She reached down, touched Ca.s.sie"s forehead, then drew back her arm and let it drop to her side. After gazing down for several more seconds, she returned to the chair.
I said, "In terms of her suffering, there"s no evidence seizures are painful."
"That"s what Dr. Eves says," she said doubtfully. "I sure hope so . . . but if you"d have seen her afterward-she was just drained."
She turned and stared out the window. I waited a while, then said, "Except for the headache, how"s she doing today?"
"Okay. For the little she"s been up."
"And the headache occurred at five this morning?"
"Yes. She woke up with it."
"Vicki was already on shift by then?"
Nod. "She"s pulling a double-came on last night for the eleven-to-seven and stayed for the seven-to-three."
"Pretty dedicated."
"She is. She"s a big help. We"re lucky to have her."
"Does she ever come out to the house?"
That surprised her. "Just a couple of times-not to help, just to visit. She brought Ca.s.sie her first LuvBunny, and now Ca.s.sie"s in love with them."
The look of surprise remained on her face. Rather than deal with it, I said, "How did Ca.s.sie let you know her head hurt?"
"By pointing to it and crying. She didn"t tell me, if that"s what you mean. She only has a few words. Daw for dog, bah-bah for bottle, and even with those, sometimes she still points. Dr. Eves says she"s a few months behind in her language development."
"It"s not unusual for children who"ve been hospitalized a lot to lag a bit. It"s not permanent."
"I try to work with her at home-talking to her as much as I can. I read to her when she"ll let me."
"Good."
"Sometimes she likes it but sometimes she"s really jumpy-especially after a bad night."
"Are there a lot of bad nights?"
"Not a lot, but they"re hard on her."
"What happens?"
"She wakes up as if she"s having a bad dream. Tossing and turning and crying. I hold her and sometimes she falls back to sleep. But sometimes she"s up for a long time-kind of weepy. The morning after, she"s usually jumpy."
"Jumpy in what way?"
"Has trouble concentrating. Other times she can concentrate on something for a long time-an hour or more. I look for those times, try to read to her, talk to her. So that her speech will pick up. Any other suggestions?"
"Sounds like you"re on the right track," I said.
"Sometimes I get the feeling she doesn"t talk because she doesn"t have to. I guess I can tell what she wants, and I give it to her before she has to talk."
"Was that what happened with the headache?"
"Exactly. She woke up crying and tossing around. First thing I did was touch her forehead to see if she was warm. Cool as a cuc.u.mber. Which didn"t surprise me-it wasn"t a scared cry. More of a pain cry. By now I can tell the difference. So I started asking her what hurt and she finally touched her head. I know it doesn"t sound scientific, but you just kind of develop a feel for a child-almost like radar."
Glance at the bed. "If her CAT scan hadn"t come back normal that same afternoon, I would have really been scared."
"Because of the headache?"
"After you"re here long enough, you see things. Start thinking of the worst things that can happen. It still scares me when she cries out at night-I never know what"s going to happen."
She broke into tears again and dabbed at her eyes with the crumpled tissue. I gave her a fresh one.
"I"m really sorry, Dr. Delaware. I just can"t stand to see her hurt."
"Of course," I said. "And the irony is that the very things that are being done to help her-the tests and procedures-are causing her the most pain."
She took a deep breath and nodded.
I said, "That"s why Dr. Eves asked me to see you. There are psychological techniques that can help children deal with procedural anxiety and, sometimes, even reduce the pain itself."
"Techniques," she said, echoing the way Vicki Bottomley had, but with none of the nurse"s sarcasm. "That would be great-I"d sure appreciate anything you could do. Watching her go through her bloodwork is like . . . It"s just horrible."
I remembered what Stephanie had said about her composure during procedures.
As if reading me, she said, "Every time someone walks in that door with a needle, I just freeze inside, even though I keep smiling. My smiles are for Ca.s.sie. I try really hard not to get upset in front of her but I know she"s got to feel it."
"The radar."
"We"re so close-she"s my one and only. She just looks at me and she knows. I"m not helping her but what can I do? I can"t just leave her alone with them."
"Dr. Eves thinks you"re doing great."
Something in the brown eyes. A momentary hardening? Then a tired smile.
"Dr. Eves is wonderful. We . . . She was the . . . She"s really been wonderful with Ca.s.sie, even though Ca.s.sie won"t have anything more to do with her. I know all these illnesses have been horrible for her, too. Every time the E.R. calls her, I feel bad about putting her through it again."
"It"s her job," I said.
She looked as if I"d struck her. "I"m sure with her it"s more than just a job."
"Yes, it is." I realized the LuvBunny was still in my hand. I was squeezing it.
Fluffing its tummy, I put it back on the ledge. Cindy watched me, stroking her braid.
"I didn"t mean to snap," she said, "but what you just said-about Dr. Eves doing her job-it made me think about my job. Being a mother. I don"t seem to be pulling that off too well, do I? No one trains you for that."
She looked away.
"Cindy," I said, leaning forward, "this is a tough thing to go through. Not exactly business as usual."
A smile danced across her lips for just an instant. Sad madonna smile.
Madonna-monster?
Stephanie had asked me to keep an open mind but I knew I was using her suspicions as a point of departure.
Guilty till proven innocent?
What Milo would call limited thinking. I resolved to concentrate on what I actually observed.
Nothing grossly pathologic, so far. No obvious signs of emotional imbalance, no overt histrionics or pathologic attention-seeking. Yet I wondered if she hadn"t succeeded-in her own quiet way-in keeping the focus squarely on herself. Starting off talking about Ca.s.sie but ending with her maternal failings.
Then again, hadn"t I elicited confession? Using shrink looks, shrink pauses and phrases to open her up?
I thought of the way she presented herself-the rope of braid that served as her worry beads, the lack of makeup, conspicuously plain clothes on a woman of her social rank.
All of it could be seen as reverse drama. In a room full of socialites she"d be noticed.
Other things clogged my a.n.a.lytical sieve as I tried to fit her to a Munchausen-by-proxy profile.
The easy usage of hospital jargon: Spiking temps . . . pulling a double.
Cyanotic . . .
Leftovers from her respiratory-tech training? Or evidence of an untoward attraction to things medical?
Or maybe nothing more ominous than too many hours spent in this place. During my years on the wards I"d met plumbers and housewives and teamsters and accountants-parents of chronically ill kids who slept and ate and lived at the hospital and ended up sounding like first-year residents.
None of them had poisoned their kids.
Cindy touched her braid and looked back at me.
I smiled, trying to look rea.s.suring, wondering about her certainty that Ca.s.sie and she were able to communicate on a near-telepathic level.
Blurred ego boundaries?
The kind of pathologic overidentification that feeds into child abuse?
Then again, what mother didn"t claim-often correctly-a radarlike link with her baby? Why suspect this mother of anything more than good bonding?
Because this mother"s babies didn"t lead healthy, happy lives.
Cindy was still looking at me. I knew I couldn"t go on weighing every nuance and still come across as genuine.
I glanced over at the child in the bed, as perfect as a bisque doll.
Her mother"s voodoo doll?
"You"re doing your best," I said. "That"s all anyone can ask."
I hoped it sounded more sincere than I felt. Before Cindy could respond, Ca.s.sie opened her eyes, yawned, rubbed her lids and sat up groggily. Both hands were out from under the covers now. The one that had been concealed was puffy and bore needle bruises and yellow Betadine stains.
Cindy rushed over to her and held her. "Good morning, baby." New music in her voice. She kissed Ca.s.sie"s cheek.
Ca.s.sie gazed up at her and let her head rest against Cindy"s abdomen. Cindy stroked her hair and held her close. Yawning again, Ca.s.sie looked around until her eyes settled on the LuvBunnies on the nightstand.
Pointing to the stuffed animals, she began making urgent whining noises: "Eh, eh."
Cindy reached over and snagged a pink animal. "Here you go, baby. It"s FunnyBunny and he"s saying, "Good morning, Miss Ca.s.sie Jones. Did you have a good dream?" "
Talking softly, slowly, in the goofy, eager-to-please voice of a kiddy-show host.
Ca.s.sie s.n.a.t.c.hed the doll. Holding it to her chest, she closed her eyes and swayed, and for a moment I thought she"d fall back asleep. But a moment later the eyes opened and stayed that way. Big and brown, just like her mother"s.
Her big-eyed gaze jumped around the room once more, swinging in my direction and stopping.
We made eye contact.
I smiled.
She screamed.
5.
Cindy held her and rocked her and said, "It"s okay. He"s our friend."
Ca.s.sie threw the LuvBunny on the floor, then began sobbing for it.
I picked it up and held it out to her. She shrank back and clung to her mother. I gave Cindy the doll, took a yellow bunny from the shelf, and sat back down.
I began to play with the animal, manipulating its arms, chatting nonsense. Ca.s.sie continued crying and Cindy kept up a quiet, comforting patter, too soft to hear. I stayed with the bunny. After a minute or so, Ca.s.sie"s volume dropped a notch.
Cindy said, "Look, honey-you see? Dr. Delaware likes the bunnies, too."
Ca.s.sie gulped, gasped, and let out a wail.
"No, he"s not going to hurt you, honey. He"s our friend."
I stared at the doll"s overbite and shook one of its paws. A white heart on its belly bore yellow letters: SillyBunny and the trademark . A tag near its crotch said MADE IN TAIWAN.