I, Robot: To Protect Book 1, page 16
“Psychopath?” Lucianne raised her hands, fingers spread. “No one’s called Sharicka that before.”
Susan did not want to get deeply into semantics. Psychiatrists, psychologists, and laypeople had argued for years, but the word psychopath still did not exist in the seventh edition of the Diagnostic and Statistical Manual of Mental Disorders, also called DSM-VII. “It’s essentially the lay term for antisocial personality disorder. And ASPD can’t be officially diagnosed before age eighteen. A major criterion for diagnosing ASPD is that the patient has been diagnosed with conduct disorder prior to the age of fifteen, so it’s only a matter of time.” Susan dismissed the explanation with an erasing movement of her hand. “My point is that, at four years old, Sharicka already meets the definition for ASPD, other than age. If she were over the age of eighteen, she’d be in prison.”
Susan paused, awaiting more questions. When they did not come, she finished, “The younger the age the antisocial behaviors start, the more likely it stems from genetic causes, not environmental. Also, the more refractory it will be to treatment and the worse the extent of the illness. A personality ingrained from the moment the egg met the sperm is a lot less amenable to treatment than one developed because of a single traumatic incident — or even because of years of abuse.” As she spoke the words, Susan felt a sudden jolt of realization. I’ve just described the difference between Sharicka and Monterey and definitively stated Monterey should prove a much simpler cure.
Susan wondered if she had just placed the parents in the position of having to defend their child from a verbal assault. As they had said, they did still love Sharicka.
But the Ansons simply mused over the words, lips tightly pursed. Finally, Elliot spoke carefully, gauging his wife’s reaction to every word. “I do not think it’s fair to subject Rylan and Misty to that, not after all Misty has already suffered.”
Lucianne nodded wearily.
The father flicked his gaze to Susan. “Is it possible you would support us in finding long-term institutional care for Sharicka? We would still visit her, of course, and attend any meetings you thought necessary. We just wouldn’t support placing her back into our home, unless some miraculous new treatment was found.”
Miraculous new treatment. Those words sparked another thought. Nanorobots for refractory psychiatric patients. Susan shook the thought away. They had not even injected the first adult patient. Goldman and Peters would surely need some significant, positive, and safe results before daring to try them out on one so young. But at least the idea brought some hope. “Anyone who would fault you for that decision doesn’t understand the situation. Your children have a right to feel safe in their own home.”
Sharicka’s father managed a crooked smile. “Thank you. It means a lot just having someone in our corner.”
“It’s easy to judge only on the superficial. It takes a lot more time and work to truly understand.” Susan could not help adding, “And don’t completely discount the possibility of that miracle.”
In the first-floor charting room, Susan sprawled across a floral-patterned chair, her legs flopped over the armrest. Engaged in the conversation, Nate relaxed in the navy blue chair across from Susan’s. The table between them held two palm-prosses, the one she had been using to type in notes about her meeting with Sharicka Anson’s parents and the one Nate had been using to proofread the day’s endocrinology entries. Currently, both lay closed as they talked about Monterey.
“Okay,” Susan said. “We’ve established we’re a normal six-year-old girl safely buckled into our car booster. In the front, Daddy is driving. For some reason, he has his seat belt undone.”
“That’s what we’re trying to establish. The car won’t start without his belt buckled, so we have to assume it was buckled at one time.”
“So he unbuckled it.”
Susan wondered if Nate was deliberately playing stupid to try her patience. “Why indeed? That’s still the million-dollar question.” She heaved a slow, deep sigh. “We know from history he’s either an excellent father or is just remembered that way to honor his memory. For now, let’s assume it’s true. That presumes he kept his seat belt buckled until some point when he unbuckled it.” Worried Nate might insert another “why” and she would have to strangle him, Susan continued. “And about that same time, the car was involved in a deadly crash. The two events are clearly connected.”
Fatal crashes had become much less frequent in the last decade since the outfitting of vehicles with sensors, monitors, alarms, and internal navigation systems. However, many people still drove older cars or overrode systems that became as much nuisance as help. The current airbag designs were safer for children at the expense of adults, except around the driver’s seat. Cars no longer started without a driver breath analysis, all seat belts in place, and a fingerprint key, so she had no reason to believe Monterey’s father had been drunk or high or medically incapacitated. At the least, those would have shown up on the black box.
Nate finally did something more than question. “I think we can discard the possibility that the father unbuckled because he anticipated the crash. Unless we have reason to believe he intended to kill both himself and his daughter?”
Susan shook her head. By all reports, father and daughter had shared an intense bond. He adored her, and the feeling was mutual. Monterey’s extreme reaction to his death confirmed that description. “Now, a conversion reaction is the involuntary loss of a bodily function, such as speech, that has no biological explanation.” Nate nodded matter-of-factly as Susan continued. “If we dissect a conversion reaction, there is always logic at its core. Often, it’s a strange logic, but logic nonetheless.”
Nate sat up straighter. “Now you’re getting into the realm of primary and secondary gain.”
Susan stiffened at his use of medical terminology, then laughed. “I keep forgetting you’ve read all those medical texts and edited thousands of charts. Sometimes I lose track of the fact that I’m not discussing this with my usual sounding board, my dad.”
“I’ll take that as a compliment,” Nate said. “Your dad’s a brilliant man.”
Susan could only agree. She had a great respect, as well as affection, for her father. “Primary gain: Not speaking somehow lessens her anxiety about either the crash itself or the loss of her father. Secondary gain: Admission to the hospital and focus on her muteness allow her to avoid mourning her father, talking about the details of the crash, and gains her the full attention of mother and staff.”
“How does not speaking decrease anxiety?”
Though simple and obvious, the words sent Susan’s thoughts in another direction. Her own mind distorted the question to how not eating with others/never dating would decrease anxiety. She sat bolt upright. “Oh, my God! My dad’s having a conversion reaction.”
Nate stared. No one outside of Susan’s head could have followed that conversational leap. “What?”
“Sorry. I just had an epiphany about something that’s made me curious for about twenty years now.”
Nate guessed, “There’s overlap between Monterey’s case and your father’s?”
Susan nodded. “I’ll deal with that later. With him.” The realization opened her to a new line of thought. “Nate, there’s the obvious. If Monterey can’t talk, she doesn’t have to relive the accident verbally. She doesn’t have to talk about her father. But what if there’s more? What if words coming out of her mouth caused the accident in the first place?”
“Voice feature to change the radio station? Perhaps the sudden switch startled him?”
Susan felt certain that was not the answer. “Something that caused her father to unbuckle his seat belt, as well as distracting him. Something like …”
Nate caught on quickly. “A request for something beyond his normal reach.”
“A dropped toy or some food, perhaps.” The logic seemed infa
Nate continued the thread. “Monterey blames herself and can’t process the emotions of an event this traumatic. So she expresses the psychological conflict through mutism.”
Susan nodded broadly. “And it would also explain something I’ve noticed in the chart but didn’t give much credence to.”
Nate waited patiently this time.
“I’ve noticed there’s a difference in what her female nurses chart compared to the males. In the males’ notes, she’s nearly comatose, while the females document some episodes of nonverbal communication. I’ve experienced that myself, while the resident who had her before me, Aiken Mallory, could not get her to respond to him in any way.”
Nate drew himself up to his full height. “Why don’t they just assign her female doctors and nurses?”
“Patterns are always easier to see in hindsight, and you have to make the assumption first. I’m going to suggest all female nurses for Monterey at rounds tomorrow.” Susan looked Nate over carefully, and another idea came to mind. “And I’m going to suggest a visit to meet you.”
“Me?” Nate clearly did not follow again. “What good would that do? According to you, I’m indistinguishable from a regular, boring male.”
Susan smiled broadly. “Except for one very important difference.”
Nate guessed, “My circuitry?”
“You can’t die in a car crash.”
Susan Calvin broached the subject with her father over a dinner of stew that she ate alone as they talked. “Dad, I used to love the big family meals with Mom.”
John dodged her gaze. “I thought we were talking about what you did at work.”
“We are,” Susan assured him around a mouthful of whole grain roll. “I have a patient who hasn’t spoken since the car accident that killed her father. And a father who hasn’t dated or eaten since the car accident that killed his wife.”
“I eat,” John protested.
“Not that I’ve seen. Not for years.”
John shrugged. He reached across the table, snagged a carrot from Susan’s stew, and took a bite. “Happy?”
Susan rolled her eyes.
John chewed and swallowed before explaining. “It’s not that I can’t eat with people anymore. It’s just that food doesn’t taste right since the accident, and I never know if something’s going to hit me the wrong way while I’m with a friend or an important client. Why spend a fortune on gourmet cooking that tastes like cardboard or plastic or dish soap? Eating in groups also makes me think of your mother, and that makes me sad. Grief is entirely normal.”
“Grief is normal,” Susan confirmed. “But it’s not supposed to keep people from participating in normal life experiences forever. Don’t you think that, after twenty years, you should have gotten over it enough to do something as ordinary as eating in public?”
John put down the remaining piece of carrot. “Susan, it’s not a matter of ‘getting over it.’ I’ve come to grips with losing your mother; but the damage the accident did to my neurological system is not reparable. My sense of taste is permanently haywire, and I’m not that great at smelling, either.”
Susan could only stare. “The … accident? You mean, you were there?”
Now it was John’s turn to stare. “Of course I was there. I was driving. Don’t you remember, Susan?”
Susan dropped her fork to sit in contemplative silence. She had just spent five minutes excoriating her father for refusing to accept the past when she had just as intently attempted to make it disappear. She tried to force her mind back to her preschool years, but she had created so many walls, diversions, and U-turns, she found it difficult to find her way.
“For a brief period, you were an orphan. You lived with Nana for months. If not for several miracles of modern science, I wouldn’t be here.”
That brought back a glimmer of memory. Susan recalled spending time alone with Nana in her cramped apartment in the Bronx. Sunlight streamed through her bedroom window every morning, waking her, and Nana had seemed as happy and welcome as the bright sun most of the time. Sometimes, though, Susan could hear her grandmother sobbing in the deepest part of the night. The mere thought made Susan shudder. She wanted to close it away, to never think of it again. My God, I’m as bad as Dad and Monterey.
“Susan, my life choices, silly as they might seem, don’t harm anyone. They don’t cripple me from doing any of the things in life I wish or need to do.”
Susan had to agree. What differentiated a conversion reaction that required hospitalization from a mild neurosis was exactly what John had described. Unlike Susan’s deliberate forgetting or John’s secluded eating, Monterey’s refusal to communicate made her activities of daily living impossible. “But what about dating?”
“What about dating?”
“Why don’t you?”
“How do you know I don’t?”
That stopped Susan cold. “You’re seeing someone?”
John smiled crookedly. “No. I didn’t date while I raised you. I made the choice to dedicate myself fully to that task, putting it above all others. How do you know what I did or didn’t do while you were at school?”
I don’t, Susan realized. “I guess I believed you would have mentioned it. I told you about my boyfriends.” They had already talked about her first date with Remington.
“When are you seeing Remy again?”
“Dinner tomorrow night.” Susan refused to be distracted. “But we’re talking about you.”
John tried again. “Surely, you don’t expect your father to discuss his sex life with you?”
Susan did not flinch. “You can tell me about nights out and girlfriends without going into those kinds of details.”
John sighed and rose from the table. He started to pace farther into the kitchen, his back to Susan. “Fine, I don’t date. And don’t get any ideas, Susan. I don’t have any desire to do so. If that ever changes, I promise I’ll let you know. For now, I like to believe that Amanda was my soul mate.” He turned back to face her.
So long as it did not make him unhappy, Susan could not condemn the mind-set. He clearly had no more interest in a second wife than she did in a second mother. “I guess that would make me the child of true love. The perfect kid.”
John grinned. “You always have been, in my eyes.”
Susan believed him. Whenever she made a mistake, he had always corrected her in a way that made it seem she had figured it out herself. She could not remember his ever raising his voice to her. As much as he had believed in her, she had believed in him. He was a treasure, a gem of a father.
Susan realized she had allowed this saint of a father to distract her from the point once again. “Thanks, Dad.”
“For what?” A hitch had entered John Calvin’s voice.
“For talking about the accident. I know how much it hurts ….”
John turned away again. He was clearly struggling to be gallant. “Had I realized … that avoiding the subject … had left you with …”
Susan helped him, “Some misconceptions? That’s not your fault; it’s mine. I guess I just didn’t want to think about how close I came to losing both of you.” She contemplated what a child’s mind could make of such a tragedy. “My preschool thoughts made you invincible. As I matured, I guess I just whisked you completely out of the memory. Safe and sound.” That realization forced Susan to look at the comparisons in a new light. “You know, Dad, I was comparing you with my patient and thought understanding you might help me to help her. Now, I realize I’m more like her. Except she got a front-row seat to her catastrophe.”
John seemed to have gotten hold of his emotions. From the back, Susan could tell he was wiping his eyes, but his voice became steady. “You never stopped speaking.”
“No.” Susan kept her o
John turned around to stare at his daughter. “Are you speaking English?”
Susan chuckled. “Freudian English, such as it is. She’s channeling her anxiety into physical symptoms.”
“How do you fix that?”
“Other doctors have tried all the usual stuff: Certain medications can help, as can properly pointing out the psychological nature of the symptoms.”
As the subject got farther from Amanda Calvin, John drifted back to the table. “You mean, letting the patient know that you know she’s faking?”
“Faking?” Susan frowned. “There’s a huge difference between a malingerer and a hysteric. In fact, you have to specifically rule out faking before you can make the diagnosis of a hysterical conversion reaction.”
“Really?” John sat, truly interested.
“Really. You also have to rule out an actual medical condition.”
John put it all together, his brow crinkled in uncertainty. “So, there’s no physical cause, but your patient actually can’t talk. It’s not something she’s doing on purpose.”
“Correct. And that’s how it’s explained to a person with a conversion reaction. With support, that’s usually enough for a gradual full recovery.”
John made a noise of interested understanding. “But it’s not working in this case?”
“Apparently not. She’s six years mute.”
“Hmm.” John studied his daughter. “So what brilliant ideas do you have to fix her?”
Susan appreciated she had no obligation to disabuse her father of the genius notion. Fathers were supposed to believe wholeheartedly in their daughters’ intelligence. “I think it’s time for her to confront the details of the accident. Not as a six-year-old in the preoperational stage of thought but as a twelve-year-old in the operational stage.”
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