The Hiding Place Read online

  “And you won’t do that here at Menaker. There is no journey. Patients are here for the long haul and, for the most part, they’re not going anywhere. And although you might make a small difference in the lives of some of these patients, that difference will be played out slowly over the course of ten or twenty years. It’s not something you’ll notice from month to month, or even from year to year. Young doctors come here because the place has a reputation of housing the sickest of the sick. I get that. I can understand the allure. But within a short time, most of them move on—because this is not what they wanted. Not really.”

  “Some of them must want it,” I countered.

  He only sighed. “A few, yes. But most don’t. I’ve read enough essays to know.”

  I’d gone home that night and managed to unearth my own medical school application essay from eight years before, and goddammit if he wasn’t right. I’d used the word difference twice, and the essay’s last sentence read, I look forward to the journey on which I am about to embark. Pathetic, I thought, standing there in my kitchen. But at the time I’d written it I’d meant every word. The next morning I called him up to accept the position. Maybe my expectations had changed since applying to medical school. Maybe I just wanted to prove Wagner wrong.

  “Did you look?” he asked, and we both knew what he was referring to.

  “Yes,” I admitted.

  “And?”

  “And I must be in the minority,” I lied. “When would you like me to start?”

  That was five years ago, and despite his predictions at the time, I’ve been relatively happy here. The nursing and support staff at Menaker are dedicated, and the faces of those I work with seldom change. There is a sense of family, and for someone like myself whose real family has been splintered in numerous ways, there is a certain nurturing reassurance in that stability. Wagner had also been right about the patients, who are clearly in it for the long haul. Practicing psychiatry in a place like this is like standing on a glacier and trying to influence the direction it will travel. It’s difficult, to say the least. But sometimes, despite all the forces working against us, we are able to effect a change—subtle, but real—and the victory can be more gratifying than one can possibly imagine. But all jobs entail occasional days when you feel like banging your head against the wall, and for me today seemed to be one of them.

  “Am I missing something here, Charles?” I asked. The volume of my voice had ratcheted up a notch. I made myself take a breath and exhale slowly before continuing. “We cannot admit a patient involuntarily to this institution with no court order and no patient records. It’s false imprisonment, tantamount to kidnapping.”

  If Wagner was concerned, he didn’t show it. “I think you should leave the legalities to me,” he advised. “Focus on the individual before you, not his paper trail. Talk to him.”

  “I’ve been talking to him. For two days now. He doesn’t say much—doesn’t seem to know what to say.”

  “It can be difficult.”

  “It’s frustrating. I have no patient history or prior assessments to help me here. I don’t even have a list of his current medications.”

  Wagner smiled through his goatee. It was a look, I suppose, that was meant to be disarming. “I think you have everything that you need right now. Talking to him is the most important thing. Everything else is secondary.”

  I turned and left the office without a retort, deciding that whatever response I might muster wasn’t worth the price of my job.

  Chapter 4

  Why don’t you tell me a little bit about your childhood,” I suggested. We were walking across the hospital grounds, an environment I felt was more conducive to psychotherapy than sitting in a small office as my patient and I stared at each other. Something about the outdoors opens people up—frees them, in a way.

  He gave me a pitying, incredulous look—one I’d already become accustomed to receiving from him. I never would figure out where that look came from, but I began to recognize it as his default expression. It was the look I imagined parents of teenagers received with regular frequency. I’m embarrassed for you because of how clueless you really are, it seemed to say, except with teenagers there was usually an added dose of resentment, and I never got that from him. Rather, Jason’s expressions were touched with empathy—something about the depth of those eyes, perhaps—almost as if he were here to help me, instead of the other way around.

  “On the surface, I was part of what you might call a traditional family. We lived in a middle-class suburban neighborhood in Columbia.”

  “Columbia, Maryland,” I clarified, and he nodded. It was located in Howard County, about a thirty-minute drive to the west of us.

  “Dad was a police officer,” he continued. “Mom used to be a teacher, but when the kids were born, she took several years off to run a part-time day care out of our house. It allowed her to stay home with us during those first couple of years.”

  “You say ‘us.’ You had siblings?”

  “A sister.”

  “Where is she now?”

  He sighed, as if he’d explained this all a thousand times before. I wondered how many psychiatrists he’d been through before me.

  “Your sister,” I prodded, waiting for him to answer my question, but he was silent, looking down at the Severn River below us.

  “Is she older or younger?”

  “She was three years older,” he said, and his use of the past tense was not lost on me.

  “Is she still alive?”

  He shook his head. “I don’t know. I haven’t spoken with her in a long time.”

  “You had a disagreement? A falling-out?”

  “No,” he said. His face struggled for a moment. Beyond the iron pickets, a seagull spread its wings and left the cliff, gliding out into the vacant space some eighty feet above the water.

  I put a hand on his shoulder. I wasn’t supposed to do that, I knew. There are rules of engagement to psychiatry, and maintaining appropriate boundaries—physical and otherwise—is one of them. What may seem like a compassionate gesture can be misconstrued. Extending a casual touch, or revealing too much personal information, for example, puts the psychiatrist at risk of being perceived by the patient as someone other than his doctor. The relationship of doctor and patient becomes less clear, and the patient’s sense of safety within that relationship can suffer. And yet, here I was with my hand resting on my patient’s shoulder for the second time this week. I found it unsettling, for I was doing it without thinking, almost as a reflex, and I didn’t understand where it was coming from. Was I attracted to him? I must admit I did feel something personal in his presence, a certain … pull. But it was hard to define, difficult to categorize. But dangerous, yes … I recognized that it had the potential to be dangerous for us both.

  “What happened to your sister?” I asked, withdrawing my hand and clasping both behind my back.

  “Gone,” he said, following the flight of the gull before it disappeared around the bend. He turned his eyes toward mine, and the hopelessness I saw there nearly broke my heart. “She’s been gone for five years now, and alive or dead, I don’t think she’s ever coming back.”

  Chapter 5

  The evening group session I ran in the Hinsdale Building on Tuesdays and Thursdays finished on time, but I had paperwork that I’d been putting off, and by the time I finally put that to rest it was almost 8 P.M. Full dark had settled across the campus, and although the hospital does a pretty good job with exterior lighting, the footprint of the place is still over twelve acres and unavoidably prone to large swaths of shadows. It’s for this reason that I don’t like leaving after dark. It’s not the patients I’m afraid of, although we house more murderers per capita at Menaker than they do at the closest prison, Brockbridge Correctional Facility in Jessup. And, yes, we’ve had our share of attacks—something the visitor brochures about this place will never mention. An experienced nurse was once killed here during the night shift, struck by a large t
elevision (this was before the days of flat screens) hurled at her by a patient while her back was turned. She’d fallen forward, the TV’s trajectory matching the arc of her fall, and the second impact had crushed her skull between the old Sony and the tiled floor. There are inherent dangers in working with people—many of them with a history of violence—whose self-control is tenuous at best.

  But no, it’s not the patients I’m afraid of, but rather the dark itself that I find menacing. It’s been that way for as long as I can remember, and I can’t help but think that it has something to do with him, the way his mind turned the final corner that night when I was eight years old, the way I had to go looking for him, terrified that I was already too late.

  The wide brick walkway from the physician offices to the front gate was well lit, but I could hear the April night breeze pushing past the oaks on either side, making their newly budding limbs shift and sway as if finally awakening from a long sleep and realizing they had someplace better to go. I could hear the trees whisper to one another, spiteful old men with malevolence in their hearts, the shadowy expanse of the grounds providing complicit cover for their furtive movements. A finger of one of the branches dipped down to graze my shoulder as I passed, catching on the slick fabric of my windbreaker, and for a moment I felt that it did not want to let go.

  “Out for a walk, Lise?” Tony Perkins called out to me from the watchman’s booth near the gate, and the sound of his voice made me jump.

  “Goin’ home, Tony,” I replied, but he held up a hand for me to stop a second.

  “Let me get someone to escort you. Make sure you get there safe.”

  I live in an apartment less than a quarter mile from the hospital, which enables me to commute by foot in all but the most inclement weather. Security here doesn’t like me to walk home at night unattended, and they often have someone accompany me on the trek if I’m leaving after dark. It’s sweet of them and reminds me how Menaker, for all its notoriety, can sometimes feel more like a close-knit community than a hospital for the criminally insane.

  Tony spoke into his radio, listened to the response. “Matt will take you,” he advised me.

  I only had to wait a minute.

  “Headin’ home late, Dr. Shields?” Matt Kavinson emerged from a side path, flashlight in hand.

  “Working hard, Matt,” I answered.

  “You always do. You mind a little company on your walk?” he asked, and I smiled, telling him I was glad to have it.

  We bid Tony a good night and left the front gate behind us, the stern silhouette of the hospital lifting its head into the night sky to watch as we descended the hill. The wind picked up and buffeted us from behind, making me wish I’d selected a heavier jacket this morning. It’s hard to know in April, as the cold gray tomb of March slams shut for another year and the hot, oppressively humid days of summer begin to rise like swarms of locusts from the Maryland marshes.

  “How was your day, Dr. Shields?” Matt asked as we rounded the last corner and my apartment complex came into view. He was good company—quiet and unobtrusive—but there were times when you could almost forget he was standing beside you.

  The image of Jason Edwards rose in my mind, those dark eyes looking out over the water below us, our mutual gaze following the gull as it disappeared around the bluff. Gone, I could hear him say … for five years now …

  “One of my patients …” I replied, hesitating, as I stopped now at the entrance to my building. What more could I share? Confidentiality prevented me from discussing such things. It’s what makes psychiatry such a lonely profession.

  Matt waited for me to go on. He turned slightly away, regarding the hedges hunkered like sentries along the front of the building. “You think you can help him?” he asked, articulating the question in my own mind, and I realized that I wasn’t sure if I could. There was something in the way Jason had looked at me today, his expression hopeless, his face defeated from the very beginning—as if I had already failed him, as if everything I had to offer was on the table, and in a cursory glance he could see there was nothing there to save him.

  “I don’t know,” I answered honestly, wishing I felt more confident in my abilities. I certainly wanted to help him, but wanting and doing are two roads that may never merge. A gust of wind snatched at the words as they left my mouth, carrying them off into the night.

  Matt was quiet for a moment. He clicked off the flashlight, now unnecessary as we stood beneath the glow of the streetlamps. “You’ll do what you can,” he said. “He believes in you.”

  I looked at him, wondering whether there was any truth to what he’d said, and found it unlikely that he could know such a thing. “Does he?”

  Matt nodded, his face a little sad, but he made an effort to smile nonetheless. “Of course,” he responded, turning to go. “You’re all he has left.”

  Chapter 6

  I lay awake that night thinking about Jason. Matt’s words—He believes in you … You’re all he has left—had struck a chord with me, and I kept mulling them over in my mind. It was an odd thing for him to say. His role at the hospital would not grant him access to the background information of our patients. And yet, human relationships trump legal and professional boundaries all the time. If he was dating a nurse who’d been there during Jason’s intake, or even knew someone who worked at Jason’s prior institution, there was a possibility that Matt knew more than I did about my own patient. That bothered me, but his words weighed on me for another reason as well. It’s the nature of psychiatry—the role we’ve chosen to play. So often we are the only tangible thing anchoring our patients to their delicate perch above the abyss. It keeps me awake at night, contemplating that relationship, and when I close my eyes in the dark, edging carefully toward the elusive precipice of sleep, I can sometimes feel them slipping from my grasp—all of them. I startle awake, reaching out for a better hold, but find myself alone in the room with nothing but black and empty space above me.

  I hadn’t commented on it today during our session, but it turns out that Jason and I grew up in the same community—Columbia, Maryland—although I can’t recall having ever run into him in those earlier years. It didn’t surprise me. I’ve made a concerted effort to distance myself from that time in my life, as if there’s still a danger of sliding backward into that lanky prepubescent body and the years of emotional abandonment that have prevented me, even now, from mustering the courage and vulnerability to maintain an intimate personal relationship.

  I was a child of distractible parents who occupied their thoughts with practical matters: their jobs and daily errands, relationships with friends and acquaintances, the maintenance of a house that was more a physical structure than a place of refuge, the anxiety of never having enough money to feel truly secure. I remember watching them as we sat around our kitchen table at dinner, my father’s eyes often distant with worry, my mother’s hands straightening her silverware over and over again, as if it might have moved when she wasn’t looking. My brother and I used to horse around, make faces at each other over the evening meal, converse in our Donald Duck voices until one of us inevitably knocked something over or snorted milk out our nose. We did it because we were children and that’s what children do, but there was also a certain desperation in that interplay, our eyes darting in the direction of our parents’ faces as we tried to get them to laugh or smile and shake their heads, their attention returning to the family in front of them. I remember that I had the foolish idea that we could somehow change them—awaken them—and one of my life’s greatest disappointments was discovering that we could not.

  The worst kind of loneliness, I think, is to be in the presence of those you love and have them treat you like you aren’t there. To this day, when I picture the face of my mother, it is always in profile, her eyes studying something in the room that is not me. There was so much worry, so much preoccupation in that expression, and because she never talked about the things that troubled her, I was left to imagine the worst. �
�What’s wrong, Momma?” I would ask, but she wouldn’t answer, or would respond with, “Hmmm?”—like I’d just disturbed her from a light snooze. Sometimes, if she was sitting still, I would slide up beside her and put my head on her lap. On good days, her fingers would absently stroke the hair on the side of my head, looping a blond lock around the soft curve of my ear, and during those moments I would feel that we were somehow closer. But just as often her hand would lie motionless in her lap, as if the weight of my head on her thigh was causing her some unseen discomfort that she was too stoic to mention, and after a while I would move away, ashamed of my own neediness, and leave her to her thoughts, the retreating tread of my footsteps nearly silent on the thick carpeting of our lifeless house. I would don my sneakers and ease out the front door, closing it gently behind me as if somewhere in the house lay a sleeping infant who must not be roused. I would go down to the creek, picking my way through the twist of underbrush, the sticker bushes slashing at the tan flesh of my calves and ankles, leaving bloody scratches that I wouldn’t notice until my evening bath. And when I’d come to my private spot in the woods, I would throw jagged little stones at the trees until my arm ached with the repetitive effort and the hollow place inside of me hurt just a little less.

  Chapter 7

  The next morning, the earth was strewn with debris from the windstorm the night before. An audience of trees looked down on severed limbs cast about the ground, their hunched and beaten postures reminding me of a congregation of amputees gathered in the wake of a war.

  I usually stop at Allison’s Bakery for a cup of coffee on my way to work. It’s along my walking route and the place always smells like a blend of coffee beans and cinnamon. They offer an assortment of fresh baked muffins and pastries as well, but lately I’ve been sticking to just coffee. I’m thirty-three, and my body hasn’t yet begun the first turn of its downward spiral, but I can feel it wanting to, feel my metabolism beginning to slow, my joints becoming less limber than they once were. I was too thin in college, and the five pounds I’ve put on since then suits me well, but I wouldn’t want it to go any further. The body will take certain liberties if it thinks no one is watching.