Dr. Neruda's Cure for Evil (53 page)

The last of our interviews, Albert, our abused and abusive thirteen-year-old, arrived late, just before lunch. With him, atypically, were two men. One waited outside with Al while the other came in to speak to us privately. He identified himself as a paratherapist—a term new to me that I assumed meant he was a glorified attendant. He explained Al had attacked another boy at the Yonkers shelter that morning. Al broke the boy’s arm and threatened to gouge out his eyes with a spoon he had filed down. They decided to bring him to our session anyway, although he was going to be shipped back to Metropolitan State Hospital and would lose his privilege of coming to see me for the other two scheduled sessions. I would have to see him in Met State’s adolescent lockup ward in the future. (That meant a barred room reeking of garbage from Dumpsters behind a side door.) The paratherapist, a bald man, asked if he should stay in the room for our session. Diane was upset by the news of Albert’s violence. I said she should call a cab and go home. She protested weakly; I insisted. She had confessed during our drive up in the car that Al’s brutalizing of his niece (Diane’s patient) prejudiced her against him. The news of this attack on another child would only intensify her dislike. After she left, I told the attendant I could handle Albert alone.

The bald paratherapist looked me up and down. There was something funny about being evaluated in this way. I was more than a foot taller and eighty pounds heavier than Al.

“Okay, I guess it’ll be safe. But don’t turn your back on him. All right? Technically we shouldn’t’ve brought him here, but they said you would insist and we can’t take him to Met State until three for some crazy reason.”

Al shuffled in, ignoring the chairs, and sat on the floor, his back against the wall. There was a welt above and around his right eye. His skin was a deep dusky black. Al’s face was elegant, a high forehead and strong chin, eyes dark and brilliant. He was a handsome boy with no adolescent awkwardness. I asked if he wanted something to drink. He said he’d like a Coke. I offered ice water. With Ritalin in his system he could do without adding caffeine. I noticed his mouth was slightly swollen. After I gave him the water I asked about his bruises and he said, sullenly, nodding at the door to the waiting room. “They did it.”

“Not the boy whose arm you broke?”

“He didn’t lay a fucking finger on me. They punched me. They enjoyed it too. You know, the bald guy’s a fag. He wants my sweet ass.”

For the next half hour Al told me how he would have enjoyed scooping out his victim’s eyes, or better still, cutting off the bald man’s balls. He told me he was sorry Diane wasn’t there. He liked looking at her tits; he wished he could bite off her nipples. He wondered if cutting off a nipple would cause a lot of blood to flow. Those were some of his milder remarks. In my previous interview with him he had been sluggish and quiet, the docile manner of a drugged kid, not this, the “monster” that was supposedly caused by a poor brain recipe. Was he off the Ritalin? Not according to his chart. Had he been dumping it? Supposedly his caretakers were too smart for that: the boys were watched while they drank their medication.

I listened patiently to his horrible threats for ten minutes and then commented, “I’m disappointed in these fantasies.”

“Yeah? I’m sorry. I’m real sorry.”

“What about me? Don’t you want to do something terrible to me?”

“Yeah? You want me to? You want me to fuck your ass?”

My fatigue caught up with me, amplified by despair at Albert’s situation. I had been up most of the night reading. If the kindling studies on rats (and Albert seemed very much like a rat at the moment) were applicable to people, then when his mother used him sexually and tortured him physically his brain chemistry was altered (presumably to compensate for the extraordinary stress) and that change was ongoing, serotonin or dopamine or lord knows what flooding him in excessive or insufficient quantities, fighting off rage, despair, and loss from a past that no matter how distant or well understood, continued to hurt him without a break or diminishment. But if true, why couldn’t it be measured against a so-called normal brain? And yet it might be true anyway. Could I fight its control with mere words?

“No, you probably want to fill my hole,” Albert was saying. “You want to suck my cock?” Albert stood up quickly. I didn’t move: I wasn’t frightened of him. He wasn’t threatening me, anyway. He pulled off his shirt. His chest was a boy’s—flat, ribs showing. A line of four scars began above his right nipple and to the right of his navel: circular puffs of twisted bleached skin where his mother had pressed out her cigarettes. He tried to cup the dark nipple beneath the first scar, but it was too flat for the gesture to work. “You want to suck my tit?”

Of course my colleagues love to prescribe drugs for patients like Albert, I thought. Perhaps it was the right road, maybe Prozac was the leading edge of some bright future where psychiatrists can heal with the ease of GPs curing ear infections, but that wasn’t why my colleagues were so eager to abandon psychotherapy for pharmacology. It was despair at the hopelessness of human relations, of our ability to heal each other with love and understanding.

“Albert,” I said, “I want to take you off Ritalin.”

Albert let go of his breast. “Maybe you want to suck my cock.” He jerked the belt of his jeans and quickly unzipped, pulling both dungarees and underpants down to his thighs.

The reality of the damage his mother had done to his penis—it had been described in his medical file and by Albert verbally—was much more horrible to see than I had imagined. I pressed the edge of my fingernails into my palms to help control my features. It was crucial not to react with either horror or pity. I asked, “When did he see you?”

“You want to suck it?”

“When did the boy you attacked see you naked? Today? Or did it happen a while ago?”

Albert rotated his hips, gyrating like a stripper. He grabbed his wounded penis. “I could make it into a pussy. They can do that. They make a hole in you and push it in. They make a clit outta this”—he squeezed the scarred head to almost nothing—“so you still
get
off.”

“Did he see you in the shower? The bathroom? Where?”

“What the fuck you talking about?”

“You’ve taken off your clothes to show me what your mother did. I understand. But I need to know exactly what happened with the other boy, Albert—”

He let go of his penis and stopped gyrating. He frowned and interrupted. “Don’t call me Albert. Okay, fuck face? That’s not my fucking name.”

“What should I call you?”

“Zebra. You like that? Call me Zebra.”

“Is that what he called you?”

“He didn’t call me nothing. You ain’t so smart. You think you know everything, but you don’t know shit. You think you making us better? You think Shawna’s better?” That was the niece he had sodomized. “She’s sucking off all the boys. She’s seven and she gives better head than your wife.”

“Did she suck off the boy whose arm you broke?”

Albert smiled. He turned around and showed off his buttocks. The burn on his right cheek had the shape of its cause, an iron’s triangle. “Kiss my ass.” He was facing the wall. He lowered his head and rushed at it. His skull whacked hard against the plasterboard. The impact pushed him back a step or two. He paused and then repeated the action. His legs wobbled this time. He staggered. I was up from my chair now. He gathered himself, slammed into the wall again, and collapsed.

I hurried over and rolled him on his back. Blood flowed from his left eyebrow. His eyes were unfocused. He probably had at least a mild concussion. I was worried about what was in his system. One possibility was a rebound effect, that his brain was accustomed to the doses of Ritalin and now demanded more and more. His physical movements were jerky, foreshadowing the damage neuroleptics and Ritalin can create, namely tardive disorder. [Neuroleptics cause tardive dyskinesia—loss of muscular control resulting in painful disfiguring spasms—in at least twenty percent of patients who take them for longer than a year. I had seen research that showed Ritalin, not a neuroleptic, can have the same effect and much quicker on children. Hence my alarm.]

While I tried to take Albert’s pulse, the attendants pushed me aside. I hadn’t heard them enter. The bald one put his knee on Albert’s chest. The other grabbed his feet, staring at his genitals, mouth open with disgust.

“Did he hurt you?” the bald one shouted.

“He never touched me,” I said. “Get off him. You’re making it hard for him to breathe.”

Albert reached—ineffectually, like a drunk grabbing for support—for the bald man’s shoulder. In response, the paratherapist put his other knee on Albert’s stomach and slapped his face.

I shoved the bald man. He was perched awkwardly and toppled easily. “Get off!” I shouted. “I said he can’t breathe!”

“Hey!” His companion complained.

The bald man glared at me, but didn’t make a move.

I told them to call an ambulance to take him to Columbia Presbyterian. I checked Al and was sure that he had a concussion. He slipped in and out of consciousness, losing it at one point for over a minute, his respiration so feeble that I began mouth-to-mouth and was prepared to do a tracheotomy. He roused enough from the CPR. I made sure his air passages were unblocked, that he was warm, and I quizzed the attendants about his medications. They claimed to know nothing. I didn’t believe them. I suspected they had raised his dose of Ritalin. I went along in the ambulance to the hospital. I called ahead to a friend in residence there who met us at the emergency room.

What followed was hours of bureaucratic hassles. X-rays confirmed Al had a concussion. The shelter insisted Al should be transferred to Metropolitan State. I wanted him kept overnight at Columbia until I could get the results of blood tests.

Until then, I had had good relations with the head of the Yonkers shelter, Becky Thornton. Not this time. She was outraged by my interference and stonewalled my questions about Albert’s assault on the boy as well as what drugs he had been given. She threatened to
get
a warrant and have Albert transferred by the police.

“You don’t want to do that,” I told her. “You don’t want me to go to court to vacate the warrant and demand an investigation. You don’t want people to ask how Albert got ahold of a weapon—”

“It was a spoon!”

“—or how well the children were being supervised or to have me testify to the brutal treatment I witnessed by your employee.”

“Tom and Bill were trying to protect you. That’s all.”

“Tom and Bill could have accidentally killed Albert.”

“That’s an outrageous charge.”

“No it isn’t. Something was affecting Al’s respiratory system and once he concussed he was in real danger of total failure. That would have been a disaster for your shelter and for my clinic. I don’t plan to expose their negligence. But if you interfere with Albert’s care, I will. At this point, I have no confidence in your people.”

“Look, I admit we can’t handle him. That’s why we want to transfer him to the Met State. We took him to your clinic as scheduled only because I knew you’d throw a fit—”

“Throw a fit? When have I ever thrown a fit?”

“Excuse me. I knew you would
complain
if we transferred him without your seeing him. It was out of respect.”

“It wasn’t out of respect. The court ordered those visits. You had to bring him. Do yourself and me and Al a favor. Leave him at Columbia overnight.”

“And what if he attacks somebody there?”

“He has a concussion.”

“That’s not a guarantee.”

“I’ll take full responsibility for him. If something happens, it’s on my head.”

“I need that in writing.”

Her two attendants, Tom and Bill, were still at Columbia. I wrote a note to satisfy her and gave it to them.

To be safe I would spend the night at his bedside. Albert was certainly capable, psychologically, of attacking someone, or escaping, or committing suicide. I could order them to put him in restraints or heavily sedate him, but that was exactly how people like Al, who have no one to sacrifice themselves for their benefit, are treated by our system. Drugs are used in place of contact; indifferent or hostile attendants instead of care. He had been bounced from psychiatric jail to shelters to foster care since he was rescued from his mother—Al’s rape of his niece was what called the police’s attention to his own abuse. I believed this new attack was another call for rescue. Something had happened; maybe it was the medication. Didn’t matter. I had to show him that someone was willing to deal with him as a person. Otherwise, certainly he would be lost. Lost as a human being; not as a menace. Eventually, the system would let him out and he could well become the world’s notion of an unfathomable monster—a vicious serial killer.

I called Diane and explained. She listened to the full account, not commenting until I was finished. “I fucked up, honey,” she said. “I was a wimp and I dumped it on you. I’m sorry. I’ll come right over.”

I insisted she rest and perhaps join me in the morning. I told her not to blame herself for her antipathy to Albert. And we discussed the beginnings of a plan.

When our talk was over, I walked down the hall to Al’s room. He was tied to the bed. I wouldn’t have the test results until morning. He was awake. His right foot was shaking, the leg’s quadricep bulging and releasing rapidly. He stared at me. I untied the straps and massaged his leg. The spasms were ferocious and completely local. The rest of his body was enervated and motionless.

“Is it hurting you? The spasms?”

He shook his head. “I don’t feel pain, you know,” he said.

I couldn’t help the muscle—its demonic animation seemed to mock me. I covered him with another blanket and asked if he wanted to eat.

He shook his head.

I rang for the nurse and told her to bring soup.

When it arrived, he said, “Don’t want it.”

I spooned up some and held it near, but not at, his lips. He stared at me. “What?” he asked.

“I think you should reconsider.”

He turned his head away, then quickly back to swallow the soup, as if tricking me. I measured another spoonful and waited. He looked at me this time without any hostility. “I ain’t gonna change,” he said.