21

The Hawk Ridge Institute for Psychiatric Care was a large, rambling complex of brick buildings, none higher than two stories, set amid rolling greenery in the foothills of the Pinaleno Mountains. Route 366 was nearby, feeding traffic into Safford, but the institute lay on a desolate back road, and its neighbors were farms and ranches and, a few miles distant, a federal prison camp.

From the road, the institute looked something like a prison itself, with its high iron fence and the guardhouse at the gate. But once inside the grounds, visitors were surprised to see flower beds, neatly tended, and sparkling fountains and birdbaths and colonnades of eucalyptus trees. The less severely afflicted patients were free to roam the property, and they could be seen here and there, some clustered in companionable groups, others solitary.

The administration building and one ward of the institute had been built in 1942. By the mid-1960s two more wards had been added, both of them L-shaped one-story structures well removed from the heart of the complex.

Then the trend of deinstitutionalizing mental patients had begun, and over the next thirty years Hawk Ridge’s population dropped by more than half. Today the institute housed one hundred and thirty-three patients, most of them considered chronic and untreatable—the hard cases who did not respond to medication. Only two of the three wards were in use; the third. Ward C, had been shut down as an economy measure. It stood in decrepit isolation, a windowless shell, one of its doors padlocked, the other bolted shut. Occasionally a staff member with a passkey slipped inside to smoke a joint or indulge some other secret vice.

Hawk Ridge was a peaceful place, and remarkably picturesque. The staid facade of the administrative center was softened by closely trimmed fir trees. Behind and above the building were the tall mountains, brownish at the lower elevations, rising to green, the details of even the highest ridgeline visible in the pellucid air.

Sometimes a hawk or, more seldom, a turkey vulture could be seen riding the high thermals, circling above a hidden gorge, and at night the cries of coyotes were heard, shrill and ghostly and unmelodic, though all too often they were drowned out by the screams.

There were screams, of course. In Ward B, known as the violent ward, where the hardest of the hard cases were kept, the screams seemed never to end. There were patients who could be prevented from screaming only by the massive application of tranquilizing drugs, and even then they would eventually learn to tolerate the medication, which would lose its effect.

Some patients would scream all the time if there were no sedatives to quiet them. Others, who cycled through stages of illness, had their lucid periods, when they could be transferred to Ward A, the admitting ward. Here they were installed as temporary guests, until their precarious mental balance was upset, and they had to be drugged and restrained in a private cell.

So, nearly always, there was somebody screaming, but the staff—three psychiatrists, seven supervising nurses, two dozen therapy aides, eight security officers, three cooks, and assorted groundskeepers and maintenance personnel—had learned to pay no attention to the noise.

Only the hospital director, John Bainbridge Cray, M.D., did not ignore the screams.

He rather liked them.

This had been a hectic morning for Cray. He had arrived at his home on the hospital grounds at 8:45, exhausted after his long night and only moderately revived by the coffee he’d consumed during the drive from Tucson.

Quickly he showered and changed, then spent some time in his garage, taking care of a few unpleasant but necessary details.

By 9:20 he was in his office. To his secretary, Margaret, he excused his tardiness by saying he’d forgotten to set his alarm dock.

His first order of business was a conference call involving an allegation of misconduct by a therapy aide, David Wilson. Wilson was accused of having beaten an unruly patient, Jocelyn Beatty, who had checked into the hospital voluntarily after experiencing symptoms of manic-depressive illness.

He spent half an hour on the phone with the patient’s mother, the attorney she had retained to represent her daughter, and a case officer employed by the Arizona Health Services Department. Cray informed them that David Wilson already had been placed on paid leave pending the outcome of an internal investigation. He offered to turn over Wilson’s duty logs to the attorney. He promised his full cooperation. And he meant it.

Cray took any allegation of misconduct with the utmost seriousness. The patients in his care were never to be mistreated. In the performance of his duties, he adhered to the most conscientious standards of professionalism. It was a point of pride with him.

Was this an inconsistency in a man of his predilections? He supposed so. But in truth he did feel something special for his patients. The women he had killed—they were nothing, merely lab rats, experimental animals set loose to run a deadly maze. The patients at the hospital, on the other hand, were his charges, almost his children, and he would not let them be hurt.

Well, there had been one exception. One patient he had meant to harm. But he’d never had the chance.

At least, not yet.

When the phone call was done, he hosted a meeting in his office. A patient, Dennis Callaghan, was set to be discharged. Cray served coffee and pastries to Dennis and his grateful parents. The atmosphere was cheery, and the strong morning sun poured through the spotless windows like a benediction.

“We just don’t know how to thank you, Doctor,” Mrs. Callaghan said, holding tight to her son’s hand. “Dennis has been in and out of places like this for ... well, all his life. You’ve managed some sort of miracle cure.”

Her husband said the same, and Dennis mumbled an echo.

Cray accepted the compliments graciously. To be honest, he did not think that either he or his staff had contributed greatly to Dennis Callaghan’s recovery. The treatment prescribed for him had been entirely routine, not much different from the strategies employed by other hospitals throughout the patient’s history. A loading dose of Haldol had been administered, then tapered to a lower dose, at which point Dennis’s condition had stabilized.

Why had the pharmaceuticals worked here and now, but not before? There was no reason. More precisely, the reason was unknown, owing to the mysterious complexity of the human organism. A certain chemical would work in one instance, have no results in another, produce crippling side effects in the third, and there was no logic to it, no pattern, only the randomness of accident.

Dennis Callaghan had been cured—at least for the moment. This was enough for his parents and for Dennis himself, and it was enough for Cray. He had learned humility in this field. He had learned not to expect to understand too much.

Once the Callaghans were gone, Cray asked Margaret to send for Walter Luntz. “There’s an errand I need him to run,” he added quite unnecessarily

Walter Luntz resided in a guest room adjacent to the kitchen area, quarters intended originally for a live-in cook. But Walter was not a cook. He was a permanent resident of the Hawk Ridge Institute, a man of forty-nine who had spent the last twenty-five years of his life under psychiatric care.

His was an unusual case. He had responded quite well to pharmacological treatment in certain respects. His thought processes were fairly lucid, and he suffered from no evident delusions. Within the structured environment of the hospital, or outside it for brief forays into the larger world, he was fine.

But send him to a halfway house or ask him to fend for himself in a rented apartment—two strategies that had been tried in the early years—and he quickly decompensated, reverting to an acute psychotic state.

Cray was just as glad that Walter could not leave the institute. The man was useful here. He did clerical chores, even ran errands, driving a used Toyota Tercel that Cray had paid for out of hospital funds. His driving was quite good, and his license had never been revoked throughout all his years of hospitalization.

The institute was understaffed, and Cray could use all the help possible.

Today Walter would perform his greatest service.

Cray heard him coming—fast, clumsy steps—and then Walter Luntz appeared in the office doorway, a tall, stoop-shouldered wreck of a man, with long, ropy, simian arms and a potbelly and a conical, hairless head.

Unlike the other patients, Walter was permitted to wear street clothes. His taste in fashion was idiosyncratic at best. Today he wore khaki trousers, a turquoise-encrusted belt, and a lime-green open-collar shirt.

“Dr. Cray?” he asked hesitantly, afraid to cross the threshold without permission.

His voice was reedy and weak, a wind instrument breathlessly played.

“Yes, Walter. Come in.”

Cray shut the door after him, then ushered Walter to the couch. The door was oak, solid-core, and it ensured privacy.

Then he explained to Walter what he wanted. He explained more than once, keeping his words simple. Walter was not unintelligent, but he was naive and prone to childish misunderstandings.

The assignment Cray offered was a challenge, perhaps too great a challenge for a man whose tasks rarely required driving more than a few miles into nearby Safford for some office supplies. But curiously Cray felt sure Walter was up to it, so long as he had clear instructions and a couple of visual aids.

One of these was a photo Cray had downloaded from the Internet during a brief on-line session this morning, and the other was a slip of paper filled out with a few letters and numbers in a large, careful hand.

“Do you understand?” he asked the man who sat with him on the sofa.

Walter nodded. His head gleamed in the sun. “I can do it, Dr. Cray”

Even so, Cray reviewed the matter one last time before sending Walter Luntz on his way.

At 10:30 he toured the facility, opening a succession of locked doors with his passkey, checking in with the psychiatrists and supervising nurses on duty in the two active wards. He had heard of hospital directors who stayed in their offices all day, inaccessible and aloof. This was not Cray’s approach.

Anyway, he needed to keep moving. There was a restlessness in him today, a droning background hum of frustration, of fury.

He had come so close with Kaylie. Had his reflexes been a few degrees sharper, or had he simply put the canister of liquid nitrogen in the backseat, safely out of her reach ...

A hundred times he had replayed the scenario in the desert, always with himself as the victor.

God damn that woman. Still alive.

But perhaps not for long.

In Ward A, Nurse Killian reported a problem with a recently admitted patient who was not responding to a rather high dosage of Haldol.

“Let me talk to him,” Cray said. “What’s his name?”

“Roger.”

“Bring him out.”

Cray met Roger at the nurses’ station. The man was young and tall, and he had the moist, limpid eyes of a suffering artist.

“Have you been hospitalized before, Roger?” Cray asked kindly.

“Yes, sir.”

“And they gave you pills?”

“Yes.”

“Which ones?” Cray swept his hand over the metal tabletop, where he had laid out a variety of standard neuroleptics. “The red? The yellow? The green?”

“All of them.”

“Which ones worked?”

A ghostly smile lit up Roger’s pale face. “The red ones were pretty good. I got better on the red.”

“Then that’s what you need. Thank you, Roger.”

When the man was gone. Nurse Killian objected to the procedure. A patient could not be allowed to prescribe his own medication.

Dorothy Killian was a good RN, and Cray was lucky to have her, but she was new at Hawk Ridge, and she didn’t know how he did things.

“It’s been my observation,” Cray said, “that the patient, especially an experienced patient like Roger, often knows which pharmaceuticals have been most beneficial to him. Let’s take him at his word.”

He prescribed a loading dose of risperidone—the red pills—and left Nurse Killian shaking her head.

Next he visited the day hall, where those patients who were not confined to their rooms congregated throughout the morning and afternoon. The room was large and airy, although the high, arched windows were unfortunately crosshatched with iron bars. Open doors led to a veranda, which had been screened in for security reasons.

Cray was quite serious about security. In the fourteen years of his directorship, there had been just three significant escape attempts, only one of which had been successful.

Cray pursed his lips. Yes, only one.

He surveyed the day hall. Ceiling fans turned languidly overhead, and sunlight gleamed on the tile floor. The room would have been exotic and beautiful, if not for the TV set babbling behind a clear plastic shield, and the patients lolling on cheap lounge chairs and badly worn couches, and the ubiquitous smell of Lysol.

A therapy aide informed Cray that a patient named Lawton, known for disruptive behavior, was demanding a Bible. This was a common request at Hawk Ridge. An obsession with religion characterized more than half the patients at any given time.

It was Cray’s hypothesis that religious impulses originated not in the cerebral cortex, the seat of thought, but rather in the more primitive limbic system, where primal emotion held sway. The limbic brain—specifically the septal region—was known to be dysfunctional in most schizophrenics.

He had expounded on this idea in The Mask of Self. If humanity’s deepest and most reverent feelings were the product of a chemical imbalance or a neurological malfunction, then was any aspect of human life truly sacred? How about life itself? And if not, then was there any reason—any logical reason—not to kill one’s fellow human beings, if one could get away with it?

Of course he had not made these last points in his book. Tactfully he had left his readers to draw their own conclusions.

“Give Lawton a Bible,” he told the attendant indifferently, “if he wants one. But make him understand that he can’t annoy or harass the others.”

“Dr. Gonzalez was afraid having the Bible might get him more agitated.”

Cray ordinarily did not overrule the psychiatrists working under him, but he saw no merit in Gonzalez’s concern. “If he gets agitated, tell him the meek will inherit the earth. That one has done the trick for centuries.” He started to move away, then added, “If he still won’t calm down, sedate him.”

A great many of Hawk Ridge’s patients were sedated throughout their stay. Some had been heavily tranquilized for years. The other psychiatrists, Cray’s subordinates, had been critical of this approach, believing that it impeded the patients’ recovery.

This might be true. But Cray would not have a lot of lunatics raising hell in the public parts of the hospital. They could scream all they liked while in seclusion, but the common areas must be kept safe and civilized.

He wandered among the patients in the day hall. They were men and women, young and old, all different, yet all curiously alike in their white sneakers and white socks and light blue, two-piece cotton garments, which looked very much like pajamas. At some institutions the patients were permitted to wear their street clothes, but Cray sniffed the dangerous scent of anarchy in this policy.

He ran a tight operation. His hospital was clean. The food in the commissary was nutritious and filling and sometimes even tasty. Discipline was enforced on both the patients and the staff. He made few mistakes.

But Kaylie—innocent little Kaylie with her freckled schoolgirl face and shy, hushed voice ...

He’d made a mistake with her. And he was paying for it even now. He had paid for twelve years.

At 11:15 his pager buzzed, displaying his secretary’s number. He called her from a phone in Dr. Bernstein’s office.

“One of the groundskeepers was working near your house,” Margaret said, worry in her voice. “He found your garage window broken. He says it looks like someone tried to get in.”‘

Cray did his best to sound concerned. “I’ll be right over to take a look.”

The morning had been routine so far, but all of that was about to change.