Case Files
Teasers & Deleted Scenes
Ashton, VA, September 2009Kay Baylor was the last to arrive. Traffic had been heavy inside the beltway--a Friday night, a holiday weekend, a few hundred thousand people trying to get their families out to the country to enjoy the last flickers of summer--or just an excuse to escape DC's cloying embrace for a day or two.
The long drive out through Virginia had calmed her nerves, though, and by the time she parked her car in the evening twilight, under one of Idlewood's majestic copper beeches, she was--not looking forward to the evening's work, but at least resigned.
She knew she was going to be last because she'd recognized Ramachandran's aged Mercedes in the parking lot, parked beside a dark green Buick sedan with a four-body trunk and an eight-cylinder engine that could not have said off-duty cop more clearly if it were airbrushed on the doors. She didn't know what Allison drove, but since she worked here, Kay was confident in her estimation that she had also beaten Kay.
The old asylum's grounds had been beautiful once, maintained perennial gardens with long sweeps of sparkling white crushed stone path. Now, the lawns got mowed and a few day lilies shoved gallantly through the thickets, but the roses had conquered all. This late in summer, they were still heavy with bloom and heavier with a rich, sweet scent no florist rose could approach. Idlewood's roses were old, from before the rise of the Hybrid Tea, and they filled the air with a texture and a tapestry of smell.
Kay let her footsteps carry her up the hill toward Idlewood's broad lawns, its sweeping prospect. She found herself leaning forward, huffing a little. Too much time behind a desk, old woman.
She passed through the massive double doors at the top of Idlewood's marble steps--marred in this age of litigation by rough black traction strips--and thought, as she thought each time, This place needs a sally-port. She endured the Idlewood Dance, sacrificing her electronics, her concealed-carry purse, and the blued-steel 9 millimeter that her ex-husband had bought for her after the Hope Mitchell incident. He'd made sure she learned to use it, too, though he'd known better than to try to teach her himself.
("Stephen, because you feel physically threatened and unsafe, you're giving me a gun. You know what we call that behavior, don't you?"
"Do you object because you don't want to carry a weapon, or because there's a name for it?")
They gave her everything back except the gun. On the other side of the first line of security, she turned left, away from the secured wing the patients inhabited. The conference rooms were on the third floor, and in the spirit of self-flagellation, she forced her out-of-breath self up the stairs instead of waiting for the lift.
When she walked in, breathing through her nose to control her panting, Rupert Beale, Casey Ramachandran, and Katharine Allison were waiting for her around an oval conference table. None of them had assumed the head. Instead Beale and Ramachandran sat behind it with an empty chair between them, like a study in contrasts. Beale was the bigger man, his barrel body softening only slightly with age, the flesh under his cheekbones starting to draw in. Ramachandran was neat, trim, and still moved with a runner's spring in his step. The hair that fringed his bald pate was steel-colored.
Allison had her back to the door; she craned around slightly as Kay walked in, enough to flash her a smile while the men half-rose. Allison was a big, broad-shouldered woman with a mane of wavy dark hair only slightly tamed by a headband and the frames of her oversized glasses. She'd kicked off her open-toed shoes under the table, and Kay could plainly see the red marks they'd left on the pale skin of her feet.
Who did a walking job in heels, unless she was a cocktail waitress? As far as Kay was concerned, Allison was the woman of steel, and her shoes proved it.
Kay shut the door behind herself and went to sit beside Allison, the same one-chair gap placing her across from Beale. He smiled quickly, a welcoming twist of his lips, and then reseated himself and returned his attention to Ramachandran.
Ramachandran waited until Kay had settled herself before picking up a remote control that was the only thing on the table other than a pyramidal speakerphone/intercom and a tray with water and glasses. "As you can probably guess," he said, "this has a limited distribution. Doctors Villette and Reyes have produced some interesting speculation on the nature of the Anomaly, and I believe everybody involved needs to be brought up to date before a subsequent discussion of how this affects our standard of care."
He glanced around the table as if to be sure he had everyone's attention. As if there were any chance of wandering eyes now--Kay knew she was not the only one sitting rapt. Seeming satisfied, Ramachandran brought them through his presentation quickly, outlining the ACTF's findings with regard to genetic markers--and the lack thereof--in known gammas and betas. By the end of it, Kay was leaning forward hard enough to numb her elbows on the tabletop. And Beale, across from her, was leaning back, his hands resting in his lap, his brow furrowed.
"The juvenile-onset betas, then," he said. "We've identified only two, and they both show this genetic modification."
"They do," Ramachandran said. "Two is not a statistically significant sample."
"It's what we have," said Beale.
They were all M.D.s in the room except Beale. But Baylor's residency was long behind her, and it was Allison who steepled her fingers and widened her eyes. "CCR5," she said. "It's like the HIV-resistance genes. There's a gene that shuts the Anomaly down."
Ramachandran's lips compressed. He's withholding. But he nodded. "There's a gene for resistance that only seems to exist in juvenile-onset betas. Melinda Grossman did not show it, and neither does Hafidha Gates--though there's something in her that could be an incomplete form."
A juvenile-onset gamma, and an adult-onset beta. Or at least, a gamma who had proved far more resistant than most to the Anomaly-induced delusions and paranoia. If gamma and beta even meant anything anymore.
"Teratogen," Allison breathed. "It's acquired? Prenatal exposure causes--Doctor Villette?"
"Or Hope Mitchell," Kay cautioned. "What about Hafidha? What about Greenwood?"
"Greenwood's parents were not on board with the DNA sampling. We have to consider the illness as a continuum," Ramachandran said. "At one extreme, almost normal mental functioning. At the other, delusion, lability, urges towards violence."
Kay opened her mouth to speak and closed it again. Client privilege. She'd earned Villette's trust the hard way, and she'd be damned if she would betray it. Even for what seemed like a very good return on investment.
"We have no evidence," Kay said carefully, "that betas are entirely free of those issues."
"Doctor Baylor," Beale said, shaking his mastiff head, "I am not free of those issues."
"Well, of course not," Allison said. "Neither am I. But this opens up a whole new series of questions. Especially when we've having some success with cognitive treatment and antipsychotics..."
"Shouldn't Doctor Reyes be here?" Kay asked, pleased with herself that she was able to say the words unselfconsciously. As if Stephen were just another colleague.
Ramachandran said, "It was felt best we hold this discussion in his absence. I will discuss our findings with him in detail."
"Best by whom?"
"One moment," Ramanchandran said. "And all will be made clear." Pressing a button on the intercom, he leaned down to it and said, "Chris, please send in Doctor Frost."
A moment passed, during which Kay swallowed a prescient chill and poured herself a glass of water. When the door opened and Frost entered with the efficient shushing of brisk footsteps on worn carpet, she did not turn to look. The men half-rose again, and there was a moment while Ramachandran introduced Frost around the table. She was a little rounded woman who should have looked soft, grandmotherly. But the light of intelligence behind her clear blue irises was bright as a cutting torch, and Kay was just as glad that Frost did not offer to shake hands.
Instead, she accepted the flat black box of the remote from Ramachandran. Without preamble, she said, "I have dissected more anomalous brains than any other pathologist of whom I am aware, and I have made some intriguing, if preliminary, findings. Combined with Doctor Allison's electrical scans, which she has so generously shared with the research team, and with the interviews conducted by Doctor Ramachandran, Doctor Beale, Doctor Baylor, and the members of the ACTF field team, they might even be called suggestive."
A click, and color images appeared on the screen. "This is a functional MRI of a normal brain," Frost said. She paused. "For suitably broad values of normal."
Beale chuckled, but Kay was profoundly certain that Frost had not intended it as a joke. She paid him no heed, merely clicking through to the next image. "While we are still experiencing a marked lack of success in isolating or even identifying a pathogen, we are becoming more confident in identifying the Anomaly's direct effects and sequelae. This is an anomalous brain, under the influence of what the ACTF refers to as jamming. It is, in fact, the brain of Hafidha Gates before she completed the progress of her disease. And this--" another click, a third image lined up beside the other two "--is what it looks like when she uses her abilities now. As you can see, and as we were previously aware, there is a significant difference."
"The amygdala is engaging," Allison said. "But the prefrontal cortex is suppressed."
"Very good, Doctor Allison," Frost said, like the kindergarten teacher she resembled. "The amygdala, as some of you may not know, is believed to perform a basic function in the formation of emotional memories. Specifically, in fear conditioning and the sort of disruptions found in post-traumatic stress. The prefrontal cortex is responsible for what we term executive function--rational decision making and impulse control. To put it more simply, Ms. Gates's disease has progressed, her ability to control her emotions has eroded, and her brain has become far more reliant on memories and behavior patterns based in operant conditioning and the fear response in order to determine a course of action. She also shows patterns of electrical activity consistent with some forms of obsessive compulsive disorder, and what you as psychologists might term magical thinking."
"She's terrified," Ramachandran translated. "She's constantly reliving patterns of fear associated with trauma. She's trapped in an OCD feedback loop and her brain is telling her that if she does not carry out certain specific actions terrible things will happen."
Frost smiled, sort of. "And, if we accept the evidence of the brain scans, and take as a given that she's consistent with other members of the gamma population, she's likely suffering from delusions not inconsistent with schizophrenic ideation. As well as harassing auditory hallucinations."
"Jesus," Beale said, after a three-second silence so stark Kay had been able to hear herself swallow. Beale paused and shook his head, but apparently it still seemed like the best word. "Jesus. I mean, you know this sort of thing has to be behind it. But it's different to see it all up there in, well, in red and yellow. And Villette doesn't show evidence of the same progressive breakdown?"
"Villette," said Villette from the door as heads whipped around, "seems to have gotten very, very lucky. No, it's okay, sit. This meeting was my idea."
He closed the door behind him, the sound of the latch making Kay realize she hadn't heard it click open. He crossed the conference room to take the sole seat at the foot of the table, closest to the door, between Kay and Beale. "Please, Doctor Frost," he said.
She extended the remote. "Since you are here, I would prefer to be excused."
But Beale stood and limped around the table and pulled out the chair between Kay and Allison. All the women on the same side. "Please," Beale said. "Sit. Your expertise is needed."
Kay didn't think Frost was mollified. Kay didn't think Frost had ever been offended in the first place. She just honestly had no desire to be in the room unless her presence was immediately and critically necessary.
But she also didn't seem inclined to push Beale out of the way to get to the door, so she was pretty much trapped into sitting as he requested.
He returned to his side of the table, and Frost clicked the remote once more. "These are functional MRIs of a selection of past and present Idlewood residents. They are not jamming in any of these images. Doctor Allison" --she glanced at Allison, and Allison nodded pray continue-- "merely asked them to review a series of positive and negative memories. This is Susannah Greenwood. Clemson McCain. Henry Clark. Roger Weathers. Jason Saito. Sofia Akadiou. Betty Johnson. As you can see, there is a direct link in some--Gates and Greenwood, and to a lesser extent Saito and McCain--between activity in the amygdala and prefrontal cortex, and the subgenual area, here."
Frost glanced around the table as if checking to make sure a class of slow learners was following her. Kay heard Villette breathing on her right hand side. She did not glance at him. She did not touch Frost's arm for attention. "I've seen images like that before."
"Doctor Baylor," Frost said, granting her the podium with a crisp birdlike headbob.
"Deep Brain Stimulation," Kay said. "It's used to treat Parkinson's, obsessive compulsive disorder, bipolar disorder, major depression. Among other serious illnesses. Devices implanted in the brain produce a constant series of pulses of weak, high-frequency current. In some patients, they've proved spectacularly effective."
"And in others," Allison said, "they might as well have stayed home and ordered pizza. And it all depends on the strength of the connections between those three brain regions. The better the connection, the better the success rate."
The sound Villette made wasn't a sigh, exactly. It was a noise of sorrow and tiredness, but it wasn't a sigh. "Some people are better equipped by nature or nurture to withstand the ravages of a brain malfunction. Genetics, history, environment--none of these are simple, guaranteed predictors of behavior. I expect the anomaly is unpredictable in the same way: that it interacts with brain chemistry and the host's personal history, and that affects who is influenced by it and to what extent. And for the same reason, some of the people who are influenced by it may be better equipped to respond to DBS."
He paused. "Patients showing the stronger connection are also more likely to be able to externalize and alienate their experience of the anomaly, which means cognitive tactics work better for them. They are also more likely to report experiencing its action as a sensed-presence effect, as if an invisible second person were with them. That's a phenomenon also found in mountain climbers and other extreme athletes, by the way. Some people theorize that it's related to the left hemisphere actually noticing the action of the right."
"A treatment," Beale said, jerking so hard in his chair that the table rattled. "You're talking about a fucking treatment."
Villette held up his hand. "A treatment that will not be effective for the majority of gammas. But which may be effective on those like Greenwood and Gates, who still have some functioning cortical control over their instinctual brain functions, and who are not sociopaths, psychopaths, or sadists apart from the functioning of the anomaly. Unfortunately, severe personality disorders are commonly found comorbid with status gamma in the... anomaloid... population, possibly because both states are influenced by trauma and brain damage. But yes. We may be able to help Hafidha."
"There are issues," Ramachandran prompted.
Villette nodded. "Hafidha is refusing surgery, and her parents back her up. Greenwood's parents may eventually be more amenable, but at this point--" he shrugged. "They're happy to have their daughter eating and alive. And frankly, Greenwood may be the best candidate for a less invasive resolution. And she's awfully young."
Beale poured himself a glass of water, slowly, keeping the ice from rattling into the glass. "Our two best candidates aren't interested."
As if Beale had not spoken, Villette went on. "Saito is a psychopathic sexual sadist. Hakes is... Hakes. Cho, Miner, and John Doe aka Henry Clark have all suffered significant brain damage, which renders them ineligible. Akadiou is insane to a legal definition, incapable of judging the right or wrong of her actions. Roger Weathers is elderly, suffers from apparent dissociative identity disorder, and is deeply engaged in therapy with Doctor Allison. Johnson doesn't believe there's anything wrong with her. Jessica Kelly is a paranoid schizophrenic..."
"Cieslewicz," Kay said. "Sense of right and wrong, has maintained his core personality, made attempts--some successful--to control the damage caused by his manifestation."
Villette sat back in his chair and nodded. "Eddie's offered his consent to the procedure. His brother, Dyson, is on board."
There was silence for almost ninety seconds, as Villette and Ramachandran--who had, oh so obviously, orchestrated this entire meeting between them--allowed the others to contemplate the intricacies of the situation.
"We need a surgeon," Kay said.
Allison glanced at Frost. Frost, seeming aware of the attention, said, "I do not operate on living persons."
"We can find someone," Ramachandran said. "And an anesthesiologist, and core staff for an OR. The question is, do we want to pursue this line of research, in the understanding that while the procedure is as routine as brain surgery can be, this application of it is not?"
Silence ruled again, but this time more briefly. Beale looked up from a study of his thumbs and said, "Doctor Villette. If you arranged this, I suppose it's you I should be asking this of. In the understanding that I am not opposed to a plan that could give relief to some of Idlewood's patients--nevertheless. Why did you request that Dr. Reyes be excluded from this meeting?"
Villette leaned forward. Kay remembered him frail, with staring eyes and brittle hair. Now muscle stretched his suit jacket across his narrow shoulders and professional conviction buoyed his voice. "Because I believe it is unfair to ask him to retain his clinical detachment where Hafidha is concerned."
"But it's not unfair to ask this of you?"
He let his lips part over his teeth. If his body was fit and his mind was sharp, there was a whole world of cornered animal in that smile. Not for the first time, Kay wondered if she had done the right thing by him.
"I'm confident of my own ruthlessness," he said.
