thought-"
"No harm done, Vicki," said Stephanie, reaching over and patting the nurse"s shoulder. "I"m sure I would have okayed Tylenol. It"s just that with this kid"s history we"ve got to be super-careful to tease out drug reactions."
"Yes, Dr. Eves. Is there anything else?"
Stephanie read more of the chart, then closed it and handed it back. "No, not at the moment, unless there"s something you want to report."
Bottomley shook her head.
"Okay, then. I"m going to go in and introduce Dr. Delaware. Anything about Ca.s.sie you want to share?"
Bottomley removed a bobby pin from her hair and stuck it back in, fastening blond strands to the cap. Her eyes were wide-set and long-lashed, a soft, pretty blue in the tense, gritty terrain of her face.
She said, "Like what?"
"Anything Dr. Delaware should know, to help Ca.s.sie and her parents, Vicki."
Bottomley stared at Stephanie for a moment, then turned to me, glaring. "There"s nothing wrong with them. They"re just regular people."
I said, "I hear Ca.s.sie gets pretty anxious about medical procedures."
Bottomley put her hands on her hips. "Wouldn"t you, if you got stuck as much as she does?"
Stephanie said, "Vicki-"
"Sure," I said, smiling. "It"s a perfectly normal reaction, but sometimes normal anxiety can be helped by behavioral treatment."
Bottomley gave a small, tight laugh. "Maybe so. Good luck."
Stephanie started to say something. I touched her arm and said, "Why don"t we get going?"
"Sure." To Bottomley: "Remember, nothing P/O except food and drink."
Bottomley held on to her smile. "Yes, Doctor. Now, if it"s all right with you, I"d like to leave the floor for a few minutes."
Stephanie looked at her watch. "Break time?"
"No. Just wanted to go down to the gift shop and get Ca.s.sie a LuvBunny-you know those stuffed bunnies, the cartoons on TV? She"s crazy about them. I figure with you people in there, she should be fine for a few minutes."
Stephanie looked at me. Bottomley followed her glance with what seemed to be satisfaction, gave another tight laugh, and left. Her walk was a brisk waddle. The starched cap floated along the empty corridor like a kite caught in a tailwind.
Stephanie took my arm and steered me away from the station.
"Sorry, Alex. I"ve never seen her like that."
"Has she been Ca.s.sie"s nurse before?"
"Several times-almost from the beginning. She and Cindy have developed a good rapport and Ca.s.sie seems to like her too. When Ca.s.sie comes in, they ask for her."
"She seems to have gotten pretty possessive."
"She does have a tendency to get involved, but I"ve always looked at that as a positive thing. Families love her-she"s one of the most committed nurses I"ve ever worked with. With morale the way it is, commitment"s hard to find."
"Does her commitment extend to home visits?"
"Not as far as I know. The only home things were a couple I did, with one of the residents, at the very beginning, to set up the sleep monitor-" She touched her mouth. "You"re not suggesting she had something to do with-"
"I"m not suggesting anything," I said, wondering if I was, because Bottomley had chapped my hide. "Just throwing out ideas."
"Hmm . . . well, that"s some idea. Munchausen nurse? I guess the medical background fits."
"There"ve been cases," I said. "Nurses and doctors looking for attention, and usually they"re the really possessive ones. But if Ca.s.sie"s problems have always started at home and resolved in the hospital, that would rule her out, unless Vicki"s a permanent resident at the Jones household."
"She isn"t. At least not as far as I know. No, of course she isn"t-I"d know if she was."
She looked unsure. Beaten down. I realized what a toll the case was taking.
"I would like to know why she was so hostile to me," I said. "Not for personal reasons but in terms of the dynamics of this family. If Vicki and the mother are tight and Vicki doesn"t like me, that could sour my consult."
"Good point . . . I don"t know what"s eating at her."
"I a.s.sume you haven"t discussed your suspicion of Cindy with her?"