a glance not to take certain musings of Dr. Ari Goldman seriously. “Isn’t it the intellect that makes the man? I mean, somewhere, there are freezers full of cryogenically frozen heads waiting for replacement bodies.”
“Where?”
“I don’t know. I thought I read that somewhere.”
Ari defended his idea. “I’m not really suggesting we toss some human’s thinker into the garbage and put Nate’s in. I’m just saying we might replace a section of brain, say after an accident or stroke, with positronic circuitry. If we can map the brain down to the molecular level, perhaps we could replace a misfiring synapse or two and cure all mental illnesses.” He gave Cody a pointed look that probably passed for return humor. “Maybe even your arachnophobia.”
“Hey! That’s a carefully guarded secret.”
Both men looked at Susan, who made a zipper motion across her lips.
The casual speculation convinced Susan her encounter with the protestor would neither get her banned from the study nor essentially killed, as Dr. Bainbridge had suggested in his initial lecture to all of the incoming residents. “If you don’t need me for anything today, I’m going back to the PIPU.”
Ari waved a gruff good-bye. Cody shrugged. “Without Payton Flowers, or the newest patient, your schedule has completely opened. We’ll call you if anything else comes up.”
That suited Susan just fine. She turned to leave.
“Oh,” Ari added, “I’m serious about letting us know if you find another subject. Someone desperate with nothing to lose.”
Susan realized if they had asked her the first day for patient suggestions, Monterey would probably have nanorobots circulating through her cerebrospinal fluid right now. The breakthrough with Nate had made even the controversial electroconvulsive therapy unnecessary. She wondered how the protestors would feel when the hospital and mother gave up the battle. Would they use Monterey’s improvement without ECT as an I-told-you-so victory for their agenda, or would the loss of a rallying point disappoint them? Would they savor their win and head for home, or would they channel their energy into a new cause, energized by their success?
Susan shook those thoughts aside. She had no real interest in the political aspects of medicine, other than simple curiosity. Her job was to see the patients, diagnose them, and make them better, to ease the burden on the children and parents in her charge. The journalists, protestors, and politicians could go to hell for all she cared. They mostly just got in the way of the practice of competent, proper medicine.
As Susan trotted down toward the bowels of the hospital, she studied her Vox to make certain she had not missed any pages or messages. Only one flashed up on the screen, a shorthand from her father wishing her a quiet, peaceful day. Susan smiled at the sentiment, touching the Kwik-key sequence to relay an “All’s well” in return. In fact, thus far, the powers that be seemed determined to keep her world quiet.
By the time Susan arrived on the PIPU, however, her streak appeared to have ended. As Saranne keyed her through the first of the doors, she said softly, “The Ansons are here.”
Susan did not know whether to smile or grimace, so she simply nodded. She appreciated that the Doctors Anson had not given up on their wayward daughter, or her caretakers; but the poor family had surely suffered enough. “Please tell me Shaden’s not pressuring them for discharge.”
“Not discharge,” Saranne assured her. “Just a simple home visit.”
Though it pained her to do so, Susan gave the suggestion serious consideration. When she had brought up the possibility of institutional care at rounds the previous week, the nurses, Stony and Clayton, and even Dr. Bainbridge had laughed. Few enough places accepted any patient for lifelong care, and none would consider a child, especially one so young, particularly a female. That had led to a discussion about inpatient psychiatry protocol, reasonable expectations, and ultimate objectives.
Susan had always understood that the eventual goal for every patient was discharge to home as quickly as possible. No one wanted to stay in the hospital longer than necessary. The intrusiveness, exposure to superbugs, and 24/7 noise were bad enough; but most patients could envision their bank accounts emptying as the hours ticked past. Third-party payers, especially the government, allowed set amounts of hospitalization time for specific diagnoses. Keeping patients longer required a ream of paperwork that brought every administrator, from the charge nurse to the CEO, down on the doctors’ heads. Inquiries often seemed more like inquisitions. Denials occurred frequently, forcing the choice between premature discharge and personal payment, which few people could afford.
Patients such as Sharicka made life especially difficult for physicians. Unlike most of the other PIPU patients, she had no evidence of psychosis or dementia. Personality disorders, even the antisocial type, were not justified diagnoses for inpatient therapy. Her youth further hampered them, as they could not even officially use the ASPD designation until she reached the age of majority.
They had to settle for ADHD, ODD, and conduct disorder, none of which sufficed for inpatient care, especially long term. Sharicka had serious and permanent issues; weeks, months, even years on the PIPU could not change her underlying problem. The treatment for her, and other children on the conduct disorder spectrum, was to medicate them to some tolerable baseline of comportment, teach the parents behavioral modification techniques, and wait for the future. Concern for imminent criminal actions was not excuse enough to interfere with anyone’s freedom, especially a child’s, whether with prison, an institution, or long-standing hospitalization.
Susan finally understood why the PIPU staff had discharged Sharicka to a therapeutic foster home after her first couple of weeks on the unit. Ultimately, everything the care team did had to bring, or at least attempt to bring, each patient one step nearer to discharge. So far, the Ansons’ insurance company had proven reasonable, but Sharicka only had to go a week or two without a violent incident for them to refuse further payment. It seemed inevitable given that Sharicka did seem truly determined to change this time. All too soon, Susan would have no choice but to discharge her, if not to her parents, then to another foster home.
Susan realized that refusing any type of visitation, then dropping Sharicka on the Ansons the day of her discharge did not serve anyone’s best interests. The purpose of home visits was to ease the patient back into everyday life as well as prepare the family for the future in gradually increasing increments. A single overnight would also reward Sharicka for trying and, with any luck, rekindle the hope her family had all but lost. “Does Sharicka even want a home visit?”
“She’s practically pleading.”
Susan walked down the hallway with Saranne, pausing to glance in the open doorway where Sharicka snuggled on her mother’s lap, her father hovering like a guard dog. He looked up as doctor and nurse walked by and gestured silently to Susan.
Susan held up a finger and nodded to indicate she would return shortly, then continued to the second massive iron door with Saranne. The nurse unlocked it, and they walked onto the unit and straight into the staffing area. Saranne could barely wait to ask, “What do you think?”
Susan found herself nodding quietly for too long. From the corner of her eye, she saw Shaden coming to join the conversation. “I . . . think . . . ,” Susan started without a clue as to how she intended to complete the sentence, “. . . it might be . . . possible.”
Shaden jumped right in, easily guessing the topic of the conversation. “She hasn’t done anything wrong in a while, Dr. Calvin.”
Susan wondered if Shaden even remembered that, earlier the same week, Sharicka had put a piece of a latex balloon into another child’s medication cup.
“Since she started taking her meds faithfully, she’s been so different.”
Susan had to admit Shaden made a good point. Sharicka did seem to have made a miraculous change in the last couple of days. “Maybe we should demand a full week of positive behavior before we inflict her on the world.”
“It’s just a home visit,” Saranne reminded Susan. “It’s routine. Most kids start those a week after they’re admitted.”
