that.”
Bainbridge looked around the nurses. “Anyone?”
For several moments, the nurses looked among one another until one finally spoke up. “Dr. Bainbridge, I don’t mean to be obstructionist, but we’re not sure about Sharicka’s diagnosis.” She glanced at her colleagues for support, and several of them gave strong nods of agreement. “She really is a darling little girl, and we think she might do fine in the right environment.”
Susan could scarcely believe what she was hearing. The doctors’ notes had clearly documented a long history of violent acts and an obsession with drowning and other forms of murder. “Didn’t she attempt to drown another patient in the toilet?”
The nurse’s pale cheeks acquired a reddish hue. “Well, yes. But we don’t know exactly what happened there. We think the other child might have baited her into it.”
Susan had read about the incident. Not only had Sharicka not denied being the aggressor, she had explained her intent to drown the other child with a smile plastered on her face. The other patient told a story of being lured to the bathroom with the promise of seeing a tiny alligator in the bowl. “And didn’t she assault a staff member and beat her head against a window?”
The cheeks turned even more crimson. “I wasn’t here when it happened, but the staff member quit soon after. She wasn’t well liked, and we think the staff member exaggerated what happened. Other than those two incidents, which have other plausible explanations, she hasn’t done anything bad here.”
Bainbridge had a thoughtful smile on his lips. “Does that ring a bell for any of you?” He looked around the residents, brows inching upward.
It did for Susan. During the summer breaks between her years of medical school, she had worked at a veterans’ psychiatric institution. She had met a patient there who had made her feel competent beyond her years. He had convinced her that she alone had broken through his desperation and loneliness, that only her brilliant diagnoses and soothing manner had worked for him. Later, she had learned about his borderline personality disorder and the ability these patients had to manipulate those around them, especially caretakers. The patient had won over every one of the nurses the same way, each believing his or her special manner and expertise had brought about remarkable changes in the patient. All of them had petitioned for extra favors, treats, or services for him.
Before Susan could speak, Nevaeh took a reasonable guess. “Schizophrenia?”
“Schizophrenia.” Bainbridge fixed his gaze fanatically on Nevaeh.
“In schizophrenia, it’s the patients who have the delusions.”
Everyone chuckled nervously at the obvious joke, which clearly insulted someone. Susan realized he aimed it at the nurses who defended criminal behavior, but they might see it as referring to the parents and alleged victims of Sharicka’s antics. Susan gave the correct answer: “Antisocial personality disorder.”
Bainbridge tapped his nose and pointed to Susan suddenly, like a game show host. “Definitely a personality disorder. Most likely antisocial type. Another possibility.” He whirled abruptly, and Monk Peterson guiltily hid his arm behind his back. “You, there. The one named after a television character.”
“Monk.” The R-1 chewed his lip as he sorted through the information in his mind. “Um . . . fetal alcohol syndrome?” He waited tensely for a reaction.
“Is that a question? Or an answer?”
“Fetal alcohol syndrome,” Monk said more confidently.
“Good thought.” Bainbridge whirled back to Susan. “History of alcoholism in the mother?”
Susan shook her head. “Sharicka was adopted as an infant. Her parents gave up all social drinking when they first started trying to get pregnant, fifteen years ago. There’s no alcohol in the house. Birth mother denied alcohol or drug use during the pregnancy, but nearly all of them do, whether or not it’s true.” Susan could understand a birth mother lying in order to ensure her child the best possible placement. “When I examine Sharicka, I’ll watch for small palpebral fissures and indistinct philtrum.”
“And flattened cheekbones,” Monk added.
“And flattened cheekbones,” Susan agreed. “But even without any of those features, she could still have all the behavioral and emotional disabilities. ARND.” Susan carefully remembered the individual words of the acronym. “Alcohol-related neurodevelopmental . . .” It seemed as if it ought to have another letter.
“Disorder,” Monk finished.
“So far,” Susan said, “treatment has focused on controlling Sharicka’s behaviors and getting her home, not on the cause of those behaviors.”
Bainbridge gave Susan a stern look. “And, yet, the cause is important to know. Why, Susan Calvin?”
Susan was up to the task. “Because it can make a difference in our treatment, Dr. Bainbridge. Or explain our failures. For example, fetal alcohol and ARND still have no known effective treatment. Nevertheless, it’s becoming far less frequent due to prevention, prenatal testing, and educational programs.”
“Good.” Bainbridge finally took his intensive focus completely off Susan. “Now, who would like to present his patients next?”
For the next two hours, the other residents described a fascinating parade of juvenile patients with diagnoses ranging from uncommon psychoses to exceptionally rare organic forms of dementia. Some were newly diagnosed and still being evaluated, while working treatments were still being sought for the more chronic patients.
Of the sixteen other patients, four had severe forms of schizophrenia, including one who was so catatonic that she had not moved or spoken in almost a year. Three had temper dysregulation disorder, previously called childhood bipolar syndrome, and another suffered from psychotic depression, as did Diesel. Two had brain damage from tumors, two from drug use, and one from serious trauma. Susan found the last three most interesting. A patient of Kendall’s had terminal primary liver cancer. Sable had a patient with an uncontrollable epileptic syndrome that kept her so sleep-deprived that she had lost touch with the real world. The last was Monk’s patient, a seven- year-old boy with an, as yet, inexplicable dementia.
Susan left rounds energized about helping her own patients as well as looking forward to the next day’s rounds and finding out what her companions had done for theirs. She had a feeling she was in for a difficult, but fascinating, ride.
Chapter 6
The door to the Calvins’ apartment swung open before Susan could insert the proper thumb into the scanner. John caught her up in an embrace on the threshold. His familiar, strong arms winched around her, and he rested his chin on the top of her head. “Hi, Susan. How was your . . . days?”
Susan chuckled. “Interesting in so many ways.” She wriggled free. “And you might regret hugging me. They keep the unit hotter than I like, and the on-call shower sucks.”
“You smell fine,” John Calvin assured her, ushering her inside. He was slender to the point of gauntness, with the same pale blue eyes and straight brown hair as Susan, though he wore his short.
Susan stepped inside the main room and looked around at furnishings that now showed a hint of her decorating taste, as well as her father’s. John had always kept things simple. Silver tubing framed myriad glass shelves holding everything from a stereo/television system to notebooks filled with his small, neat writings. The walls had held only black-and-white diplomas and a single color picture of the only woman he had ever loved: Amanda Calvin, Susan’s mother. As a child, she had memorized every detail, every line, and she suspected her father had done the same. Since moving in, Susan had added a handful of tasteful paintings, with splashes of blues, greens, and reds.
John closed the door behind his daughter. “I have a casserole ready and waiting for you in the kitchen.”
That intrigued Susan. Her father’s casseroles were a mishmash of whatever remained in the refrigerator. Despite their experimental nature, they always wound up tasting at least reasonably good, if only because he had a keen eye when it came to shopping, especially for fruits and vegetables.
Susan walked through the den into the kitchen. She barely glanced at the familiar cupboards or the refrigerator/freezer, which still sported her childhood drawings clamped to the stainless-steel surface with animal- shaped Happeez. She took her usual seat and waited for her father to serve. He would have already eaten, she
