Over the Edge (47 page)

'What about chicken soup?'

'As a matter of fact, I cooked a pot last night. A noble palliative.'

'Let's talk about drugs,' said Milo. 'On a theoretical level.'

'Really, Sergeant, I'm sure you're aware that my position as a defence witness for Mr. Cadmus precludes any discussion of his case with the police.'

'That's not exactly true, Doctor. It's only your conversations with Cadmus, your notes, and your final report that are off-limits. And once you testify in court, even those will be fair game.'

Mainwaring shook his head.

'Not being an attorney, I can't evaluate the validity of that assertion, Sergeant. In any event, I have nothing to offer by way of theoretical speculation. Every case must be judged on its own merits.'

Milo leaned forward suddenly and cracked his knuckles. The sound made Mainwaring flinch.

'You could call Souza,' said the detective. 'If he decides to be straight, he'll admit I'm right and tell you to cooperate. Or he might advise you to stonewall while he pushes enough paper to stall me - to avoid looking like a patsy; lawyers like to play power games. In the meantime,

you'd be wasting time: taken out of this nice warm house; forced to take a long ride in this kind of weather; sitting in an ugly room down at the West L.A. station; cooling your heels while Souza and the DA sling fifty-dollar words at each other. All at the expense of your paperwork. And after it's over, chances are you'll still be required to talk to me.'

'To what end, Sergeant? What's the purpose of this?'

'Police business,' said Milo, opening the pad again and writing in it.

Mainwaring bit down hard on the pipe.

'Sergeant,' he said between clenched jaws, 'I do believe you're trying to bully me.'

'Far from it, Doc. Just trying to show you your options.'

The psychiatrist glared at me.

'How can your ethics allow you to participate in this type of outrageousness?'

When I didn't answer, he stood and walked to a phone resting on an end table. He lifted the receiver and punched three digits before putting it down.

'Just what is it you want to know?'

'How different drugs affect behaviour.'

'On a theoretical level?'

'Right.'

He sat down again.

'What kind of behaviour, Sergeant?'

'Psychosis.'

'Dr. Delaware and I have already discussed that, as I'm sure he's told you.' Wheeling on me: 'Why in blazes are you pursuing a dead issue?'

'This has nothing to do with Dr. Delaware,' said Milo. 'Like I said, it's police business.'

'Then why is he here?'

'As a technical adviser. Would you rather he wait in another room?'

That suggestion seemed to alarm the psychiatrist.

'No.' He shrank back defeatedly. 'What's the difference at this point? Just get on with it.'

'Great. Let's talk a little about LSD, Doc. It stimulates schizophrenia, doesn't it?'

'Not very effectively.'

'No? I thought it was a pretty good psychotomimetic'

The use of the esoteric term raised Mainwaring's eyebrows.

'For research purposes only,' he said.

Milo stared at him expectantly, and he threw up his hands.

'It's difficult to explain in a brief discussion,' he said. 'Suffice it to say that an educated party would never confuse LSD toxicity with chronic psychosis.'

'I'm willing to be educated,' said Milo.

Mainwaring started to protest, then straightened his shoulders, cleared his throat and assumed a pedantic tone.

'Lysergic acid diethylamide,' he intoned, 'evokes an acute, rather stereotypic psychoticlike reaction that once caused some researchers to view it as an attractive tool for study. Clinically, however, its effects differ significantly from the symptoms of the chronic schizophrenias.'

'What do you mean by significantly?'

'LSD intoxication is characterised by florid visual distortions - arrays of colours, often dark green or brown; dramatic changes in the shapes or sizes of familiar objects -and overwhelming delusions of omnipotence. LSD users may feel huge, godlike, capable of anything. Which is why some of them jump out of windows, convinced they can fly. When hallucinations occur in schizoprenia, they are typically auditory. Schizophrenics hear voices, are tormented by them. The voices may be muddled and indistinct or quite clear. They may admonish the patient, insult him, tell him he is worthless or evil, instruct him to carry out bizarre behaviours. While omnipotent feelings can exist in schizophrenia, they usually ebb and flow in relation to a complex paranoiac system. Most schizophrenics feel worthless, entrapped, insignificant. Threatened.' He sat back and smoked, trying to look professional but not succeeding. 'Anything else, Sergeant?'

'I've seen LSD trippers who were hearing things,' said Milo. 'And plenty who were pretty paranoid.'

'That's true,' said Mainwaring. 'But in LSD abuse the auditory disturbance is generally secondary to the visual. And quite often subjectively positive. The patient reports sensory enhancement: Music sounds fuller, sweeter. Humdrum sounds acquire richer timbres. The paranoia you cite is typical of the unpleasant LSD experience - the so-called bum trip. The majority of LSD reactions, however, are experienced as positive. Mind-expanding. Which is in stark contrast with schizophrenia, Sergeant.'

'No happy madmen?'

'Unfortunately not. Schizophrenia is a disease, not a recreational state. The schizophrenic rarely experiences pleasure. On the contrary, his world is bleak and terrifying; his suffering, intense - a private hell, Sergeant. And prior to the development of biological psychiatry, that hell was often permanent.'

'What about PCP?'

'Cadmus was tested for it. As he was for LSD.'

'We're not talking about Cadmus, remember?'

Mainwaring blanched, blinked, and struggled to regain pedagogic aloofness. His lips tightened, and a white ring formed around them.

'Yes, of course. That's exactly why I didn't want to have this discussion - '

'How's that cold?'

The white ring expanded, then disappeared as the psychiatrist forced his face to relax.

'Much better, thank you.'

'Figured it had to be 'cause I haven't heard you sniff since that first time. Four days, you say?'

'Three and a half. The symptoms have just about disappeared.'

'That's good. Weather like this, you have to be careful. Stay away from stress.'

'Absolutely,' said Mainwaring, searching the detective's face for hidden meaning. Milo responded with a blank stare.

'Is there anything else I can help you with, Sergeant?'

'We were talking about PCP,' said Milo.

'What would you like to know about it?'

'For starters, how well it mimics schizophrenia.'

'That's an extremely complex question. Phencyclidine is a fascinating agent, very poorly understood. No doubt the primary site of activity is the autonomic nervous system. However - '

'It drives people crazy, doesn't it?'

'Sometimes.'

'Sometimes?'

'That's correct. Individuals vary greatly in their sensitivity. Some habitual PCP abusers experience euphoria; others become acutely psychotic after a single dose.'

'Psychotic as in schizophrenia?'

'It's not that simple, Sergeant.'

'I can deal with complexity.'

'Very well.' Mainwaring frowned. 'To discuss schizophrenia intelligently, one must bear in mind that it isn't a single disease entity. It's a collection of disorders, with varying symptom constellations. Moderate-dose PCP reactions conform most closely to the type we call catatonia - disturbances of body posture and speech. But even catatonia is divided into subtypes.'

He stopped, as if waiting for his words to crystallise. Hoping he'd said enough.

'Go on,' said Milo.

'What I'm trying to emphasise is that phencyclidine is a complex drug with complex, unpredictable reactions. I've observed patients who manifest the mutism and grimacing of stuporous catatonia, others who display the waxy catalepsy of classical catatonia - they become human manikins. The ones you'd he most likely to come into contact with display symptoms that uncannily resemble an agitated catatonia: psychpmotor agitation; profuse but incoherent speech; destructive violence directed against the self and others.'

'What about paranoid schizophrenia?'

'In some patients large doses of phencyclidine can cause auditory hallucinations of a paranoid nature. Others respond to high-dose abuse with the kind of grandiosity and

hyperactivity that leads to a false diagnosis of unipolar affective psychosis - mania, in lay terms.'

'Sounds like a hell of a psychotomimetic to me, Doc'

'In the abstract. But by itself that's meaningless. All the commonly abused drugs are potentially psychotomimetic, Sergeant. Amphetamines, cocaine, barbiturates, hashish. Even marijuana can cause psychotic symptoms when ingested in sufficient dosage. That's precisely why any psychiatrist worth his salt will observe his patient carefully and test for drug history and the presence of narcotics in the system as a differential prior to establishing the diagnosis of schizophrenia.'

'That kind of screening is routine?'

Mainwaring nodded.

'So what you're saying is that although drug reactions can mimic schizophrenia, it would be hard to fool a doctor.'

'I wouldn't go quite that far. Not all doctors are sophisticated about psychoactive agents. An inexperienced observer - a surgeon, a general practitioner, even a psychiatric resident who lacked familiarity with drugs -might conceivably mistake drug intoxication for psychosis. But not a board-certified psychiatrist.'

'Which is what you are.'

'Correct.'

Milo got up from the couch, smiling sheepishly. 'So I guess I've been barking up the wrong tree, huh?'

'I'm afraid so, Sergeant.'

He walked over and looked down at Mainwaring, put away his pad, and began extending his hand. But just as the psychiatrist started to reciprocate, he pulled it back and scratched his head.

'One more thing,' he said. 'This routine screening, does it include anticholinergics?'

The pipe in Mainwaring's mouth trembled. He used one hand to hold it still, then removed it and made a show of examining the tobacco within.

'No,' he said. 'Why would it?'

'I've done a little
 
research of my own,'
 
said Milo.

'Found that atropine and scopolamine derivatives have been used to drive people crazy. By South American Indians, medieval witches.'

'The classic belladonna potion?' said Mainwaring offhandedly. Both hands were shaking now.

'You got it.'

'Interesting concept.' The pipe had gone out, and it took three matches to relight it.

'Isn't it?' Milo smiled. 'Ever seen it?'

'Forced atropine intoxication? No.'

'Who said anything about forced?'

'I - we were talking about witches. I assumed you - '

'I meant any type of atropine intoxication. Ever seen it?'

'Not for years. It's extremely rare.'

'You never did any research or writing about it?'

The psychiatrist grew reflective.

'Not to my recollection.'

Milo cued me with a look.

'There was an article in The Canyon Oaks Quarterly,' I said, 'about the importance of screening elderly patients for anti-cholinergics so as not to misdiagnose senile psychosis.'

Mainwaring bit his lip and looked pained. He stroked the stem of his pipe and answered in a low, shaky voice.

'Ah, yes. That's true. Many of the organic anti-Parkinsonian agents contain anticholinergics. The newer drugs are cleaner in that regard, but some patients don't respond to them. When the organics are used, medical management can get tricky. The article was intended as a bit of continuing education for our referral sources. We try to do that kind of - '

'Who wrote it?' asked Milo, staring down at the psychiatrist.

'Dr. Djibouti did.'

'All by himself?'

'Basically.'

'Basically?'

'I read an early draft. He was the primary author.'

'Interesting,' said Milo. 'Seems we have a little discrepancy. He says you collaborated. That the original

idea was yours, even though he did most of the writing.'

'He's being gracious.' Mainwaring smiled edgily. 'The loyalty of an associate. In any event, why the fuss over a little - '

Milo took a step closer, so that the psychiatrist had to crane his neck to look up at him, put his hands on his hips, and shook his head.

'Doc,' he said softly, 'how about we cut the crap?'

Mainwaring fumbled with the pipe and dropped it. Ashes and embers scattered on the carpet. He watched them glow, then die, looked up with the guilty terror of a child caught masturbating.

'I have absolutely no idea - '

'Then let me explain it to you. Just a couple of hours ago I had a meeting with a whole bunch of specialists at County Hospital. Professors of medicine. Neurologists, toxi-cologists, bunch of other ologists. Experts, just like you. They showed me lab reports. Drug screenings. Explained everything in terms a cop could understand. Seems James Cadmus has been systematically poisoned with anticholinergics. For a long time. During the period he was under your care. The professors were pretty damned horrified about a doctor's doing that to a patient. More than willing to testify. They even wanted to file a complaint with the medical examiner's. I held them off.'

Mainwaring moved his lips soundlessly. He retrieved the pipe and pointed it like a pistol.

'This is all rubbish. I haven't poisoned anyone.'

'The professors thought otherwise, Guy.'

'Then they're bloody wrong!'

Milo let him stew for a while before speaking again.

'Talk about your Hippocratic oath,' he said.

'I tell you I haven't poisoned anyone!'

'Way the professors figured it, you slipped it to him every time you medicated him. Not only was it subtle, but there was an added benefit: seems Thorazine and the other medicines you gave him supercharged the anticholinergics. Potentiation they called it. The equivalent of a massive OD.'