“Do you think the mother really wants help?”
“For the girl? She says she does. But more important, the kid’s motivated. She’s the one who called the help line.”
“Seven years old and she called herself?”
“The volunteer on the line couldn’t believe it either. The line’s not intended for kids. Once in a while they get a teenager they refer to Adolescent Medicine. But Melissa must have seen one of their public service commercials on TV, copied down the number, and dialed it. And she was up late to do it- the call came in just after ten P.M.”
She lifted the Gladstone bag chest-high, popped it open, and pulled out a cassette.
“I know it sounds bizarre, but I’ve got the proof right here. They tape everything that comes over the line. I had them make me a copy.”
I said, “She must be pretty precocious.”
“Must be. I wish I’d had a chance to actually spend some time with her- what a neat kid, to take the initiative.” She paused. “What a hurt she must be going through. Anyway, after I listened to the tape I phoned the number she gave the volunteer and reached the mother. She had no idea Melissa had called. When I told her, she broke down and started to cry. But when I asked her to come in for a consultation, she said she was ill and couldn’t. I thought it was something physically debilitating, so I offered to go out there. Hence, my Gothic home visit.”
She held the tape out to me. “If you’d like, you can have a listen. It’s really something. I told the mother I’d be talking to a psychologist, took the liberty of giving her your name. But don’t feel any pressure.”
I took the cassette. “Thanks for thinking of me, but I honestly don’t know if
“She can come to the other side of town- Melissa can. A servant will bring her.”
I shook my head. “In a case like this, the mother should be actively involved.”
She frowned. “I know. It’s not optimal. But do you have techniques that can help the girl at all without maternal involvement? Just lower her anxiety level a bit? Anything you did might reduce her risk of turning out totally screwed up. It would be a real good deed.”
“Maybe,” I said. “If the mother doesn’t sabotage therapy.”
“I don’t think she will. She’s antsy, but seemed to really love the kid. The guilt helps us there- think how inadequate she must feel, the kid calling in like that. She knows this isn’t the right way to raise a child but can’t break out of her own pathology. It’s got to feel horrible for her. The way I see it, this is the right time to harness the guilt. If the kid gets better, maybe Mom’ll see the light, get some help for herself.”
“Is there a father in the picture?”
“No, she’s a widow. It happened when Melissa was a baby. Heart attack. I got the impression he was a much older man.”
“Sounds like you learned a lot from a brief visit.”
Her cheeks colored. “One tries. Listen, I don’t expect you to disrupt your life and drive out there on a regular basis. But getting a referral closer to home wouldn’t make any difference. Mom never leaves to go
“Okay.”
“I know I sound overinvolved and maybe I am- but the whole idea of a seven-year-old calling in like that… And that house.” She raised her eyebrows. “Besides, I figure it won’t be long before my practice really gets crazy and I don’t have the time to give anyone this kind of individual attention. So I might as well enjoy it while I can, right?”
Another reach into the Gladstone. “Anyway, here’s the relevant data.” She handed me a piece of note paper topped with the logo of a pharmaceutical company. On it she’d printed:
Pt: Melissa Dickinson, DOB 6/21/71.
Mom: Gina Dickinson.
And a phone number.
I took it and put it in my pocket.
“Thanks,” she said. “At least payment won’t be a hassle. They’re not exactly Medi-Cal.”
I said, “Are you the physician of record, or do they have someone they’ve been seeing?”
“According to the mother, there’s a family doctor in Sierra Madre that Melissa’s seen occasionally in the past- immunizations, school physicals, nothing ongoing. Physically, she’s a very healthy girl. But he’s not really in the picture- hasn’t been for years. She didn’t want him contacted.”
“Why’s that?”
“The whole therapy thing. The stigma. To be perfectly frank, I had to do a sell-job. This is San Labrador we’re talking about; they’re still fighting the twentieth century. But she will cooperate- I got a commitment out of her. As to whether or not I’ll end up being their regular doc, I don’t know. Either way, if you want to send me a report, I’d sure be interested in finding out how she does.”
“Sure,” I said. “You just mentioned school physicals. Despite the fears, does she attend classes regularly?”
“She did until recently. Servants drove her and picked her up; parent-teacher conferences were conducted over the phone. Maybe in that neck of the woods it’s not that strange, but it can’t have been great for the kid, the mother never showing up for anything. Despite that, Melissa’s a terrific student- straight A’s. The mother made a point of showing me the report cards.”
I said, “What do you mean by “until recently’?”
“Lately she’s been starting to exhibit some definite symptoms of school phobia: vague physical complaints, crying in the morning, claiming she’s too scared to go to school. The mother’s been letting her stay home. To me that’s a big fat danger sign.”
“Sure is,” I said. “Especially with her role model.”
“Yup. The old biopsychosocial chain. Take enough histories and all you see is chains.”
“Chain mail,” I said. “Tough armor.”
She nodded. “But maybe we can break one this time, huh? Wouldn’t that be uplifting?”
I saw patients all afternoon, finished a stack of charts. As I cleared my desk I listened to the tape.
FEMALE ADULT VOICE: Cathcart help line.
CHILD’S VOICE: (
ADULT VOICE: Help line. How may I help you?
CHILD’S VOICE: Is this (
AV: This is the Cathcart Hospital help line. What can I do for you?
CV: I need help. I’m…
AV: Yes?
AV: Hello? Are you there?
CV: I… I’m scared.
AV: Scared of what, dear?
CV: Everything.
AV: Is there something- or someone- right there with you, scaring you?
CV:… No.
AV: No one at all?
CV: No.
AV: Are you in some kind of danger, dear?
