A Vision of Fire (3 page)

There was a paper pharmacy bag, still stapled at the top. Caitlin noted the physician's name, Deshpande, and the recipient's name, fabricated most likely, which did not include “Maanik” or “Pawar.”

Caitlin opened the bag and retrieved a pair of amber containers. “Vasoflex. This is for insomnia and recurrent nightmares.” She looked at the other, surprised. “Risperdal. This is a potent antipsychotic.”

“That is a correct medication, yes?” Hansa asked.

“If you're bipolar and haven't slept for a few days,” Caitlin replied.
“We don't use it as a prophylactic, ‘just in case' medicine. Mrs. Pawar, your doctor
did
come by and see her, yes?”

There was silence. He hadn't. That was illegal in New York State. Caitlin glanced over at Ben, who gave her a cautioning look. Rules were obviously being bent here.

“That's a potent mix to put in her body without an examination and after just a few hours,” Caitlin said.

“I am sorry,” Mrs. Pawar said, more to her daughter than to Caitlin. “We did not know what else to do.”

“It's not your fault,” Caitlin lied, not wanting to make a bad situation worse. “But until we know the trigger, we're not going to give her these.”

“Dr. O'Hara, we are watched,” the ambassador said unapologetically. “Our doctor is also with the United Nations. He keeps a log. Confidentiality means nothing in diplomacy; word would spread. I'm afraid the delegations will see my distraction as a potential weakness and press for advantage, or worse. There is still a stigma against mental illness in both India and Pakistan. If anyone were to find out she was receiving psychiatric treatments—”

“Sir, there is no illness if a situation is treated.”

“That is a technical distinction,” the ambassador said. “I know it is difficult for Americans to understand the concept of family shame, and though Hansa and I do not subscribe to the idea, many still do.”

“I do understand and there is no need to explain or apologize—”

“But there is,” he interrupted. “I am in a delicate position. Accusations of evil spirits are still a quite common response to mental illness in both countries. If her condition is known—in fact,
when
her condition is known, as I am sure we have only a week, two at most, before discovery—I could be removed from the negotiations, Dr. O'Hara, or either side could use it as an excuse to leave the negotiating table and turn this matter over to their military forces. A doctor's visit to my home could be used to prove not just that I am incapable of mediating, but that the entire negotiation process is forfeit.”

“We needed a caregiver no one knows,” Ben said. “That's why I called you.”

Caitlin didn't like it but she understood. The good of the many outweighed the needs of a few.

Ganak went on. “I know this is a terrible imposition, but Ben gives you a glowing report. Will you help?”

“Of course.”

Ganak and his wife shared a relieved look, then smiled gratefully at Caitlin.

“If you will excuse me, doctor, I must get back,” the ambassador said. He gently moved the girl out of his arms so that she was lying against her pillows. She still did not stir.

Caitlin moved closer to the young woman. “Ben, will you call my office and tell them I'm tied up in an emergency? This is going to take longer than I thought.”

“Naturally.”

“Mrs. Pawar, we're going to have to impose on your housekeeper again,” Caitlin said. “Please ask her to pick up several boxes of cotton pads, six-ply bandage rolls as wide as they make them, and oregano oil. That won't sting your daughter awake; we want her to sleep.”

Mrs. Pawar nodded. The ambassador rose and cupped his wife's face briefly as he passed her. She followed him out of the room. Ben nodded to Caitlin and smiled briefly in gratitude, then left the room, closing the door behind him.

Alone with the girl, Caitlin experienced another chill. The isolation and dread she had felt in the hallway seemed magnified here. There were no street sounds, no hovering air traffic anywhere near the United Nations, no sense of the time of day, no fresh air. She realized, though, that she might be responding to more than the environment and the girl's condition. Politically, what happened here would radiate in all directions, affect countless lives. There was no room for mistakes.

Good thing you never make any
, she needled herself, thinking back to her conversation with Director Qanooni.

Maanik continued to sleep, her breathing shallow, her pulse at the low end of normal but not a cause for alarm. Her skin was cool but not cold. Caitlin asked for a thermometer; her temperature was normal. She checked for bruises on her neck, felt her scalp for abrasions or any sign of concussion.

When the housekeeper returned, Caitlin removed Maanik's bandages, then soaked several cotton pads with the oregano oil and gave them to Mrs. Pawar to hold ready. She picked up the girl's right arm with a gentle hand, held a soaked pad over one of the wounds, then wiped down gently but firmly to the wrist.

There was no reaction from Maanik. Her forearm twitched, but the girl's eyes did not even move behind her eyelids.

“My poor girl,” Mrs. Pawar said.

Caitlin was concerned, not by the cuts, which were fairly superficial, but by the near-complete lack of response. This was not a normal slumber or the common numbness and disconnection that arose from an unexpected emotional event. She dropped the cotton pad and, taking Maanik's hand, applied sharp pressure to the nail bed of Maanik's pinky, trying to gauge her level of consciousness. The girl did not react. Caitlin pulled up the girl's left eyelid and the pupil immediately began to dilate.

That's strange
, Caitlin thought.
There's no light here—

“Help!” The girl screamed and bolted upright.

CHAPTER 3

C
ries of terror seemed to explode from deep in Maanik's chest. Caitlin jolted back, giving the girl room to move but holding firmly to her wrists. Maanik was trying to scrape at her forearms while flinging her body back and forth on the bed.

“Maanik!” Caitlin called.

“Maanik!” Mrs. Pawar repeated from a corner of the room. “
Ise banda!
”

But the girl did not stop. She shook her head back and forth, not in resistance but in what seemed like rage. Caitlin wasn't sure she was even hearing them.

Releasing Maanik's wrists, she pressed her palms on the girl's shoulders and shifted them, not holding her down or shaking her but simply moving one shoulder up and the other down with strong purpose. It was an adaptation of a Chinese Qigong method Caitlin had used before to calm panic attacks.

Within moments, Maanik's screams became slightly more subdued—but only slightly.

“Mrs. Pawar, turn on the light,” Caitlin said.

The woman hurried to the switch. An overhead fixture glowed. Caitlin angled Maanik's body slightly so she was looking up.

“Maanik, listen to me,” Caitlin said. “You are looking at a large TV screen. Whatever you are seeing is on the screen. Do you understand? Look at the screen. Everything is on the screen.”

Caitlin watched the girl's pupils focus on a point over her shoulder. The pauses lengthened between the screams, and they sounded like urgent announcements now instead of bursts of pure terror.

“Maanik, move your right foot.”

The girl did not move.

“Maanik, keep looking at the screen and move your right foot.”

The girl slid her right foot down the bed. Her breath had turned ragged and panting but she was not summoning breath for another scream. She was starting to recover.

“Maanik, I am going to count now. When you hear me say a number, you will see that number on the screen. When you hear ‘eight,' you will want to go to sleep. When you hear ‘five,' you will let yourself go to sleep. Okay?”

Her breathing was growing calmer. But there was no indication that she'd heard or understood.

Caitlin glanced around the room, the movement of her head easing the tension in her shoulders. She noticed that Jack London, instead of staying near his human like most worried dogs would have, was behind the curtains. He was sniffing hard and appeared to be moving along the edges of the windows.

Caitlin took one more deep breath, then said, “Okay, I'm going to begin counting.” She maintained a light pressure on Maanik's shoulders. “Ten. Look at the ten on your screen. Keep looking. Nine. Eight.”

Nothing changed.

“Maanik, when I say the word ‘eight' you will feel how tired you are, how nice it would be to go to sleep. Look at the screen. Eight.”

The girl's shoulders sagged under her hands.

Caitlin felt Jack London sitting down on her foot. Now he was watching Maanik.

“Very good. Seven. Six. You can feel your eyelids closing. Five.”

Maanik's eyes closed as the countdown finished.

Jack London shook his head, sensing the crisis had passed, then yawned and trotted from the room.

Caitlin relaxed as well. She stood, pulled a light cover over Maanik's resting form, and backed toward the corner of the room where Mrs. Pawar had found safety. She could see that amid the mother's concern for her daughter, this protective and dignified woman was also scared of Caitlin.

“Hypnosis is a very common tool for psychiatrists, please don't worry.”

“But how did you . . . she was unreachable!”

“Only to normal forms of communication. Maanik was actually very responsive to hypnosis, almost as if she has experienced it before. Has she ever been hypnotized?”

“No, never.”

Caitlin was used to skepticism, but under Mrs. Pawar's gaze she felt like a wizard.

“This is just a temporary fix,” Caitlin said. “At this point I would strongly suggest that you admit Maanik to a psychiatric hospital—”

“Absolutely not,” Mrs. Pawar interrupted.

“But she's already a danger to herself, and at any minute—”

Mrs. Pawar was shaking her head. “It would be noticed and it would be publicized, doctor. It is not possible at this time.”

She folded her arms and rested the back of a hand against her lips, and Caitlin saw how hard she was working to keep it together in the face of the day's events. Pushing the matter would worsen the situation for the mother and do nothing for the daughter.

“All right,” Caitlin said, pulling her prescription pad and a pen from her purse. “I'm going to give you a different prescription—­clonazepam. It's a sedative and a muscle relaxant, less radical than the others, and Maanik can be named the recipient without raising suspicions, in case anyone finds out. Give her the pill on a full stomach and when it takes effect, clean her forearms with the oil, all right?”

Mrs. Pawar nodded.

Caitlin indicated that they should leave the room. Mrs. Pawar followed her into the hall. As Caitlin left the door ajar she asked, “If you'll excuse me, Mrs. Pawar, I must ask: has Maanik ever suffered any kind of trauma? An attack, abuse at any age? Sexual abuse? Physical or emotional?”

Caitlin watched the woman grow weary under these most difficult of questions. She shook her head no. Caitlin pushed a little further.

“I know that you lived in New Delhi not long ago, and I know that New Delhi is experiencing an epidemic of sexual assault. Is there
any
chance at all that Maanik could have been assaulted and not told you?”

Mrs. Pawar did not look Caitlin in the eye but Caitlin knew that was cultural, not deceptive. “There is no chance,” Mrs. Pawar said. “We raised a miracle. We raised a safe child. She was unscarred until she saw the attack on my husband.”

Caitlin reached out and held Mrs. Pawar's hands for a moment. “I believe you,” she said.

“Thank you.”

“Thank
you
,” Caitlin replied. “I know this isn't easy but it's necessary. We will find the cause of this. We will make her world safe again.”

“How long will that take? Do you have any idea?”

“I don't,” Caitlin admitted.

“What if—if it happens again?”

“It may very well. I'll leave you my number. If there is another episode, even a very mild one, call me. I'll come right over.”

The relief in Mrs. Pawar's eyes was profound.

The housekeeper stepped forward—a small woman with the first touches of gray in her hair—and showed Caitlin to the door. But Caitlin turned suddenly. She felt goose bumps along her arms, as though cold air was blowing up her sleeves.

“Doctor?” Mrs. Pawar asked. “What is it?”

Caitlin looked down at her arms. Her sleeves weren't moving. There was no vent on the floor or the wall.

“Sorry,” Caitlin said. “I thought I left something back there.”

Smiling and wishing the women a good day, Caitlin walked into the hallway. The odd feeling passed as the elevator descended and the course of her day resumed and the lives of the patients she had to see crowded Caitlin's mind.

• • •

The rest of the day passed swiftly and without incident. Caitlin attributed her earlier restlessness to Ben's anxiety, the Pawars' fear, and the uneasy zeitgeist of a city that seemed to be waiting for bad news. Something about the Kashmir crisis was gripping people who usually forgot about major news events within a day or two. She overheard several conversations about the assassination attempt and whether nuclear war was likely. It was the top trending topic on Twitter, and her colleagues were sharing news articles over e-mail. An Associated Press update mentioned the ambassador's return to the negotiations and his cold reception. The talks had not recovered from the damage of Ganak's sudden departure—his “unexplained abandonment,” one Indian delegate had called it.

Ben was right
, she thought.
They're just looking for reasons to be petulant. Little girls and boys with very dangerous toys.

Late in the afternoon, Caitlin headed to a café on Twenty-Seventh Street. Jacob's cooking class, held in a test kitchen one floor up, would be finishing in twenty minutes. She sat in a private corner with a cup of jasmine tea, hunched over her phone for an overdue conversation.

The man on the other end was unhappy and more than a little condescending.

“Dr. Deshpande, I assure you, it is
not
post-traumatic stress disor
der,” she said to Maanik's physician. “I have never heard of a rapid, cyclical repetition of PTSD symptoms.”

“Perhaps a review of the current medical literature might convince you to revisit that opinion?” the doctor suggested.

Caitlin bristled but decided that methodology was not the battle she should be fighting.

“Yes, of course, I will be doing that,” she said. “But in my experience with crisis survivors locally and globally, this is wholly atypical. Now,” she continued before he could interject another cover-his-ass approach, “are you sure there is nothing in Maanik's history that could be a precursor to this?”

“Nothing. I am certain you checked for head trauma while you were there, Dr. O'Hara? She was thrown to the sidewalk when the shooting occurred—”

“There were no bruises, no reason to infer nausea, no reaction that would suggest headaches—”

“ ‘Infer,' ‘suggest,' ” he said. “That is why I prescribed what I did. Because you frankly do not know.”

“And
you
didn't request an MRI,” Caitlin shot back. “I understand why, I do. But that doesn't justify nuking her body with that cocktail you prescribed.”

“The ambassador was needed. Another incident had to be averted. And your method did not work, I understand? Not quite?”

This discussion was pointless. Caitlin got back on topic. “What about when she was a child?” she pressed. “I know the Pawars have only been here two years, but you have her records from India?”

“I came to New York with the Pawars,” he said. “The ambassador arranged for my post at the United Nations. As for Maanik, the most serious ailment I have ever treated was a sprained ankle last winter from ice-skating. And before you interrupt me again, no, her head did not touch the ice. She is supremely healthy in every way. Which is why I felt—and still feel—she could handle that ‘cocktail.' ”

“What about psychologically?” Caitlin asked. “Has she ever exhibited an extended period of despondency, withdrawal?”

Dr. Deshpande laughed. “Those are words that could never apply to Maanik. She is a precocious, vital, outgoing girl, Dr. O'Hara, and has always been so.”

“The drugs you prescribed. Had Maanik ever taken those or anything like them?”

“No, and I will spare you the discomfort of asking: Mrs. Pawar is concealing nothing about domestic abuse or assault. Her family is strong and loving and Maanik is one of the happiest teenagers I have encountered. I have no doubt that the mental trauma of witnessing her father's attack altered her body's chemistry and it is manifesting mentally. We can
safely
use medications temporarily to remind the body of what normal is, and she will adjust and return to herself.”

“
Or
we can look for an approach that addresses the cause and not just the symptoms,” Caitlin replied. She saw no reason to press this further. She thanked the doctor and ended the call. At least he had agreed to stick with just the clonazepam for now, since the immediate crisis had passed.

But Dr. Deshpande was right about one thing: had it passed for good? She flashed to the bloody S-curves on Maanik's forearms. Every day Caitlin provided therapy to high school students for Roosevelt Hospital. She counseled college students from the John Jay College of Criminal Justice, consulted for international agencies, oversaw the development of a mental health program for refugees, and closely monitored world news for potential hot spots of trauma where she might be needed. This work was her life and her passion. And yet, with all her specialized experience behind her, she was stumped by Maanik. Something about the terror, the scratching, the look in her eyes. To say it unsettled her would be an understatement.

Caitlin lifted her shoulders high and dropped them—a literal effort to shrug off the residue of the afternoon. Ten more minutes before Jacob would be down. She discreetly massaged just above her eye
brows, the tips of her ears, behind her ears, down her skull to her neck. It helped.

Her phone vibrated once—a text from her younger sister, Abby, a surgeon in Santa Monica, California:
How was it??

Caitlin sighed. She knew what this was about: last night's date, which now seemed a hundred years ago. She'd text back later. She signaled the server for the bill, closed her eyes, and listened to the low murmur of conversation around her, cars outside, the flutter of a paper pinned to the wall near a heating vent.

Maanik came back to her thoughts—would she remember what happened when she woke? Caitlin thought of Ben, how scared he had seemed. Did he know something he wasn't sharing? She thought of all her clients whose appointments she'd had to cancel that afternoon, and the UN negotiations.

“Will that be cash or charge?”

Startled back to the room, Caitlin gave the server seven dollars and gathered her things. She exited the café into the lobby, peered through its windows onto Twenty-Seventh Street, saw nothing unusual. She checked her messages. Nothing new. She walked around the lobby twice, sat down on a bench made of recycled plastic, thought of Jack London back at the Pawars' apartment. She smiled, then called her own therapist and left a message, asking for a call back. “Nothing urgent,” she said. Caitlin just needed to talk.

Then Jacob was hurrying across the lobby, still young enough to be excited to see her, saying and signing, “Hi, Mom!” at the same time. At school he leaned toward sign language as a means of communicating; after school he usually used his hearing aids. Caitlin marveled at how he straddled both worlds, even when faced with occasional pressure from other kids to “pick one.”