any kind occurring before age ten.
“And it’s definitely psychiatric this time,” Susan said without a hint of doubt. “She’s had the most complete workup for medical illnesses I’ve ever seen in my life. They’ve tried every antianxiety drug ever invented, including some so old we didn’t learn about them in school. Her brain looks perfectly normal on MRI, even in the speech areas. On the other hand, the mutism started when she was involved in an auto accident that killed her father. No one knows exactly what happened, but she was firmly buckled into her booster and he . . . was not.”
Stony’s eyes glimmered. “So, what’s your theory, Susan?”
Susan had nothing to add. “I agree with everyone else. She suffered a major trauma, and the mutism is a conversion reaction. Somehow, not speaking binds her anxiety and guards her against future pain. It’s rare in children but not unheard of.”
“So.” Bainbridge sounded relieved the department seemed to have this patient in hand. “What are we going to do with her?”
Susan sighed. Monterey was not the uncomplicated patient she initially seemed.
Nevaeh stepped into the fray for the first time since rounds began. “What about homeopathic treatments? She might benefit from acupuncture or something naturopathic.”
Sensing another tirade from Dr. Bainbridge, Susan jumped in swiftly. “Monterey’s mother shopped her from healer to healer. She’s tried the whole gamut: faith, herbal teas, acupuncture, hypnotists, aminconmi, random ingredients of the Krebs cycle, mega doses of indiscriminate vitamins, Scientology, soul whisperers, psychics, you name it. When she started experimenting with toxic comas, child protective services stepped in and brought her here.”
The tirade came from Nevaeh instead. “Lots of natural products work, with no impurities and fewer side effects.”
Dr. Bainbridge’s cheeks purpled. “Sure they do. Some of the most potent drugs in history were natural: digitalis from foxglove, aspirin from willow bark, curare, muscarinic mushrooms, rattlesnake venom. Unfortunately, they were also all deadly poisons, most even at low dosages.”
Kendall could not help butting in. “I consider death a pretty significant side effect, even if it’s the only one.”
“Exactly.” Dr. Bainbridge launched into what Susan had tried to avoid. “We eventually discarded all of them for safer and more effective alternatives; yet people still insist on self-medicating with arbitrary doses of unproven plant substances, believing them safer.” He shook his head. “In the public mind, anecdotal ‘evidence’ and false promises trump science every time.”
Stony gave Susan a pleading look. She alone could get the proceedings back on topic, by applying them to Monterey Zdrazil.
Trying to remain diplomatic, without antagonizing Bainbridge, Susan cut in. “The technique we’re planning to use on Monterey isn’t terribly scientific, either. We’re trying to get permission for old-fashioned ECT.”
That shut down the discussion.
Nevaeh finally broke the silence. “So, we’re denigrating a few harmless herbal treatments; but we’re perfectly fine with frying a child’s brain?”
Stony’s eyes went round as coins. Nostrils flared all around the group. No one spoke to an attending like that, short of another attending.
To Susan’s surprise, Bainbridge did not fret over Nevaeh’s verbal attack, though he did give Stony a significant look. Apparently, he expected the R-3 to lecture the R-1s on appropriate behavior after rounds. “So, it’s perfectly fine to stab a child with pins and needles of no known benefit, fill her full of untested poisons, or bleed her with leeches; but using an effective, studied, painless technique is ‘frying her brain’?”
Apparently realizing her mistake, Nevaeh tried to fade into the background. Her defense came from an unlikely place.
“In all fairness,” Stony said, “ECT isn’t harmless.”
“I didn’t say ‘harmless,’ ” Bainbridge pointed out. “I said effective, studied, and painless. The decision is whether it’s worth a bit of potential memory loss to regain a life for this child.”
“Assuming it works,” Stony said. “Otherwise, it’s potential memory loss in a child for no gain at all.”
Stony had had a bit more time to consider the situation, having come on service a few days earlier. “I’m not saying I’m for or against it in this case. Just that there is an argument for both sides.”
Susan did not feel as neutral about the situation. “We’ve wasted six years already and tried everything else known to man, including much less tested and effective therapies. It’s not as if Monterey is a busy mute with an otherwise active life. She’s one step from catatonia, and she’s only twelve years old. She’s lost half her life to this already. This obviously isn’t going away by itself. We have to do something, and ECT appears to be all that’s left.” She glanced at Nevaeh. “At least all that’s logically left from a medical standpoint.”
Bainbridge smiled. “Let’s do it, then.”
Stony shook his head, and Susan knew where he had to go next. “We can’t. There’s a legal injunction against us.”
Bainbridge stared. “After trying everything else, her mom’s fighting this?”
“Not her mom. The Society for Humanity. The SFH.”
Bainbridge groaned. “Those god-awful ignorant protestors?”
“They’re defining it as torture and experimentation on a little girl.”
Bainbridge groaned louder. “So, what are we doing about it?”
“Fighting it legally. Looking for precedent for using ECT on a child.”
“So, in the meantime, she languishes here.”
“Apparently.”
As there seemed nothing more to say about Monterey, Susan moved on. “My last patient is Sharicka Anson, a four-year-old female of mixed race with juvenile conduct disorder.”
Bainbridge held up a hand. “Did you say ‘fourteen-year-old’?”
“Four-year-old,” Susan repeated.
“Four-year-old.” Bainbridge shook his head. “Four? As in baby?”
“Four, as in preschool. Definitely no baby.” Susan quoted from the chart, as she had yet to meet the child. “Three purported attempts at murder, two of them on the unit, and possibly more.”
“At four years old.” Bainbridge seemed incapable of getting past that point. “What kind of history does she have?”
“Adopted as an infant into a doting, professional family. Met milestones shockingly early. Sat up at two months, talked at six months, put words together by twelve months, carried on full conversations with adults before the age of two years.”
“That certainly doesn’t sound like an environment ripe for abuse.” Bainbridge shoved his glasses up his nose. “Though you never know.”
“Never missed a well exam. Got all her vaccinations on time. No documented injuries or bruises. Proud parents bragged about her early accomplishments, chalked them up to a lot of attention and reading to her every night. No history of questionable visits to the ER. Two older siblings, both adopted, with no difficulties at home or school. Child protective services noted some hostility from the parents, but not until the third thorough investigation.”
Kendall winced. “Which I imagine could make a saint turn hostile. Strangers with the authority of the state behind them grilling your children, your doctors, your school, your family and neighbors. Every little thing you’ve ever said or done scrutinized. Suspicions planted in the minds of all your acquaintances who figure CPS wouldn’t be investigating for
Susan had to agree. “Everything came out clean on investigation. No founded abuse.”
Bainbridge only nodded thoughtfully. “Halfway into the 2030s, and people still want to believe all children are sugar and spice. Physical diseases, cancer, asthma, metabolic syndromes, those are sad accidents of fate. Anything that goes wrong mentally has to be the parents’ fault.”
Sable finally spoke up. “Doesn’t heredity have the greatest influence on personality?”
“Bingo.” Bainbridge jabbed a hand toward Sable. “There’s no question babies come with a preformed personality. What do we know about the biological parents?”
Susan wished she had had time to dissect Sharicka’s enormous chart. “I’m . . . not sure. I’ll have to check on
