The Reach

revealed a black man in blue janitor's overalls pushing a mop across a bare floor; he smiled as he glanced at them and then away, his mop moving with more purpose.

'That's Jeffrey,' Wasserman said, after they'd passed. 'He's sort of a jack-of-all-trades around here, I've had him for years. He cleans up the place, acts as a general handyman, even helps with the patients. They love him.'

The raised voices of children grew louder as they turned a corner and passed by the empty cafeteria. 'Forgive me,' she said, 'but you seem young to be running a place like this.'

'My grandfather started a clinic many years ago in West-wood, and moved to this location when I was just a boy. He was a great man. I'm simply following in his footsteps.' Wasserman stopped in front of a set of wide double doors. 'This is one of my favorite places.'

Inside the carpeted room were different kinds of play sets, tunnels and rings, blocks, tables, and chalkboards. Eight or nine children crawled and tumbled over themselves and played with several white-shirted adults, and for a moment Jess was fooled into thinking she was in a playroom like any other, before the details bled through. Wire mesh over the windows. A child of perhaps six in the corner rocking slowly back and forth in repeated, rhythmic motion, another muttering to himself and patting his head roughly with his palm. A third rubbing her chapped hands together again and again over a plastic toy sink.

She had done group casework before, assisted in community outreach programs, visited hospitals and sat in on counseling sessions. But this would be different.

Face it, head-on. This is what you want, what you need.

Her brother's death had given Jess a deep resolve to make the health care environment easier and more accessible for mental health patients, especially children. It had been a long road, but now here she was and it was time to put up or shut up.

'We try to keep the numbers down,' Wasserman was saying. 'They're easily distracted.'

'Is she here?'

'Sarah? Oh no. These children are minimally supervised and generally nonviolent. We've had to keep her separated for some time now.'

A young man spotted them from across the room. He moved in a sidestep, shuffling motion, skirting the younger children and coming to their side like a nervous bird looking to be fed. 'Twenty-three. Twenty-three steps.'

'Hello, Dennis.' Wasserman smiled. 'Dennis helps out with the younger children.'

'Do I go to bed early tonight?' Dennis said. He had a plump, boyish face; he was dressed like a boy of six or seven, red baseball cap, blue striped pullover shirt and blue shorts, Velcro shoes with long, white socks pulled up almost to his knees. The stubble on his cheeks stood out in awkward contrast to the rest of him. 'Is it Thuuuurrrs- day? Thursdays are early nights. Friday I go outside. Not Wednesday.'

'This is Miss Chambers, Dennis. She'll be visiting us for a while. You might see her, and if you do I don't want you to be afraid. She's our friend.'

'Do you love me? Then say it. Sa-aaay it.'

'I love you, Dennis.'

'I make her spirit glow.' Dennis smiled brightly and shuffled away, muttering to himself and pulling at the brim of his cap.

'One of our roles here is to place various psychopathologies in a developmental context. Most of Dennis's mannerisms would not seem all that out of place in a four-year-old. However, in a boy of almost eighteen, they are extreme. At the core is our belief that most adolescent pathologies stem from normal childhood development.'

'Sigmund Freud.'

'He pioneered the concept, yes.'

'But you don't adhere to his theory of psychosexual development.'

'Not as a general rule. Piaget's cognitive theory is more appropriate.'

They watched the group of children for a moment. 'There are things to learn about each of them,' Wasserman said. 'For example, Dennis doesn't like to be touched. Most of the time he's harmless and quiet, but if you touch him he'll become extremely agitated. That is a simple rule. For Sarah, you'll have to learn more.'

'And what about biological causes of mental disorder?'

Wasserman looked at her like a parent at a misbehaving child. She was suddenly aware that he was lecturing to her. 'This is a progressive facility, Miss Chambers. Our staff is well educated. We treat chemical imbalance with medications, and provide support with play therapy and modeling.'

Wasserman turned and proceeded out the door. After a moment, and a deep breath to calm her singing nerves, Jess followed, her briefcase tucked tightly under her arm.

'Sarah's in the basement level at the moment, in one of our quiet rooms,' Wasserman said, as they walked to a set of elevators next to the fire stairs. 'You might be a bit shocked at first by her appearance. Let me assure you that everything has been done to make her life here as comfortable as possible. However, she's been very difficult recently. There are precautions that must be taken in regards to her safety and that of those who work around her. She's deceptively strong, and as I said before, she can be very clever.'

'I'm curious, Doctor. Why did you introduce me to Dennis?'

'To show you that not all of our guests are so severely restricted. And to see how you reacted to him.'

'I hope I didn't disappoint you.'

'It's important that they not sense your discomfort. If you're unsure of how to proceed in a given situation, and all of us are at some point, it is best to refer to your superior.'

The elevator doors opened onto another world. Heavy cinder block walls and bare concrete floors met them as they stepped from the elevator into a narrow rectangular room. The overhead lighting was bright and unwavering, but it was the shadows Jess noticed. Clinging like cobwebs to the corners, they disappeared when she turned her gaze on them, but then returned to lurk at the edges of her sight. Perhaps it was her mood.

A heavy woman wearing a white coat stepped out from behind a desk as they approached. She was large through the shoulders and hips and very dark-skinned, and moved with a quiet shuffle so that she seemed to avoid the light, slipping through it like one of the shadows.

'This is Maria. She'll be here whenever you need anything. Maria is well trained in handling our difficult patients. And her English is getting much better. Isn't that so?'

'Si,' Maria said. Pockmarked skin stretched across darkly plump cheeks. Her expression was inscrutable, but her eyes darted nervously back and forth. 'Gracias, thank you.'

They entered a corridor lined with solid metal doors on either side, each of them with an eye-high, centered window. The air smelled damp with the slightest hint of lemon cleanser.

Jess could hear noises from behind the walls, thumps and muffled shouting. She concentrated on Wasserman's back as he spoke over his shoulder.

'Most of our patients are assigned a counselor and a team that works together to ensure that things are progressing. I've taken a personal interest in Sarah, and in this instance you'll be working directly with Maria and myself. Often you'll be alone. Sarah tends to react badly to crowds.' Nearly at the end of the corridor, he stopped at a door and turned to her. 'Are there any more questions before you have a look?'

About a million of them. Jess squared her own shoulders and faced him. 'I have to admit here, Dr. Wasserman, I don't feel comfortable with what you've given me. Really it would be better if I could study the file. I need to know what tests she's been given, what sort of diagnoses have been made--'

'Sarah has a schizophreniform psychotic disorder. She was diagnosed at age six. As I'm sure you're aware, diagnoses of this sort prior to six years of age are extremely rare. Sarah was always difficult, but by her sixth birthday she was showing signs of marked withdrawal, looseness of association, and a breakdown of reality testing. There were hallucinations--'

'I understood that those didn't start until early adolescence.'

'Not in this case.' Wasserman paused and seemed to choose his words carefully. 'Sarah began to believe. . . still believes. . . that she could influence people. That she could bend things to her will. Fantasies of omnipotence are not uncommon--again, this stems from early childhood--but in Sarah these fantasies extended far beyond the normal stages. And then the phobias and the suicide attempts began. Recently she has grown so uncontrollable that we've had no choice but to confine her to the basement for good portions of the day. She fought us by