Live To Tell Part 10

Danielle found an empty room, gesturing for them to enter. D.D. and Alex had started their inquiry with the nurse manager, Karen Rober. She wasn't as hands-on, however, recommending they speak to Danielle, who, conveniently enough, walked through the front doors a moment later. The look that had pa.s.sed over Danielle's features when she'd spotted D.D.'s police creds had been interesting. A mix of horror and anger. And, immediately after, shuttered tightness.

Karen had a.s.signed Danielle to the detectives. Otherwise, D.D. wasn't sure the young nurse would've agreed to walk down the hall with them, let alone answer any questions. Now Danielle pulled out a chair at the wooden table, set down her files, sat, fidgeted, and got back up again.

"I'm gonna grab some water," she announced. "Need anything?"

D.D. and Alex shook their heads. The nurse popped out; they took their seats.

"First impressions?" D.D. murmured.

"Twitchy," Alex said.

"She should be twitchy. She's being questioned by the police."

"Twitchier," he amended.

"Yeah, that's what I think, too."

Danielle reappeared, bearing a cup with a lid and a straw. She took a seat across from Alex and D.D., not as close as she could be, but not too far away. The nurse was younger than D.D. would've thought. Athletic build, dark hair swept back in a ponytail. Pretty, under normal circ.u.mstances. Tense, given these circ.u.mstances.

"Sure you don't need anything?" the nurse asked, plucking at the manila folder in front of her.

"We're good," D.D. replied. "Busy afternoon?"

"We've had busier."

"How many kids are out there?" D.D. asked, easing into things. She wanted to take her time with Danielle. She was curious what made the nurse tick-or fidget, as the case might be.

"Fifteen. More crowded than we'd like, but not acute."

"Acute?"

Danielle had to think about it. "A psych ward is acute when we have more than we can handle. It's not a specific number of kids; it's the dynamics of the kids. Eight kids can send us over the top if they're involved cases that didn't mix well. On the other hand, we've effectively handled up to eighteen." She paused. "Not that I'd like to do that again."

"How long have you been here?" D.D. asked.

"Eight years."

"Sounds like a long time, given the field of work."

The nurse shrugged. "We're a progressive unit, which makes us a better place to work than most pediatric psych wards. Some of our MCs have been here twenty years or more."

"MCs?" Alex spoke up.

"Milieu counselors. Did you notice the guy in the hallway? The one with the great baritone?"

"The gym coach," D.D. filled in.

"That's Greg. He's a milieu counselor. We refer to the environment within our unit as the milieu. Greg's job is to help sustain that environment-safe, nurturing, dynamic. Mine, too, but I'm an RN. MCs don't need to have a degree, just a lot of energy and creativity to work with the kids."

"What makes this a progressive unit?"

"We don't snow kids-"

"'Snow'?" D.D. interrupted.

"Drug them senseless. Most of our kids are on multiple prescriptions. Plus we use PRNs-medications given as needed, say Benadryl-to help soothe a child having a bad day. But we medicate to a functional, not nonfunctional, state."

Danielle fiddled with the straw in her cup. When D.D. didn't immediately ask another question, letting the silence draw out, the nurse volunteered on her own: "We also refuse to physically restrain the kids. During an outburst, most psych units will resort to tying a kid to a bed. They tell the kid it's for his own good, but it's still a s.h.i.+tty thing to do. Let me put it this way: Once we had a five-year-old girl whose shoulders wouldn't stay in their sockets because her parents' idea of babysitting was to hog-tie her so they could go drinking. When the girl was finally admitted to the ER for severe dehydration, an intern ordered physical restraints because the girl kept freaking out. Can you imagine how that must've felt to her? She finally gets away from her parents, and she's still being trussed up like cattle. Eighty percent of our kids have already suffered a severe trauma. We don't need to add to that."

D.D. was impressed. "So," she summarized, "no snowing, no tying. When the kids go all Lord of the Flies, what d'you do?"

"CPS-collaborative problem-solving. CPS was developed by Dr. Ross Greene, an expert in explosive children. Dr. Greene's primary a.s.sumption is that a child will do well if a child can do well. Meaning, if we have children who won't do well, it's because they don't know how-maybe they have issues with frustration tolerance, or rigid thinking, or cognitive deficiencies. Our goal then is to teach the child the skills he or she is lacking, through CPS."

D.D. considered this. Tried it on a couple of times, actually. She didn't buy it. She glanced over at Alex, who appeared equally skeptical.

This time, he took the lead: "You're saying a child goes psycho and you ... talk her out of it? Hey, honey, please stop throwing a chair out that window. Now, now, Georgie, no more strangling baby Jane."

Danielle finally cracked a smile. "Interestingly enough, most of our parents sound just as convinced as you. Example?"

"Example," he agreed.

"Ten-year-old girl. Admitted with a history of explosive rages and petty arson. Within two hours of arrival, she walked up to Greg-the gym coach-and decked him. Didn't say a word. Hit first, thought later."

"What did Greg do?" D.D. asked.

"Nothing. Guy's a good two hundred and twenty pounds and the girl barely topped seventy. Blow glanced off his stomach. Then she tried to kick him in the b.a.l.l.s. That got him moving faster."

Alex's eyes widened. "But no snowing, no tying?"

"Two male counselors intervened, trying to guide the girl back to her room. She lashed out again, screaming at the top of her lungs. Other kids started getting wiggy, so our nurse manager ordered the male MCs to disappear. Second they were out of sight, the girl calmed down and returned peacefully to her room on her own."

"It was the men who set her off," D.D. filled in. "The girl had an issue with men."

"Exactly. Large men with dark hair, who may or may not bear a resemblance to the girl's stepdad, as a matter of fact. That's what triggered her outburst. Observing that gave us something to work with. Something we would not have learned if we'd restrained her or medicated her."

"All right," Alex granted. "No snowing, no tying. But where's the talking?"

"Once the girl calmed down, I reviewed the incident with her. We discussed what she did. I talked to her about other options for approaching boys that didn't involve trying to kill them. It was an ongoing process, obviously, but that's what we're here for-to help kids understand what's going on inside their heads, and what they can do to manage their jumbled emotions. Kids want to do well. They want to feel in control. And they're willing to work, if you're willing to guide."

"Did the girl get better?" Alex asked.

"By the end of her stay, she and Greg were best buds. You'd never know."

"And Ozzie Harrington?" D.D. said. "Was he another success story-one day roaring like a lion, next day gentle as a lamb?"

Danielle shuttered up. She sat back, stroking the top of the manila file with her thumb. When she met D.D.'s gaze again, her blue eyes were wary, but also hard. A woman who'd been there, and done that. Curious and more curious, D.D. thought.

"Tell me what happened," the nurse said, avoiding D.D.'s question.

"Been watching the news?" D.D. asked.

"No. Been working the unit."

"Why do you a.s.sume an unhappy ending?" D.D. pressed.

"Ozzie's dead," Danielle stated.

"Again, why a.s.sume the negative?"

"Because Karen told me to talk to you, and if Ozzie were still alive, answering your questions would violate his rights."

D.D. considered the matter. "Yeah, he's dead."

"Just him, or did he hurt others?"

"Why don't you tell us what you think?"

"f.u.c.k it." Danielle broke open the case file and began.

"Oswald was admitted in the spring of last year. He'd spent six months with his foster family before suffering a 'psychotic break.' The parents had gone out for the evening, leaving him and their two other children alone with a babysitter. Halfway through dinner, both their cell phones started ringing. The babysitter and two kids were now locked in the bathroom. Ozzie was on the other side of the door, armed with a hammer and screaming he was going to kill them.

"The parents ordered the babysitter to call nine-one-one, then headed home. They arrived around the same time two officers were wrestling Ozzie to the ground. The EMTs sedated the boy and brought him to the ER, which referred him to us.

"Upon admittance, he was nearly catatonic. We see this often in a child who's just experienced a significant traumatic event. We kept him on Ativan for the first forty-eight hours, while we caught up on his patient history. Ozzie's file revealed multiple diagnoses, including severe ADHD, attachment disorder, Nonverbal Learning Disorder, Mood Disorder NOS, and other nonspecific development delays. The psychiatrist expressed concern that, due to the death of Ozzie's birth mother, not enough was known about the first three years of his life."

"Meaning?" D.D. prodded.

"Ozzie's speech and social skills were delayed. At eight, he showed some traits that were autistic in nature-he wouldn't make eye contact, he sat and rocked for hours, while mumbling sounds only he understood."

"You're talking Rain Man?" D.D. clarified, making a note.

"That would be one example of an individual on the Autism Spectrum Disorder," the nurse answered dryly. "Bear in mind, it is a spectrum, and you shouldn't count on Hollywood for information. In Ozzie's case, we determined the traits weren't due to ASD, but were more consistent with the kind of self-soothing techniques learned by severely neglected children. Ozzie was a feral child."

"So not Rain Man, but Tarzan?" Alex spoke up.

Danielle shot him a look.

"With a feral child," she continued pointedly, "there's no caretaker present to meet the child's needs, disrupting the normal development cycle. The child cries. Nothing happens. The child stops crying. And talking, and bonding, and having any sense of belonging to a larger world. Mentally, the child atrophies, leading to delayed speech and socialization in Ozzie's case."

D.D. frowned. "I thought Ozzie's mom died when he was three. He was home alone with the body, but surely a couple of weeks of abandonment doesn't cause everything you just described."

"According to the ME, Ozzie's mother had died eight to ten weeks prior to discovery. During that time, it appears Ozzie survived by eating dry cereal, uncooked pasta, and anything else he could forage from the cupboards. He was also a good climber, which helped him get water from the sink, etc. In fact, social services thought his survival skills were particularly well developed for a three-year-old-meaning maybe Ozzie's mother was sick for a bit before she died. Maybe, in fact, Ozzie had been taking care of himself for a long while, which would explain his feral traits."

"So Ozzie got off to a rough start," D.D. summarized. "But eventually, the proper authorities got involved and ..."

"And he ping-ponged through seven or eight foster families before landing with the Harringtons."

"Why the Harringtons?"

"Have to ask the state. Though," Danielle corrected herself, "the parents, Denise and Patrick, both seemed very committed to him. Some foster families request special-needs kids. They have a background with special needs-either grew up with a special-needs sibling, or have occupational training. Some believe they can make a difference and want to try."

"And Denise and Patrick?" D.D. prodded.

"I don't think they had any idea what they were getting into," the nurse answered bluntly. "But they appeared committed to helping Ozzie. They struck me as the religious type-doing G.o.d's will here on earth."

D.D. made a note. That sounded consistent with other things they'd learned about the happy couple.

"So Ozzie had this psychotic break. What does that mean?"

"He stripped off his clothes, then went around the house with a hammer, tras.h.i.+ng the furniture while screaming death threats."

"So he had a particularly violent temper tantrum?"

"Oh, if he'd caught someone, he would've hurt them," Danielle said seriously. "A kid in such an elevated rage-state is having an out-of-body experience. You can't reach them with words, with love, with logic. They're gone, in orbit. Afterward, they'll remember almost nothing of what they said or did, including that they bashed the brains out of the family dog, or tore apart their own favorite teddy bear. Hiding is the best policy. And in the aftermath, the entire family needs post-traumatic stress counseling, especially the siblings."

D.D. made a note of that, too. Therapist for the Harrington family? Things can come out in therapy....

"After Ozzie's admitted here, then what happens?"

Danielle shrugged. "We started him on aripiprazole, often used for the treatment of schizophrenia and bipolar disorder. That seemed to pull him together for about eight weeks, then he began to suffer from akathisia and we had to take him off."

"Akathisia?"

"Ozzie complained that it felt like little people were inside his skin, crunching his bones. That's akathisia. He also started suffering from perseverative thoughts."

"Perseverative thoughts?" D.D.

"It's like OCD, except with thinking. He'd get a notion in his head, I want a red car, and then he couldn't get it back out. He'd spend six, seven hours saying over and over again, I want a red car, I want a red car, I want a red car. Now subst.i.tute red rum for red car, and you can see the danger of perseverative thoughts."

D.D.'s eyes widened. "He's going through all this, and he's what, seven, eight years old?"

"He's going through all this, and yes, he's eight. And we're seeing more kids like him all the time. Parents think the worst thing that can happen to their five-year-old is cancer. They're wrong; the worst thing that can happen to their five-year-old is mental illness. Cancer, the docs have tools available. Mental illness in prep.u.b.escents ... There are so few drugs we can use, then the kids develop a tolerance, and by age eight we're out of options. They require a lifetime regimen of anti-psychotic medication, except we don't have anything left. One week we get them stabilized. The next they plunge back into the abyss."

"Is that what happened to Ozzie?" D.D. asked.

Danielle picked up the case file, read briskly. "We took Ozzie off the aripiprazole. At which time he claimed ghosts were appearing in the windows of his room and ordering him to kill people. So we put him back on a very low dosage of aripiprazole, trying to minimize the side effects while still making some attempt at regulating his brain chemistry. In the short term, we noticed a positive change in behavior."

"In the short term," D.D. repeated. "Meaning in the long term ...?"

"We don't know."

"You don't know?"

The nurse shook her head. "His parents discharged him. Against our advice. They had moved, gotten a new place. Denise said it was time to bring him home."

Alex held up a hand. "Whoa, whoa, whoa. Ozzie reports ghosts are telling him to murder people, and they take him home?"

"It happens."