Alex Delaware hunts a twenty-first-century Jack the Ripper
R a g i n g e m o t i o n s , d e a d t i s s u e .
Polar opposites was the way Jeremy Carrier had always seen it. In a hospital setting, no two disciplines were less connected than psychology and pathology. As a practitioner of the former, Jeremy prided himself on an open mind; a good psychotherapist worked hard at avoiding stereotypes. But during all his years of training and clinical work at City Central Hospital, Jeremy had met few pathologists who didn't fit a mold: withdrawn, mumbly types, more comfortable with gobbets of necrosed flesh, the abstract expressionism of cell smears, and the cold-storage ambience of the basement morgue, than with living, breathing patients.
And his fellow psychologists, psychiatrists, and all the other soldiers of the mental health army, were, more often than not, overly delicate souls repelled by the sight of blood. Not that Jeremy had actually known any pathologists, even after a decade of passing them in the hallways. The social structure of the hospital had regressed to high school sensibilities:
Us-Them as religion, a lusty proliferation of castes, cliques, and cabals, endless jockeying for power and turf. Adding to that was the end-means inversion that captures every bureaucracy: the hospital had devolved from a healing place needing funds to treat patients to a large-scale municipal employer requiring patient fees to meet its staff payroll. All that created a certain asocial flavor. A confederacy of isolates.
At City Central, like was attracted to like, and only the last-ditch necessities of patient care led to cross-pollination: internists finally admitting defeat and calling in surgeons, generalists taking deep breaths before plunging into the morass of consultation. What reason could there be for a pathologist to contact a psychologist?
Because of all that-and because life's hellish wrist-flick had turned Jeremy Carrier into a tormented, distracted young man-he was caught off-balance by Arthur Chess's overture. Perhaps Jeremy's distractibility formed the basis for all that followed.
For nearly a year, Jeremy had seen Arthur once a week, but the two men had never exchanged a word. Yet here was Arthur, settling down opposite Jeremy in the doctors' dining room and asking if Jeremy cared for company. It was just before 3 p.m., an off-hour for lunch, and the room was nearly empty.
Jeremy said, "Sure," then realized he was anything but.
Arthur nodded and settled his big frame into a small chair. His tray bore two helpings of fried chicken, a hillock of mashed potatoes glazed with gravy, a perfect square of corn bread, a small bowl of succotash, and a sweating can of Coca-Cola. Staring at the food, Jeremy wondered: Southern roots? He tried to recall if Arthur's voice had ever betrayed Southern inflections, didn't think so. If anything, the old man's baritone was flavored by New England. Arthur Chess showed no immediate interest in conversation. Spreading a napkin on his lap, he began shearing through the first piece of chicken. He cut quickly and gracefully, using long fingers tipped by broad nails stubbed short. His long white lab coat was snowy-clean but for a disturbing spatter of pinkish stains on the right sleeve. The shirt beneath the coat was a blue pinpoint Oxford spread-collar. Arthur's magenta bow tie hung askew in a way that suggested intention.
Jeremy figured the pathologist for at least sixty-five, maybe older, but Arthur's pink skin glowed with health. A neat, white, mustachless beard, which gave insight into what Lincoln's would've looked like had Honest Abe been allowed to grow old, fringed Arthur's long face. His bald head was lunar and imposing under cruel hospital lighting.
Jeremy knew of Arthur's reputation the way one is aware of a stranger's biography. Once Head of Pathology, Professor Chess had stepped down from administrative duties a few years ago to concentrate on scholarship. Something to do with soft-tissue sarcomas, the minutiae of cell-wall permeability, or whatnot. Arthur also had a reputation as a world traveler and an amateur lepidopterist. His treatise on the carrion-eating butterflies of Australia had been featured in the hospital gift shop, alongside the usual paperback diversions. Jeremy had noticed the single stack of dry-looking, dirt brown volumes because they drabbed in comparison with the jackets of lurid best-sellers. The brown stack never seemed to reduce; why would a patient want to read about bugs that ate corpses? Arthur ate three bites of chicken and put down his fork. "I really do hope this isn't an intrusion, Dr. Carrier."
"Not at all, Dr. Chess. Is there something you need?"
"Need?" Arthur was amused. "No, just seeking a bit of social discourse. I've noticed that you tend to dine alone."
"My schedule," lied Jeremy. "Unpredictable." Since his life had gone to hell, he'd been avoiding social discourse with anyone but patients. He'd gotten to the point where he could fake friendly. But sometimes, on the darkest of days, any human contact was painful.
Life's little wrist-flick...
"Of course," said Chess. "Given the nature of your work, that would have to be the case."
"Sir?" said Jeremy.
"The unpredictability of human emotions."
Arthur nodded gravely, as if the two of them had reached a momentous agreement. A moment later, he said, "Jeremy-may I call you Jeremy?-Jeremy, I noticed you weren't at our little Tuesday get-together this week."
"A situation came up," said Jeremy, feeling like a child caught playing hookey. He forced a smile. "Unpredictable emotions."
"Something that resolved well, I hope?" Jeremy nodded. "Anything new come up at T.B.?"
"Two new diagnoses, an adenosarcoma, and a CML. Typical presentations, the usual spirited discussion. To be honest, you didn't miss a thing."
Our little Tuesday get-together was Tumor Board. A weekly ritual, 8 to 9 a.m., in the larger conference room, Arthur Chess presiding over a confab of oncologists, radiotherapists, surgeons, nurse specialists. Commanding the slide projector, wielding a light wand, and his voluminous memory.
For nearly a year, Jeremy had been the mental health army's representative. In all that time, he'd spoken up once. He'd attended his first Tumor Board years before, as an intern, finding the experience an ironic grotesquerie: slides of tumor-ravaged cells click-clicked on a giant screen, the images obscured by nicotine haze. At least a third of the cancer doctors and nurses were puffing away. Jeremy's supervisor at the time, an astonishingly pompous psychoanalyst, had wielded a Meerschaum pipe of Freudian proportions and blown Latakia fumes in Jeremy's face.
Arthur had been running things back then, too, and he'd looked much the same, Jeremy realized. The chief pathologist hadn't smoked, but neither had he objected. A few months later, a wealthy benefactor touring the hospital poked her head in and gasped. Soon after, the hospital passed a no-smoking rule, and the mood at subsequent Tumor Boards grew testy. Arthur sectioned a tiny square of corn bread from the host slab and chewed thoughtfully. "No loss for you, Jeremy, but I do believe that your presence contributes."
"Even if you don't say much, the fact that you're there keeps the rest of us on our toes. Sensitivity-wise."
"Well," said Jeremy, wondering why the old man was bullshitting him so shamelessly, "anything that helps sensitivity."
"The time you did speak up," said Arthur, "taught us all a lesson."
Jeremy felt his face go hot. "I felt it was relevant."
"Oh, it was, Jeremy. Not everyone saw it that way, but it was."
The time he spoke up had been six weeks ago. Arthur flashing slides of a metastasized stomach carcinoma on the big screen, defining the tumors in the precise Latin poetry of histology. The patient, a fifty-eight-year-old woman named Anna Duran, had been referred to Jeremy because of "unresponsive demeanor."
Jeremy found her initially sullen. Rather than try to draw her out, he refilled her empty cup with tea, got himself coffee, plumped her pillows, then sat down by her bedside and waited. Not caring much if she responded, or not. It had been that way since Jocelyn. He didn't even try anymore. And the funny thing was, patients reacted to his apathy by opening up more quickly. Grief had made him a more effective therapist. Jeremy, flabbergasted, gave the matter some thought and decided patients probably perceived his blank face and statue posture as some sort of immutable, Zen-like calm.
If only they knew...
By the time she finished her tea, Anna Duran was ready to talk. Which is why Jeremy was forced to speak up, twenty minutes into a contentious exchange between Mrs. Duran's attending oncologist and the treating radiotherapist. Both specialists were voluble men, well-intentioned, dedicated to their craft, but overly focused, baby-bathwater-tossers. Complicating matters further, neither cared for the other. That morning they'd slipped into an increasingly heated debate on treatment sequence that left the rest of the attendees peeking at their watches. Jeremy had resolved to stay out of it. Tuesday mornings were an annoyance, his turn the result of a mandatory rotation that placed him in too-close proximity to death. But that morning, something propelled him to his feet.
The sudden motion fixed fifty pairs of eyes upon him.
The oncologist had just completed a pronouncement. The radiotherapist, about to embark on a response, was deterred by the look on Jeremy's face. Arthur Chess rolled the light wand between his hands. "Yes, Dr. Carrier?"
Jeremy faced the sparring physicians. "Gentlemen, your debate may be justified on medical grounds, but you're wasting your time. Mrs. Duran won't agree to any form of treatment."
The oncologist said, "And why is that, Doctor?"
"She doesn't trust anyone here," said Jeremy. "She was operated on six years ago-emergency appendectomy with postop sepsis. She's convinced that's what gave her stomach cancer. Her plan is to discharge herself and to seek out a local faith healer- a curandero."
The oncologist's eyes hardened. "Is that so, Doctor?"
"I'm afraid so, Doctor."
"Quaint and charmingly idiotic. Why wasn't I informed of this?"
"You just were," said Jeremy. "She told me yesterday. I left a message at your office."
The oncologist's shoulders dropped. "Well, then... I suggest you return to her bedside and convince her of the error of her ways."
"Not my job," said Jeremy. "She needs guidance from you. But frankly, I don't think there's anything anyone can say."
"Oh, really?" The oncologist's smile was acrid. "She's ready to see her witch doctor, then curl up and die?"
"She believes treatment made her sick and that more will kill her. It's a stomach carcinoma. What are we really offering her?"
No answer. Everyone in the room knew the stats. Stomach cancer so advanced was no grounds for optimism.
"Calming her down's not your job, Dr. Carrier?" said the oncologist. "What exactly is your job, vis ˆ vis Tumor Board?"
"Good question," said Jeremy. And he left the room.
He'd expected a summons to the Chief Psychiatrist's office for a reprimand and a transfer off the board. None came, and when he showed up next Tuesday, he was met with what seemed to be respectful looks and nods.
Drop your interest in patients and patients talk to you more readily.
Mouth off at the honchos and gain collegial esteem.
Irony stank. From that point
"The thing is," said Arthur, "we cellular types get so immersed in details that we forget there's a person involved."
In your case, there's no longer a person involved.
Jeremy said, "Dr. Chess, I just did my job. I'm really not comfortable being thought of as an arbiter of anything. Now, if you'll excuse me."
"Of course," said Arthur, unperturbed, as Jeremy bussed his tray and left the dining room. Mumbling something Jeremy couldn't make out.
Later, much later, Jeremy was fairly certain he'd decoded Arthur's parting words:
"Until the next time."
Excerpted from The Conspiracy Club by Jonathan Kellerman. Copyright 2003 by Jonathan Kellerman.
Excerpted by permission of Ballantine Books, a division of Random House, Inc.
All rights reserved. No part of this excerpt may be reproduced or
reprinted without permission in writing from the publisher.
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Copyright © 2003 Newfront Productions, Inc. and Random House