Little Black Lies

She picks an invisible bug off her face.

A pink sore swells up, adding to the constellation of scabs dotting her skin, remnants of previous invisible bugs. Tiffany is a “frequent flyer” as they say, in and out of the psychiatric ward. She’s been my patient twice already, both times delusional and coming off crystal meth. She does the usual circuit: emergency room, psych ward, rehab, streets, and repeat. A cycle destined to continue until interrupted by jail, death, or less likely, sobriety. Tiffany sits on her hospital bed staring off into space, the skimpy blue blanket over her knees. She is emaciated, her spine jutting out of the back of her hospital gown. A penny-sized patch of scalp gleams through her bleach-blond, stringy roots, due to her penchant for yanking out clumps of hair (otherwise known as trichotillomania, in case Dr. Grant asks me, which he will.)

“I’ve got to go now, Tiffany. Anything else I can do for you?”

She doesn’t answer or even look at me. Either she’s psychotic or ignoring me or both, but I don’t have time to figure out which because we’re rounding in five minutes, and I still haven’t finished my charts. I run down the hall to the nurses’ station, which is in chaos. Jason and Dr. A, the other two psychiatry residents, are elbow to elbow in the tiny room, mint-green charts in precarious towers around them. The nurses jog around us, saying “Excuse me” too loudly, as they sort out meds and record vitals, ready to sign out, punch out, and get the hell out of Dodge as the seven o’clock shift drifts in.

Dr. A grabs an order sheet from the stack. “Did anyone discontinue the IV on Mr. Wisnoski?”

“Mr. who?” one of the nurses calls back.

“Bed nine. Mr. Wisnoski. This should be done expediently.”

“Whatever you say,” the nurse answers, putting on latex gloves and heading to the room. Dr. A’s real name is Dr. Adoonyaddayt, and his first name is just as unpronounceable. So everybody calls him Dr. A. He has a strong Thai accent and obsessively studies an online dictionary to improve his vocabulary. He is, as he told me, “building a compendium of knowledge.” Dr. A appointed Jason to be his “idiom tutor,” to better connect with American patients. He used to be a neuro­surgeon in Thailand but is slumming with us in psychiatry now because it’s impossible for foreign medical graduates to get into neurosurgery here. Dr. A is easily the smartest of our threesome.

“I thought Wisnoski was mine,” Jason says. “He’s yours?”

“Mine,” Dr. A answers, taking the chart from his hand. Jason is dressed to the nines as usual, with his trademark bow tie (he has more colors than I thought existed, a compendium of bow ties in his closet), bangs gelled up and bleached just so. Jason is gay to the point of cliché, which I pointed out to him over beer one night, though he disagreed. “I’m Chinese American. Cliché would be me tutoring you in math.”

The new medical student (Tom?) hasn’t picked up a chart yet. He watches us running around like beheaded chickens and yawns. I like to play a little game, figuring out which fields the medical students are headed into, which I can usually guess in the first five minutes. This one, surgeon for sure.

“Zoe,” Jason calls out to me. “You got the new one?”

“Which one, Tiffany?”

“No,” he says. “The transfer. Vallano.”

“Oh, the one from Syracuse. Yup, I got her,” I answer, grabbing her enormous chart, which tumbles open. “Dr. Grant’s special present for me.”

Jason guffaws, cracking open his own charts. “He sure does love you.”

“Ah yes, such is my lot,” I answer, flipping through her chart. It’s obvious Dr. Grant doesn’t like me, though I can’t figure out why. It could be the Yale thing. But then again, maybe not. Could be a lot of things. Could be that I don’t like him, and being a psychiatrist extraordinaire, he senses this.

Footsteps thump down the hall as Dr. Grant appears in the doorway. Beads of sweat mix into the curly hair at his temples from walking up ten flights of stairs. In my opinion, anyone who walks up ten flights of stairs on a daily basis needs a psychiatrist. Dr. Grant is wearing gray pants with a thin pinstripe and a checkered blue shirt, a combination that suggests his closet light burned out. He is a small, slight man. I could crush him in a thumbsie war.

“Ready to round?” he asks.

We file out of the cramped nurses’ station, and the medical student strides over to shake his hand. “Kevin,” he says.

Kevin, Tom, same thing. We stack the charts into the metal rolling cart and then Jason pushes it, clattering down the hallway. We pass by gray-blue walls, sometimes more blue than gray, sometimes more gray than blue, depending on the soot. The floor tiles are an atrocious teal blue (the approval committee was either color-blind or on mushrooms), dented and scraped from years of residents and food carts rattling down the hall.

“All right, first victim,” Dr. Grant says, stopping just outside the room. Dr. Grant always calls the patients “victims” when we round. I haven’t taken the time to analyze this, but it does seem peculiar. To his credit, he says it quietly at least, so the already paranoid patients don’t get any ideas. “Mr. Wisnoski. Who’s got this one?”

“This is my patient, sir,” answers Dr. A. He calls everyone “sir.”

“Okay. Go ahead and present.”

“Mr. Wisnoski is a forty-nine-year-old Caucasian gentleman with a long-standing history of depression. He was found unresponsive by his wife after overdosing on Ambien.”

“How many pills?”

“Thirty pills, sir. He took one month’s dose. He was taken by the EMT to the ER, where he underwent gastric lavage and quickly recovered.”

“Meds?” Dr. Grant asks.

“Prozac, forty milligrams qd. He’s been on multiple SSRIs before without success but had reportedly been feeling better on Prozac.”

“So why did he try to kill himself?” Dr. Grant glances around and zeroes in on me, as usual. “Dr. Goldman?”

I’m still not used to the “doctor” thing, telling nurses “Just call me Zoe.” “The problem is,” I answer, “Prozac actually was effective.”

Kevin is chewing a large piece of pink gum, which smells of strawberry. I can tell Dr. Grant is feeling the stress of ignoring this.

“Tell us what you mean by that, Dr. Goldman.”

“Oftentimes a patient is most at risk for suicide when there is some improvement in functionality,” I explain. “They finally have the wherewithal to commit suicide.”

“That’s right,” he admits, though it pains him. We all head into the room, but it is empty, the patient’s disheveled blue blanket crumpled on the bed. The room reeks of charcoal, which stains the sheets from last night’s stomach pump. After some consternation, we discover from a nurse that Mr. Wisnoski is off getting an EEG.

So we move on down the list to the next room. The name is drawn in fat black marker into the doorplate. “Vallano.” This is my add-on, the transfer.

“Dr. Goldman?”

“Okay,” I say, ready to launch. “Ms. Sofia Vallano is a thirty-six-year-old Caucasian female with a history of narcissism and possibly sociopathy on her Axis II. She has been in Upstate Mental Community Hospital since age fourteen for the murder of her mother.”

“Holy shit” escapes from Jason, to a glare from Dr. Grant. Still, you can’t blame him; she did kill her mother.

“Any other family members?” Dr. Grant asks.

“One brother, listed as a lost contact, one sister the same. The brother was reportedly injured in the incident.”

“Go on,” Dr. Grant says.

“After the closure of UMCH, she was transferred here for further treatment and evaluation,” I continue.

“And,” Dr. Grant announces, “possibly for discharge, pending our recommendations.”

“Discharge, really?” I ask.

“Yes, really.”

I slide her chart back into the cart. “Based on what findings? Has her diagnosis changed?”

“Well now, Dr. Goldman, that’s our job to find out. She’s been a ward of the state for over twenty years now. If she’s truly a sociopath, I grant you, we may not be able to release her to society. If she’s narcissistic, however, maybe we can.” He skims through her old discharge summary. “From what I can see, UMCH has been kicking the can down the road on this one for a while now.”

“She never went to prison?” the medical student asks, still chewing gum.

“Not fit to stand trial. Okay, let’s see how she’s doing.” Dr. Grant knocks on the door in a quick series.

And there is Sofia Vallano, perched on the bed, reading a magazine. I’m not sure what I expected. Some baleful creature with blood dripping from her eyeteeth maybe. But this is not what I see. Sofia Vallano is a stunning mix of colors: shiny black hair, royal blue eyes, and opera red lips. Something like Elizabeth Taylor in her middle years, curvaceous and unapologetically sexual. They say the devil comes well dressed.

“Hello,” she says with a smile. A knowing smile, as if she’s laughing at a joke we aren’t in on. She does not put down the magazine.

“Hello,” says Dr. Grant.

“I’m Dr. Goldman,” I say, extending my hand. My skin is damp in hers. “I’ll be the main resident taking care of you, along with Dr. Grant, who’s in charge. Just saying hello for now, but I’ll be back to see you later.”

“Okay,” she answers and looks back down at her magazine. Obviously she’s been through the likes of us before. A cloying scent rises off the magazine perfume ad on her lap. Redolent and musky.

We say our good-byes and all head back to see Mr. Wisnoski, who still isn’t back from EEG.

“Who’s next?” Dr. Grant asks. “Dr. Chang? Do you have anyone?”

“Yes, I have Mrs. Greene,” Jason answers.

“Would you like to present?”

“Fifty-six-year-old African American female with a history of bipolar II. She came in today after a manic episode, now apparently consistent with bipolar I.”

“And how was that determined?”

“Last night, she climbed onstage at Les Misérables to sing during one of the solos.”

“Which one?” I ask, immediately regretting the question, which is not terribly relevant to the diagnosis and also tells me my Adderall hasn’t kicked in yet.

“‘I Dreamed a Dream,’ I think,” he answers.

“Ah, the Susan Boyle one,” says Dr. A in appreciation. “I find that song most gratifying.”

Dr. Grant surveys us all with incredulity. “Doctors, could you at least pretend to be professional here?” Dr. A drops his gaze shamefully, and Jason twirls his bangs. Kevin chews on. “Meds?” Dr. Grant asks.

“She was on Trileptal,” Jason says. “Three hundred BID but stopped it due to nausea three weeks ago. The history is all from her sister because the patient is not giving a reliable history. Her speech is extremely pressured.”

“Ah yes,” Dr. A says. “In bouts of mania, actually,”—he pronounces this act-tually, with a hard t—“the speech is quite rapid, and one cannot get the word in edgily.”

“He means ‘edgewise,’” Jason explains.

“Ah, edgewise, so it is.” Dr. A pulls the little black notebook out of his lab-coat pocket, where he jots down all his ill-begotten idioms.

Dr. Grant crosses his arms. One summer when I was in high school, my mom enrolled me in ADHD camp (sold to me as a drama camp) to boost the self-esteem of her ever-slouching, moody giant of a daughter. We played this game called Name That Emotion, where one group would act out an emotion and the other group would call out what it was. If I had to name that emotion for Dr. Grant assessing his crop of psychiatry residents, it would be disgust. We head to the next victim, our Broadway hopeful, but alas, she is getting a CAT scan, so we head back to see Mr. Wisnoski, who is still in EEG.

Dr. Grant looks supremely frustrated. “Anyone else to see?”

“I have Tiffany,” I say.

“Oh, Tiffany, I know her. She can wait.” He chews on the inside of his lip, thinking. “All right. I guess we’ll finish rounds this afternoon. Just make sure you see all your patients and write your notes in the meantime.”

So we split up to see our respective patients. The nurses’ station has slowed to a hum now. I settle down to Sofia’s chart, which is massive, not to mention the three bursting manila envelopes from UMCH, but at least I can feel my focus turning on. As I open the chart, the perfume card from the magazine falls out, the heady smell of perfume rising up from the page like an olfactory hallucination.

The nightmare is always the same. Bloodstains on my hands, red as finger paint.

I am hiding, but I don’t know why. I don’t know where I am, or who I’m hiding from.

A whirring noise buzzes in time with my hands; my fingers are pulsing in pain. Moonlight streams through the window, spattering the tile floor, interlaced with shadows of tree branches. I rub my cheek against my teddy bear. Soft, blue teddy bear, bristles stiff with drying blood. Teddy’s name is Po-Po. His black-bead eye glints in the moonlight. His other eye went missing weeks ago, rolled somewhere, under a kitchen rug or in between the couch cushions maybe. No matter, I love my one-eyed teddy. I am hiding Po-Po, too.

The room is warm, blazing warm, and I smell smoke all around, like sweet tobacco. Like the smell of my dad’s rolled cigarettes.

The shadows of the tree branches move on the floor, like witch’s fingers.

“Zoe?” a voice calls out, sweet as pie, patient. “Zoe?” It is a singsong voice. I tuck myself in tighter, barely breathing. If I fold myself up, they will not find me. My heart bangs in my ears. I watch the slit of light beneath the door for movement. My teddy trembles in my wet, bleeding hands.

“Zoe? Honey, come here. We just want to help you. Come on, honey.”

The voice is calm, soothing. Mommy? Is she calling me? Relief surges through my body like water on a fire.

“Mommy!” I scream with every fiber in my body. I forget that I am hiding, forget that someone may find me. “Mommy! Mommy!” It is a shriek, a prayer.

And then the door opens, and my heart stops.

“Zoe!” Scotty is shaking me by the arm. My heart leaps out of my chest and I sit up like a shot, my pajama top slimy with sweat.

“What the fuck?” he asks. Charitable, considering he is my brother. And my screaming just tore him from the arms of his latest paramour, now wide awake and wondering why he’s living with some crazy woman bellowing in the next room. “What was that all about?”

“The fire,” I say, confused, catching my breath.

“The fire?” He looks confused, too, maybe because he just woke up, or maybe because the fire was over twenty years ago. “I didn’t know you were still having those nightmares,” he says, his voice gravelly with sleep.

“I didn’t either.” I haven’t had a nightmare about the fire since high school.

My brother stands up from my bed, all limbs, hair tousled. Half of his face looks monstrous in the shadows, like the Phantom of the Opera. He stretches up his arms with a yawn, his eyes turning toward his bedroom. “You okay?”

“Yeah, I’m fine.” I’m not sure this is true, but after all, he does have someone waiting in his bed. And I am old enough to go back to sleep without my mommy.

“Thanks,” I call to his retreating figure. Soft voices float into the hallway as he returns to his bedroom, “What’s-wrong-with-her?” noises. I lay back down in bed, my pattering heart slowing. Headlights flash on my wall as a car rumbles down the street.

Three in the morning.

A brown spider twirls on a web in the corner of the ceiling. Thinking back to my medical school lecture on poisonous spiders, I vaguely recall it’s the brown ones you have to watch out for, that would kill you dead in seconds. Or maybe it was the brown ones that were harmless, and the red ones that were deadly. This does seem like an important distinction, though not necessarily at 3:03 a.m. I shut my eyes and try to sleep, but I’ve played this game before, and sleep has no intention of coming, not anytime soon. Sleep is perverse in that way, abandoning you just when you need it most.

Unless I have some Xanax left.

This hope drags me to the bathroom, the bright light stinging my eyes. I untwist the cap and peer in to see my little white pill shining up at me like a beacon from its orange plastic bottle. Thank God. I’m not addicted to the stuff, but it’s easy to see how that could happen. I have, in fact, seen it happen.

I pop the pill into my mouth and climb back in bed. My brain slows to a thrum, listening to the Xanax. Arms jelly, legs jelly, brain jelly, melting into the bed. But before I fade off, the finest gossamer of a thought sticks in my brain like a burr.

The fire. After twenty years, why am I dreaming about the fire?

Tell me about the dream,” Sam says.

I am lying on the stiff, chocolate-brown leather couch in his office, playing with an iron puzzle. Rings and figure eights that supposedly unlink into a necklace, with the apparent purpose of driving crazy patients even crazier.

“It’s about a fire,” I say.

“Okay,” he says, in a measured voice. Sam always has a measured voice, part of the psychiatric bedside-manner thing I need to work on. He taps his knuckles on his glossy wooden desk. Everything in his office is glossy. It reminds me of the inside of a yacht: shiny, dark-cherry wooden furniture, deep navy-blue walls, anchor bookends, and a brass barometer on his desk. He has an oversized compass, too, with a desert-tan face and red and blue hands that always point true north. Which is odd, because the room faces east. I pointed this out once, and he gave me a polite smile that said, Maybe your Adderall needs adjusting. “Tell me more,” he says.

“About the dream? It’s a nightmare, really. A memory.”

“A memory of what?”

I shake some blood back into my feet, which are dangling over the couch. This couch is not meant for tall people. Then again, most people probably don’t actually lie on the couch. “Does anyone else actually lie on the couch?” I ask, since the thought strikes.

“Zoe, how about we try to focus on the dream?”

I sit up, clanking the iron puzzle back on the table. Focus, right.

“You say the dream is a memory. A memory of what?”

“A memory of the fire. The fire that killed my birth mother.”

Sam stares at me. “Go on.”

“It was just the two of us in the house when it happened. I was four years old. I survived, obviously, but she didn’t.”

“Wow,” he says, though it’s a measured “wow.”

“My mom, my adoptive mom, told me about it when I was little, because I don’t remember it very well. Only what I can piece together from the nightmare.”

“Mmm-hmm,” Sam says. “Mmm-hmm” is big in psychiatry. Another thing I have to work on: getting just the right tone for my “Mmm-hmm.” “And what do you remember?” he asks.

I think back to the house. My parents showed it to me when we visited their old neighborhood once, a boring suburban house with skimpy dental trim around the front door. Somehow I had envisioned a different house, wet with ashes, smoke still rising. But of course, this was years later, and a new house now stood in its place. Phoenix will rise again.

“I remember the smell of smoke,” I say. “And my hands, I remember my hands being cut.” I show him the fine white lines that zigzag my palms. Show-and-tell. “Something fell off the house when it was burning, sliced them up.”

“How about your mom? Can you remember her at all?” he asks.

I shake my head. “Not really. I wish I could. I have a photo of us from when I was a baby. That’s all I really have of her. Everything else was destroyed in the fire.” I pick up the heavy metal puzzle again from the table and clink it around. “My mom knew her, though. My adoptive mom. She was her best friend.”

“Really?”

“Yeah. She agreed to raise me if anything should ever happen. And then the fire happened.”

Sam leans back in his own chocolate-brown leather chair with a creak and crosses his arms. I can tell he is viewing me in a new light. I’ve met with him only a few times since I came back home, so it’s been mainly a getting-to-know-you affair, mixed with some Adderall tweaking to keep my thoughts from flying too far. We haven’t had the “My mother died in a fire” chat yet; I like to go two or three dates before springing that on a new psychiatrist.

“But the real issue,” I say, “is why am I dreaming about the fire again?”

“What do you mean by that?”

“I used to have the nightmare every single night when I was a kid.”

He considers this. “Likely a form of post-traumatic stress disorder.”

“Yes, PTSD was my official diagnosis for a while,” I say. When my poor new mom didn’t sleep for years, comforting me as I screamed out night after night for my other mommy. We tried a spate of medications for the nightmares: clonidine, clonazepam, melatonin, phenobarbital. Nothing worked. Then one night, freshman year of high school, the nightmares just stopped. Like magic.

“Do you have any ideas about it?” Sam asks. “Why you had the nightmare again?”

“I don’t know.” I unlink a knot in the dull metal chain, the leather crunching as I lean forward on the couch. It is a spectacularly uncomfortable couch. “Probably because I’m back in Buffalo.”

“Now that you’re home for residency, you mean?”

“Right, because I didn’t have the nightmare at all when I was at Yale. I didn’t even think about it, actually.”

Sam nods, playing with his beard. His beard, eyes, and hair are all the same exact shade of coffee brown. He matches the room. Sam is better-looking than most psychiatrists I’ve met. I’m always surprised to find him attractive. Not that I would date my psychiatrist, but you know.

“Let’s give it some time,” he says. “If you keep having the nightmares, we can talk about possible therapies. Like dream rehearsal, did you ever try that one?”

“I don’t think so.”

“Okay. We can always come back to that if we need to.” He looks down at his notes. “How is your mother doing?”

“She has her good and bad days.” I tinker with the metal puzzle. “It’s weird. We’ll have this almost normal conversation, and then she doesn’t even remember she’s in Buffalo.”

“Not unusual. Social graces can stay intact for quite a while.”

“I guess.” I put the puzzle down. “Sometimes I wonder if we did the right thing though. Moving her there.

“It’s natural to feel guilty, Zoe. But you want her to be safe.”

“Yeah, but it was Scotty’s idea, really. I never thought she was that bad.”

Sam gives me a questioning look. “Didn’t you say she almost burned the house down?”