Denial (3 page)

I took the chart to a sitting area just across from his office and began to read through it.  The admitting psychiatrist's initial not was dated December 11, 1992:

IDENTIFYING DATA:  The patient is a middle-aged male with no know address who was brought to the emergency room by the police and then admitted to the locked psychiatric unit.  He gave his name as General William C. Westmoreland.

HISTORY OF PRESENT ILLNESS:
 
According to police, Mr. ‘Westmoreland’ stole a marble bust of the Madonna from the altar of the Church of Angels during Sunday services today.  He was found by officers at the Lynn Common seated on a park bench embracing it.  On direct questioning he informed them that he was in love with the statue, intended to bring it back to life and planned to marry it.

On admission, the patient repeated his belief that he has the power to ‘breathe life into’ the Madonna.  He was extremely upset that the carving had been taken from him.  His affect alternated between rage and despondency.  At several points during our interview he broke into tears.

Mr. Westmoreland did not respond to questions about his perceptions, but seemed preoccupied with internal stimuli.  It is likely that he is experiencing both auditory and visual hallucinations.

The patient denied homicidal ideation but remained mute when questioned about suicidal thoughts.

Blood and urine toxic screens for alcohol and illicit drugs were negative.

The fact that the patient has adopted the name of a well-known general would suggest that he is a veteran of the conflict in Vietnam, but he does not confirm this.  Nor does he respond to questions about his Social Security number, last address or actual family name.

PAST PSYCHIATRIC HISTORY:
Unknown.  The patient does, however, have a series of horizontal scars on his left wrist suggesting a past suicide attempt.

PAST MEDICAL HISTORY:
 
Unknown

ASSESSMENT AND PLAN:
 
The patient clearly suffers from a psychotic condition that may prove to be chronic paranoid schizophrenia or a delusional depression.  In either case the use of antipsychotic medications is indicated and will be initiated.  Antidepressant medication will be considered.  We will continue to monitor Mr. Westmoreland's safety carefully, given his refusal to answer questions related to suicidality.

Tom Klein, M.D.

Attending Physician

Stonehill 3

According to the daily progress notes on the chart, Westmoreland had refused to take any of the medications prescribed for him.  Dr. Klein had filed a substituted judgment motion with the Lynn District Court and gotten permission to inject him three times a day with an intramuscular preparation of Thorazine.

Westmoreland had fought against the injections for days, spending as long as six hours at a stretch in  a seclusion room, tied down in four-point restraints.  But within a week Klein's notes described him as ‘greatly improved’; first he willingly accepted the shots, then he agreed to take his medicine by mouth.  Ten days after being admitted, he assured the treatment team he had no feelings whatsoever for the statue.  He was discharged to the Lynn Shelter with a supply of Thorazine and an outpatient appointment at a local clinic.  The unused, two-year-old bottle of Thorazine found on him at the crime scene probably meant he'd never followed up.

I smirked, thinking about the ‘dramatic ten-day recovery’ from a ‘paranoid schizophrenic reaction’ that Klein had documented in Westmoreland's discharge summary.  There was a serious flaw in his reasoning:  Thorazine takes about three weeks to stop psychotic thinking.

I was suddenly aware of someone standing over me.  I looked up and saw Kevin Malloy.

"The pieces seem to fit together, don't they?" he taunted.  "Her blood all over him.  Him being a patient where she worked.  And — this just in from your buddy Levitsky:  Sperm from someone with Westmoreland's blood type was inside her.  But, you know, you can never be too careful with a killer's rights.  Maybe we should wait to take a confession until someone can show us a fucking videotape of him cutting her up."

I got to my feet, moved within a foot of him and looked straight into his black eyes.  "You'd like to watch a snuff film like that, wouldn't you?  I can tell.  You'd enjoy the panic in a woman's face the moment she realizes her life is about to be drained, that she's looking into the last face she'll ever see.  You dream about crossing the line."

He stared at me for a few seconds.  "You don't know jack shit about me," he said.

I handed him the chart.  "You can only hope," I said, then walked past him.

*            *            *

I found Kathy in the oversized closet that passes for a doctor's on-call room.  She was wearing scrubs, sitting on the bed writing out her obstetrical note.  "Seven pounds, ten ounces," she said, glancing at me.  "I swear I saw him smile at his mother when she held him."

I sat next to her but said nothing.  I was born shy of five pounds to a mother so mortified by the look of pregnancy that she starved to keep her girth in check.  Images of maternal bliss have never moved me.  "I'm sorry about Sarah," I said.

She slipped her pen into her shirt pocket and let her head fall into her hands.  "Who did it?" she asked.

"A man with schizophrenia turned himself in."

She gazed up at the ceiling.  "Was she shot?"

"He used a knife."

A tear started down her face.  "Did he, you know... Did he... do anything else?"

"Yes.  He did.  He raped her."

"He
raped
her?"  She stared at me, and her expression changed gradually from sad to confused.  She leaned so close to me I could feel her breath, then, suddenly, drew back like she had smelled something rancid.  "You're doing coke!"

The call room is just off the main hospital corridor.  "Quiet down, damn it," I said.

"Don't talk to me like a fucking child!"  She stood up.  "I can't believe you'd go back to it.  You're not even five months out of detox."

I got up and looked in the mirror.  There was white powder just under my nose.  I wiped it away and turned to her.  "You should be a cop."

"You fucking bastard," she sputtered, shaking her head.  "Don't you think I've lost enough?  Do I have to wake up and find you stroked out next to me in bed?"

"I'm not going to die on you, Kathy."

She tried to push past me.

I backed up against the door.  "I'll get off it as soon as this case is over.  I promise."

"Don't waste your breath.  I don't care what you have to say."

"You never do."

"Oh, you poor, misunderstood boy.  Let me see if I have it right:  You have to get high because I'm not sensitive enough to your needs."  Her lip curled.  "What bullshit."

I took a step toward her and laid my hands gently on her shoulders.  "Let's talk about this at home."

"I'm not coming home.  I had more than my fill five months ago."

I lost it.  "You had more than your fill of me — or Trevor Lucas?  Half the goddamn hospital still talks about you shacking up with that egomaniac while I was sweating my balls trying to get clean."

"Funny — before you got sober I would have sworn you cared more about scoring drugs than you did about how often I was getting laid."

"So you decided a plastic surgeon could pinch-hit for a while.  That's loyalty, Kathy.  Real character.  You have another specialty in mind now?  A urologist might be kind of interesting for you."

Her face turned to pure defiance. "At least Trevor wasn't too wired to get it up."

I felt like smacking her, but I figured that was what she was looking for — to trade one kind of pain for another.  I took a deep breath.  "You and I going at one another isn't going to bring Sarah back."

"I don't need a shrink to tell me my friend isn't coming back from the grave.  OK?  And if you knew anything, you'd know that you're the only one I've ever wanted to bring back.  But you're too coked up to think."  She moved toward me and reached for the door handle.

I slipped in front of it.  "We're not finished."

She took two steps back and grabbed the pen out of her pocket, clutching it like a dagger.  She was trembling.  "Get out of my way.  Now."

I knew enough about Kathy's temper to know I could end up with anything from a dry-cleaning bill to eye surgery.  I eased over toward the bed.

She hurled the pen at me but missed.  It bounced off the wall.  "Don't call me or page me or come looking for me," she said through clenched teeth.  "We're through."  She stormed out.

Part of me wanted to follow her.  But I figured her anger would flip back into grief on its own.  I looked in the mirror to make sure there was no powder left on my lip, smoothed my turtleneck into my pants and walked out.

*            *            *

Gut feelings are not random events.  They are crystallizations of subtleties — things seen but not seen, heard but not heard.  So I listened to myself with my ‘third ear’ when I still couldn’t get my mind off one thing Levitsky mentioned at the autopsy.  Sarah had suffered no vaginal trauma.  I drove back to the morgue and let myself into his lab.

He didn't hear me come in.  He was hunched over a microscope examining slides of tissue he had taken — as he always put it,
harvested
— from Sarah's chest.  "She had serious fibrotic changes at the margins of the wound," he said for the microphone.

"Could be a smudge," I whispered.

He looked up at me and rolled his chair to one side.  "See for yourself."

I peered through the scope's eyepieces but had no idea what I was supposed to see.  I'd been happy to forget pathology after nearly failing the course in medical school.  "Terrible.  What is it caused by?"

"A bad case of fibrocystic disease, I'd have to say at this point.  The damage is serious enough to wonder about a pervasive connective tissue disorder — something like scleroderma that can really turn membranes to leather — but I don't find evidence for it in any other part of the body.  Her esophagus, for example, was soft and pink."

"I'm sure she'd be relieved to hear you speak of it that way, Paulson.  Did you determine time of death?"

"Midnight, give or take an hour."

"Westmoreland called the police just after three
A.M.
  That leaves plenty of time for him to have gotten rid of the knife — and the breasts."

"Cooked them up into a nice stew," Levitsky laughed.  "Is that Malloy a piece of work, or what?"

"He's a piece of crap.  But I've got something else on my mind."

"What's that?"

"You said you'd found no evidence of forced intercourse."

"Correct."

"No tears.  No hematoma.  No bruises.  No nothing."

"Right."

"And..."

"And what?"

"Westmoreland didn't tell me much, but he seemed clear on one thing:  He had sex with her.  And I hear you've found that his blood type matches whoever came inside her.  Do you see perfectly normal genital anatomy in cases of rape?  Rape and murder?"

"Not often."  Levitsky hated loose ends more than anyone I knew.  He let out a sigh.

"So tell me:  How come there's no vaginal damage?"

"Maybe she got too scared to keep fighting and just let it happen.  Maybe she had a thing for bums, and he killed her after they went to the moon together."

"Sure."

"Hey, I don't put anything past people."

"That's your answer?"

He shrugged.

"She wanted it?"

"What are you pushing for?  You're the maven on human behavior.  I just report what I see."

"So it's over, as far as you're concerned.  Case closed."

Levitsky smoothed a wrinkle from his lab coat.  "You forget who you're dealing with here?  Since when have you known me to
give up
?  I'm a compulsive, Frank.  A drill bit.  Sometimes the answer comes to me in my sleep.  I've literally had dreams about the aorta.  And the appendix.  I once dreamed I was a bacterium —
Clostridium difficile
to be exact — and I was eroding my cadaver's ulcerated colon.  I stained for Clostridium in the morning and, sure enough, found it."  He was getting overly excited.  "I've been a fucking cytomegalovirus during a five-minute nap on my couch between sitcoms, my friend.  And these things don't just visit me in my sleep.  I might be eating rigatoni—"

I held up a hand.  "I get the picture.  You're not signing off."

"No.  But our friends at the police station would like me to.  Malloy's already called me three times to ask when my final — accent,
final
— report will be in."

"Emma Hancock doesn't want any loose ends interfering with her nailing the commissioner's job.  She gave me a day and a half to come up with any reason Westmoreland shouldn’t be fast-tracked for trial.  And that was hours ago."

"You didn't find him competent?"

"Taking a confession from him now would be like taking one from a child having a nightmare.  He doesn't even know what's happening to him.  He's lost in a psychotic fog of voices and visions."

"Opinions like that aren't going to make you the darling of law enforcement."

"No," I allowed.  "Hancock was pretty steamed.  I can't even say for sure that she'll stick to our bargain."

"You've got to lose here.  People at the station are starting to trust you again.  You're getting regular work.  It's been a while since I've heard anyone talking about—"