Breaking the Silence

  In the staff cafeteria one afternoon, a young woman took the seat across the table from Sarah.

  “Hi.” The woman smiled. “I’m Colleen Price.” She was petite with an adorable, blond pixie haircut, and Sarah recognized her as a nurse from ward two.

  Sarah lowered her sandwich to her plate. “Sarah Tolley,” she said.

  “I was the nurse assigned to Julia Nichols when she was on ward two,” Colleen said. “I hear she’s yours now.”

  They talked a bit about Julia’s history. “Dr. Palmiento’s trying LSD with her,” Sarah said.

  Colleen lifted the top slice of bread on her sandwich, removed the lettuce leaf and set it on the edge of her plate. “And is it helping her?” she asked.

  “Too soon to tell,” Sarah said.

  “Do you think that’s the right approach for her?”

  Sarah hesitated. It was blasphemy to disagree with Dr. P., but when she looked at Colleen, she knew she was looking into the eyes of a comrade. “No,” she said. “I’m not one hundred percent sure it’s the right approach for anyone.”

  Colleen smiled. “Neither am I. Nor am I sure about half the things Dr. P. comes up with.” Her voice was barely more than a whisper.

  “How long have you been here?” Sarah asked.

  “Nearly a year.”

  “I’ve only been here a couple of months,” Sarah said. “I’m shocked by some of the things he does. The high voltage of the ECT, for example.”

  “And doing ECT every day on some patients.”

  “And the slumber room.”

  Colleen rolled her eyes. “What are you giving the patients in there? When I was up on ward three the other day, I saw a couple of them walking around like zombies, bumping into the walls. One of them peed right there on the floor.”

  “They get a mixture,” Sarah said. “A little bit of everything.” She rattled off the names of the drugs. “Have you seen the isolation room?”

  “I did,” Colleen said softly. “It just about made me cry.”

  The isolation room had been a terrible shock to Sarah. It was not a room at all, but rather a long, rectangular box, barely larger than a coffin. The patients wore goggles designed to keep them in total darkness and earphones that emitted a constant, monotonous hum. Their arms and legs were padded to reduce their sense of touch. Except for bathroom and meal breaks, they remained in the box as long as a month. It was another way to achieve the extreme confusion Dr. P. valued so much.

  “I feel old-fashioned,” Sarah said, “but I simply can’t understand how such treatment can help more than it can harm.”

  Colleen nodded her agreement. “The word torture comes to mind,” she said.

  Sarah sat back in her chair, both relieved and disconcerted by this conversation. “I thought I was going crazy,” she said. “Everyone seems to think what Dr. P. is doing is so great. So innovative. I figured I must be the one out of step.”

  “Well, you may be. But if you are, then I’m out of step with you.”

  “I’m beginning to think this is the wrong place for me,” Sarah admitted. “I’m upset every night when I go home.”

  Colleen surprised her by reaching across the table and grabbing her hand. “You mustn’t leave!” she said, leaning closer. “Listen to me. I’ve thought of leaving a million times. But if those of us who really care about the patients leave, who’s left to speak up for them?”

  “Don’t you think the rest of the staff cares?” Sarah asked. “Don’t you think Dr. P. truly wants his patients to get well?”

  Colleen looked thoughtful. “I do think Dr. Palmiento believes he’s doing the right thing,” she said after a minute. “He has tremendous optimism and self-confidence in his ability to cure people, and I like that about him. He tries hard, and his ultimate goal is the same as ours. And the staff cares, too. I think they believe they’re doing the right thing in following Dr. P.’s treatment protocols. But I don’t agree with them, and neither do you. And I think we have to stay here to provide some balance.”

  “Are there others who disagree with Dr. P.’s methods?”

  “There are a few. And there were more. But as soon as they spoke up, they were fired. So I don’t speak up.” Colleen swallowed a bite of her sandwich. “What do you think Julia Nichols needs?” she asked.

  Sarah set her plate and its unfinished sandwich to the side of the table. “I think she needs antipsychotic medication,” she said, “and then I think she needs to be treated with respect and understanding. She needs to be listened to by someone who cares. Who empathizes. Dr. P. listens, but if she doesn’t tell him what he wants to hear, he berates her.” She looked across the table at her new friend. “How can we expect her to get well…to become a mentally healthy woman…when we treat her like she’s less than human?”

  “We can’t,” Colleen said. “That’s why she needs you. You and I have the same approach. Some day we’ll open up our own little clinic, but for now, we’ll stay here and do all we can to help these patients.”

  Colleen was right. They would have to stay at Saint Margaret’s, quietly doing their best despite the uphill battle.

  “Are you married?” Colleen suddenly changed the subject.

  “Yes. My husband is a reporter for the Washington Post.” She felt the tension ease out of her body at the thought of Joe. “How about you?”

  “I’m divorced,” Colleen said quietly, as if the fact shamed her. “But I have a little boy, Sammy, who’s two. He’s my sunshine.” She grinned. “Do you have any kids?”

  “Not yet.” She and Joe were trying their best. “What do you do about a baby-sitter for Sammy while you’re at work?”

  “My ex-mother-in-law takes care of him. She’s a gem, even if her son is a jerk.”

  Sarah began eating lunch with Colleen every day. Talking with her friend, whether about work or their private lives, gave her the strength to go back upstairs and face the suffering on ward three.

  She thought she was making some progress with Julia. For as long as an hour, Julia would talk rationally with her about her childhood, and citing this, Sarah was able to discourage Dr. P. from giving her any more LSD. He’d spoken of putting Julia in the slumber room, but Sarah had been able to thwart that, as well. Then it all blew up in her face.

  She walked into Julia’s room after lunch one day while the patient was brushing her glorious hair. At first, Julia smiled at her, but the smile quickly disappeared. Pulling open her top dresser drawer, she began flinging the clothes from it into the air, as if hunting for something buried among the garments.

  “You stole it!” she shouted at Sarah, who took a step back, disturbed by the anger in Julia’s voice.

  “Stole what?” she asked.

  “My pin!” She pointed to the pin attached to the collar of Sarah’s uniform. “It was right here in my drawer, and you took it!”

  “This?” Sarah touched the pin. “This was a wedding gift from my husband,” she said. “You’ve seen me wear it many times before, Julia.”

  Julia ripped the drawer from the dresser and turned it upside down, shaking it. “It was here and now it’s there!” she screamed, staring at Sarah’s collar.

  “No, see?” Sarah dared to step a bit closer. “See the way the pin is formed? It’s an S and a J together. It stands for Sarah and Joe. My husband and me.”

  Julia did not seem to hear her explanation. With impressive physical power, she swung the drawer forward and let it go, sending it flying through the air in Sarah’s direction. Sarah ducked, but the corner of the drawer caught her right temple.

  The pain was instant and searing. Pressing her hand to her head, Sarah opened the door and ran into the hall.

  “Security!” she called.

  The bulky men dressed in white were already racing toward the room. Someone must have overheard the altercation and called them. Sarah leaned against the wall, the blood dripping through her fingers and down her wrist, as she listened to the men try to subdue the shrieking, furious woman
who thought she’d been robbed.

  Another of the nurses ran up to Sarah and pressed a piece of gauze against her wounded temple. “You’ll need a couple of stitches,” she said. “And Julia Nichols needs a month or so in the slumber room.”

  “No,” Sarah said weakly. And then she fainted.

  The following morning, Dr. Palmiento called her into his office.

  “How are you?” He stood up and put one of his big hands on her shoulder, genuine concern in his face. He led her to a chair.

  Her temple was bandaged. The cut had required only three stitches, but her head still ached from the blow.

  “I’m all right.” She smiled. “I shouldn’t have argued with her. I should have found some other way to—”

  “Hush,” he said softly. He leaned against his desk, half sitting on its edge. “I’ve made a decision about Julia Nichols that I want you to know about,” he said.

  The slumber room, she figured. She was not sure she had the strength to argue with him about it. “She was doing well with me,” she said. “I think she was—”

  He stopped her with a hand in the air. “I let you try your way with her,” he said. “The talking approach. It’s been tried for many years with these patients, but it simply isn’t enough when they’re so disturbed. Still, I wanted to give you free rein with her, and I thought perhaps it was helping. But the reality is, there is only one way to rid Mrs. Nichols of her violent behavior.” He hesitated, his green eyes impaling her. “I’ve scheduled her for a lobotomy on Wednesday.”

  “A lobotomy?” Sarah stared at him.

  “Yes. She’ll be in far better control of herself—”

  “That’s because she’ll be in a stupor!” Sarah nearly shouted. “For the rest of her life!” She knew she was being either courageous or extraordinarily stupid to speak to him that way. “Please, Dr. P., let me do some research into other methods that have been effective with patients like Julia.” Perhaps the word research would have an impact on him. “Please. Let me try before you do something as permanent as a lobotomy.”

  “There are no other methods that are effective with someone like her,” he said. He leaned toward Sarah, looking at her as though she were slow-witted. “Deep in your heart, you know that, don’t you?”

  “But a lobotomy is not a cure,” she said. “It’s simply a way to make her easier to take care of. To turn her into a docile, dim-witted, childlike—”

  Palmiento stood up straight. “You need to read up on lobotomies, Sarah,” he said. “We can’t have you working here if you don’t understand the valuable place that procedure has in the treatment of the mentally ill.”

  Sarah looked down at her hands where they lay folded in her lap. Her head throbbed.

  “I’ve been in this business thirty years to your…ten, is it?”

  “Thirteen.” Sarah straightened her spine with pride.

  “And as you know,” Dr. Palmiento continued, “I’m considered one of the top psychiatrists in the country.”

  “Yes, I know that.”

  “So, it would behoove you to acknowledge the fact that I just may be better qualified than you are to decide what should be done in the case of Julia Nichols. She will have a lobotomy at three o’clock Wednesday afternoon. And I want you to be there, since she’s your patient.”

  “You want me to…?” The thought horrified her.

  “You’ve had some surgical training, isn’t that right?”

  “As a student, yes, but—”

  “And I haven’t failed to notice that, although you are still unrealistic about what works and what doesn’t in the treatment of mental illness, you are one of our most skillful nurses. I want you to be able to assist me in the future with surgical procedures. We’ll start training you with Mrs. Nichols.”

  She didn’t know what to say. This was her job. She had to do as she was told.

  That night, she snuggled with Joe in bed. She’d told him what had happened and her horror at the thought of her patient being lobotomized.

  “Maybe he’s right,” Joe said, stroking her hair. “Maybe there are people whose lives are so tortured and unbearable that destroying the hurtful part of their brain is the only way to help them. There must be some good reason the procedure won a Nobel Prize.”

  “I refuse to believe it’s the only solution,” Sarah said. “Julia is so…she’s beautiful, Joe. She’s young. She has such spirit.”

  Joe lightly touched the bandage on her temple. “She has spirit, all right.” He laughed.

  “It’s going to be horrid,” Sarah said. “At least Dr. P. agreed not to shave her head, after I pleaded with him. Her hair is extraordinary, and it’s the one thing she truly cares about.”

  “She’s lucky she has you,” Joe said, leaning over to kiss her. “And so am I.”

  The orderly wheeled Julia into the operating room on a gurney. She was wearing a hospital gown and had been given only mild sedation, just enough to take the fight out of her. Her eyes were open, and she smiled at Sarah when she spotted her in the room, recognizing her in spite of Sarah’s surgical cap and mask.

  “Hello, Julia,” Sarah said through the mask. She helped the orderly transfer Julia from the gurney to the operating table. Joyce Love was also in the room, ready to assist in the surgery.

  Julia reached for Sarah’s hand. Surprised by the gesture, Sarah held the young woman’s hand tightly, knowing she must sense that something dreadful was about to happen to her. Sarah was now glad to be there. It would be an ordeal for her, but Julia needed someone she knew cared about her in that room.

  Dr. Palmiento entered the OR dressed in a surgical gown, his mask in place. “How are you feeling, Julia?” he asked in that fatherly tone he was so good at employing. He squeezed Julia’s shoulder.

  “Fine,” she replied.

  “Now, I’m just going to slip this eye mask over your eyes,” he said. “Then this bright light won’t bother you. It’s annoying, isn’t it? The light?”

  He put the mask in place, then reached for the razor. He couldn’t be preparing to shave her head, Sarah thought, but sure enough, he began to do exactly that.

  Sarah looked at him across the operating table. “You promised,” she said.

  “This—” he held up a long, loose tress of auburn hair“—won’t mean a thing to her in half an hour.” He sounded annoyed, and Sarah said no more, although inside she was seething.

  “Syringe,” he said, and Joyce Love handed him the syringe she had filled with a local anesthetic. He injected the anesthetic around the area of Julia’s scalp to be incised.

  Sarah hated that patients undergoing lobotomies only received local anesthetic, but Dr. P. said it was necessary for him to be able to know when he had “destroyed the offending portion of her brain.”

  Although she was not usually squeamish, the sound of the drill and the spray of bone shavings into the air turned Sarah’s stomach. She stared at the wall instead of watching the surgery, hoping no one would notice.

  Dr. P. requested one instrument after another. From the corner of her eye, Sarah saw Joyce hand them to him, but she kept her gaze steady on the wall. Finally Joyce handed Palmiento the steel spatula, and Sarah knew the moment for destruction had arrived.

  “Julia, how old are you?” Dr. P. asked as he worked.

  “Tenny-eight,” Julia slurred.

  “Good,” Dr. Palmiento said. Sarah imagined him digging deeper into the burr hole with his spatula.

  “Can you count to ten for me, Julia?” he asked.

  Julia grunted something unintelligible, and Dr. P. continued his destruction.

  “Sing me a nursery rhyme, Julia,” he said after a few minutes. “How about the one about Mary and her lamb?”

  “Blah. Gibble,” Julia said.

  “Count to ten, Julia,” Palmiento asked.

  Nothing.

  The wall blurred in front of Sarah’s eyes. Julia’s fight and fire were gone.

  The moment she could escape, Sarah excused
herself from the operating room and went into the staff restroom. Shutting herself inside one of the stalls, she cried, knowing that the scars from Julia’s surgery would forever be etched across her own heart.

  22

  LAURA HAD FINALLY GOTTEN EMMA TO SLEEP AFTER A COUPLE of hours of nightmares and tears. Now she lay in her own bed, surrounded by the books on Alzheimer’s she’d borrowed from the library. She was searching through indexes and chapter headings, trying to determine if someone with Alzheimer’s could make up stories rich in detail and told with clarity and enthusiasm. Laura was beginning to wonder if Sarah’s description of the goings-on at Saint Margaret’s might be a figment of her imagination. The events were beginning to border on the unbelievable. Who would put a psychiatric patient in a “coffinlike box” for a month? Probably, Laura reasoned, Sarah had simply confused the facts in her memory.

  One of her books stated that “the Alzheimer’s patient’s vivid recollections from the past may lead the caretaker to think the patient is more lucid than he or she actually is.” That fit Sarah, certainly. It was almost eerie. On their walks, Sarah would slip into the past, losing her infirmity as she described an incident in what seemed like perfect detail. A moment later, she would look down the street and have no idea where she was, or even if she was on land or water. Sarah didn’t even remember Laura’s name from one visit to the next. She did know, however, that Laura’s appearance meant she could go for a walk.

  The phone rang a moment after Laura had turned out the light and settled under the covers. She picked up the receiver from her night table.

  “I hope I didn’t wake you.” The voice was Ray’s, and Laura stopped breathing for a second before realizing it was Stuart on the line.

  “Stuart!” she said. “You sounded so much like Ray, for a minute I thought…”

  “Oh, sorry,” he said.

  “It’s hardly your fault.” She laughed.

  “Well, listen. I know it’s late, but I just came across an article in the latest Publishers Weekly and I wanted to read it to you.”

  “Go ahead.”