Т Паркер - The Room of White Fire

Now I sat at a small table in my room at the Days Inn in Ukiah, having forwarded my images of Clay Hickman’s formulary to Paige Hulet before calling her. I didn’t tell where I’d gotten them. And I said nothing about John Vazquez.

The silence at her end was a long one. I heard the ice clinking in her glass. Finally, she spoke. “This is not Clay’s formulary. These are not the drugs I’ve prescribed for Clay. Some go back before my time at Arcadia, but... What is this? Where did you get it?”

It took me a second to get my brain around that idea. If the drugs on the dispensary computer tablet were not prescribed by Clay’s physician, who were they prescribed by? “What are you giving him now?”

Another silence. I poured a second light bourbon. Through the crack I’d left between the heavy curtains, I saw a Mendocino Sheriff’s prowler moving down State Street.

“Two years ago,” she said, “when I joined Arcadia and took over Clay’s treatment, I thought his diagnosis of schizophrenia was questionable. There were manic episodes that didn’t fit, and his responses to the meds were erratic, so I reclassified Clay as schizoaffective disorder, bipolar type. He was exhibiting sustained bursts of goal-oriented hyperactivity. To answer your question, I went to lithium and paliperidone, antipsychotics. His anxiety was very high. The benzodiazepines are often a good answer for anxiety. They seemed to work for a while. Clay stabilized. His anxiety subsided, the manic phases shortened. The risk was mood cycle acceleration or medication-induced psychosis. Clay showed neither for, well, a while.”

“How long a while?”

“One year. Then his paranoia and anxiety came back again, especially pronounced just prior to a visit from his family. Those visits were a huge stressor. So I moved him to aripiprazole. The danger there was extrapyramidal symptoms — tremors, restlessness, akathisia.”

“Akathisia?”

“Literally, akathisia is the inability to sit. In the medical sense, it’s a compelling need to be in motion. It’s a common side effect of many antipsychotics.”

“What did you make of his behavior, given those meds?”

“Overall? It was somewhat bewildering. So I tried another approach. I discontinued paliperidone and aripiprazole in favor of olanzapine. It’s a good medication but you’ve got to watch for weight gain and increase in blood sugar. I took Clay’s blood twice a week. When his psychosis became treatment-refractory I went textbook — clozapine, which has less side effects and is also indicated for suicidality. As I told you before, Clay ideated suicide — but never acted. Your turn, Roland. Where did you get this bizarre formulary I’m looking at?”

I told her it came from the computer tablet assigned to one of the staff dispensers, Donald Tice, who was almost always assigned patients with last names beginning with H.

“But these are not Clay’s prescriptions,” said Dr. Hulet. “I write his prescriptions.”

“What do they do, these drugs?”

A pause. “I’m only familiar with some of them. Others, I’ve never known to be compounded and are not commercially available.”

“Lysergic acid diethylamide is LSD.”

“Yes — still manufactured for research. Experimental microdosing to aid in creative thinking.”

“Jesus, Paige — he’s been taking acid, just for starters.”

“No! They are not his prescribed meds. He cannot have been taking them.”

“Don’t you get it? It’s why his responses were so wrong. You thought you were treating Clay but you weren’t. Someone else had complete control over his meds. And some of them were drugs you’ve never even heard of .”

“Impossible. Arcadia has checks and bal—”

“I saw it with my own eyes. Tice got every pill and dose straight off his computer tablet. That’s where I got the formulary. What are you people trying to do to Clay Hickman?”

I hung up, went outside, and lit a cigarette. Felt my heart knocking against my ribs. The night was cool and damp and I thought of John Vazquez lying on his kitchen floor while his wife and son covered him in a blanket. I was angry at Paige Hulet and whoever was drugging Clay behind her back. I was also tired and hungry and mean. Felt like hitting somebody who deserved it, eating a decent dinner, and getting a good night’s sleep.

Ten minutes later I was back inside and Paige called. “I’ve read through Donald’s formulary,” she said. “Unacceptable. I was prescribing Clay’s medications while Donald was dispensing others, and I failed to understand what was happening. But it tracks. For instance, in April of last year, when Clay began to trust me in therapy, Donald commenced twice-weekly doses of LSD. And if you look back at the last two Aprils — which coincides with visits from Clay’s family — Donald had been giving him four hundred micrograms of LSD every day! Thirty doses in April of last year. Not only that, but Donald suspended Clay’s antianxiety meds for the whole month. It’s as if Donald is trying to make Clay anxious and hallucinatory just before his parents arrive. As if Donald doesn’t want Clay to see his own mother and father.”

I wondered if Donald Tice had also told Clay that his parents wanted to put him in a state institution. Parents who still believe that their son was an aircraft mechanic in Iraq, I thought. Who might not even suspect that Clay was in a black-site torture chamber for two years, working under Briggs Spencer and Timothy Tritt — Deimos and Phobos, gods of terror and fear.

When Paige spoke again, her voice had risen and I heard the bitterness in it. “Roland, I ran scores of scans on Clay. I did EEGs and blood work, sometimes twice a week, just trying to figure out why my medications weren’t helping him. I tested him for drug allergies, food allergies, pollen allergies — you name it. I made sure he had good vitamins and herbal teas, for god’s sake. I’ve been deceived. I feel sick. Truly sick.”

I thought back to my conversation with Evan Southern as we watched Morpheus dispensing his potions at Arcadia. “Did you know that Donald Tice was with Clay and Briggs Spencer in Romania?”

“Donald in Romania?”

“Spencer-Tritt recruited him. Along with other loyal young men who would do what they were told and keep their mouths shut. Like Clay Hickman and John Vazquez.”

All she offered then was silence. So I improvised a little. “Briggs Spencer knew what Donald was doing with the meds behind your back, Paige. He knows everything that happens at Arcadia, through Alec and his security people, and the cameras and microphones. Briggs Spencer probably created Clay’s formulary himself. Donald is just his employee. Still.”

I listened to her breathing. And the hum of the mini-refrigerator in my room. “Roland, could I count on you to testify to having seen Donald Tice dispensing from his computer tablet?”

“It wouldn’t matter. I didn’t see him give Clay anything.”

“But it might give the state medical board enough to open an investigation. Or even the San Diego district attorney. Who knows what Tice would tell them? They damaged my patient while he was under my care. I can testify that Clay’s behavior was not what it should have been, had my prescriptions been used. Would you do it? Would you testify to what you’ve seen?”

I had to think on that. For the first time since I’d set foot in Arcadia, I saw that Clay Hickman — the missing lunatic with violence in his past — was a victim as well as a menace. “I’d consider.”

“I’m taking that as a yes. Now do you see how important it is, Roland? That you call me first when you find Clay? Not Alec or Briggs?”