On Isabella Street

Chapter Three Marion

three MARION

Tuesday morning, bright and early as always, Marion rose and dressed for work. She’d laid out her clothes the night before, and it took no time to brush her long blond hair and roll it into a tight bun. She never rushed if she could avoid it, didn’t like the sense of urgency that stuck out like a hurdle in the path of her deliberate equilibrium. By rising early, she was able to make her routine comfortable then arrive at work fully awake and ready to be productive.

Humming to herself, she popped a couple of pieces of bread into the toaster, pulled a jar of her mother’s strawberry jam from the refrigerator, then plugged in the kettle. With her mind on her Tuesday schedule, she poured a spoonful of Nescafé into a cup and waited for the water to boil.

This was the perfect apartment for Marion. She’d learned all about it before she’d moved in two years ago. She appreciated knowing details before she agreed to anything. Being prepared led to fewer mistakes.

When she was considering 105 Isabella Street as a home, Marion’s first step was to figure out its location in relation to everything else. The apartment building was on a quiet street between Jarvis and Church, a short two blocks north of Wellesley. It was about a half-hour walk to work or campus, and the buses were conveniently regular, though they didn’t stop on her street. It was also a half-hour walk in the other direction to Yorkville, which interested her. Marion had strolled through the popular spot, and on occasion she had played with the idea of “hanging around,” as people called it, but so far, she hadn’t. She didn’t feel she was ready for that kind of scene, whatever that meant.

The apartment building was just under ten years old, built in 1959, and she’d liked the look of it right away. It stood out from the street’s redbrick, Victorian-style homes and low-rise apartment buildings. In comparison, the pale white bricks of 105 made the building look almost elegant. Every floor had twenty-four apartments, either one-bedroom or bachelor, divided into three hallways in a T, and almost every apartment had a huge balcony. The laundry room was on the first floor, where noisy machines chugged all day long, and Jack’s Variety Store was nearby for her groceries. And if she ever bought a car, the building had its own underground parking garage, tucked neatly beneath a grassy yard. But why buy a car when she never went anywhere? Walking suited her just fine.

“?‘Goodbye, Ruby Tuesday,’?” Marion sang without thinking, then she bent and stroked Chester’s head. “See you later.”

After throwing back her coffee then cleaning her cup and saucer, Marion collected her bag and stepped into the hallway, locking the door behind her. The heavy aroma of sweating onions immediately clouded around her, and she thought it was coming from 517, where Mrs. Moore would be making cabbage soup again. The poor woman always looked tired. Her husband was a veteran of the last war and had been badly wounded in battle. Mrs. Moore was a tiny little thing, so they hired a girl to bring groceries up to 517 as well as to clean. She rarely saw any sign of Mr. Moore.

The Levins lived in 503. They told Marion they had a nonnegotiable clause in their lease guaranteeing them a southern exposure and balcony to contain their massive garden.

Like Mrs. Moore, the Romanos in 505 were always cooking. Especially when their large family came to visit, which was fairly often. Every year near the end of summer, Marion came home to the heady aroma of Mrs. Romano canning tomatoes. Last year, she’d been invited to help, and that had been an experience in itself. Marion had returned to her apartment afterward with an entire pot of pasta and two cans of homemade sauce. It had taken her three days to eat all that pasta. Just thinking of it made her mouth water.

Outside her apartment door, she paused, hearing a dozen tentative notes being plucked on a guitar in the next apartment. The melody almost sounded like a foreign scale, and she remembered enough from her childhood piano lessons to know they were in a minor key. The tune was vaguely familiar, though she couldn’t quite place it. A sad song, she thought, setting her bag on the floor. Something about painting things black to match the singer’s unhappy life. His voice came to her—the Rolling Stones, she recalled, pleased with herself. The notes stopped, then they began again, more confident this time. Marion preferred this tender, slower performance; the original sounded hostile. Then a girl began to sing, and Marion closed her eyes, soaking in the gentle melody.

“?‘I see a red door, and I want it painted black…’?”

Halfway through the song, the guitar gave a percussive twang, as if the musician had smacked the strings with her palm. She heard a woman’s muffled voice in conversation, so she collected her bag and proceeded briskly down the hall to the elevator. She had stopped to listen, not to be seen.

She pushed the button and heard a click behind her. “Good morning,” she said to Mr. Snoop. “Have a nice day.”

The door closed.

The song had embedded itself in her mind, and her steps matched the lyrics as she strolled down Jarvis to Wellesley then waited for the bus to Wellesley Station. It was a nice walk; the air was a little warmer today, and she’d worn her cheerful yellow cardigan.

“Good morning,” the bus driver said, nodding as she dropped her quarter into the fare box.

“It is, isn’t it?” she replied. “Transfer, please.”

She took a seat then watched the familiar press of rush hour from her window. Marion’s destination this morning, as it was three mornings every week, was the massive old Queen Street Mental Health Centre, popularly known as 999 Queen Street West. The original building had been constructed more than a hundred years before, in 1850, and had been named the Provincial Lunatic Asylum. It was the oldest public mental health hospital in all of English-speaking Canada. When the doors had first opened, the place had filled with every sort of society’s rejects: hysterics, depressives, psychotics, schizophrenics, idiots. Over the next hundred years, patients were admitted then treated within their walls, outside of the public eye. Out of sight, out of mind.

After its first twenty-one years, the building became the Asylum for the Insane, then the more dignified-sounding Hospital for the Insane. After being inundated by a huge influx of veterans following World War I, the name was whittled down to the Ontario Hospital.

So much had been learned since those early years, so many improvements made, that a seismic shift in psychiatric treatment was underway. Deinstitutionalization, defined as the safe release of psychiatric patients into the community, had been made possible through astonishing developments in psychiatric drugs. The media and the general public supported the idea, declaring that people with psychiatric illnesses should no longer be hidden away. The provincial government hoped to promote community integration by transferring patient care to newly setup community mental health centres. By shutting down the institutions, they also hoped to save a great deal of money. The Ontario Hospital was about to become redundant.

Marion did not support deinstitutionalization in the least. For the past two years, she had burned internally over the dangerous plan. Closing down the hospitals and entrusting patients’ care to community centres could only do harm to both the patients and the public at large. At one point, she had mentioned her concerns to Paul McKenny, another doctor at the hospital, but their conversation had gone no further than that. To her shame, even though Marion believed very strongly that the plan was a bad one, she hadn’t worked up the nerve to speak with her boss, Dr. Bernstein, to voice her objections. As she had always done, Marion kept her head down, unwilling to rock the boat. She knew how easily a woman could get swept overboard by the men pulling the oars.

But there was a storm coming. She could feel it.

The bus pulled into Wellesley Station and descended underground. From there, Marion took the subway to Queen Street, then the 501 streetcar to Ossington. As they rumbled past 999 Queen Street West, she became uncomfortably aware of the local myth manifesting: some of her fellow passengers were holding their breath, wanting to avoid catching whatever contagion was within the walls of “the nuthouse.”

When the streetcar reached her stop, Marion exited on Queen Street then walked through the centre’s entrance, which was part of the institution’s new Administration Building. It had been constructed ten years ago, directly in front of the old structure, and since the two were the same width, the asylum was completely blocked from view for anyone passing by. Again, out of sight, out of mind. In a few years, the original building would be demolished, along with the old system of care.

“Good morning, Dr. Hart,” chirped the secretary by the entrance. A vase of fresh tulips stood in a sunbeam on the corner of her desk, their bright red petals curving toward the source.

Marion inhaled the nutty aroma of coffee with pleasure. “Good morning, Miss Prentice.” She paused by the folders affixed to the walls, checking for anything that might have come in for her, then pulled out the week’s schedule, a listing of two new patients, a memo about a staff meeting—the usual.

“I hope you enjoyed your weekend.”

“Oh yes. We went to my grandparents’ house, and my father was in charge of the barbecue. He claims he’s never burned a hot dog in his life, but his perfect record ended yesterday. Afterward, we shot off fireworks. Did you get to see any?”

“A little,” Marion replied, scanning a file. “I watched from my balcony, so I saw what I could over top of the other buildings. Better than nothing. Is Dr. Bernstein in yet?”

It was a silly question. Her boss was always there early.

“About an hour ago.”

“That man never sleeps,” Marion muttered. “I thought I was the early bird.”

Miss Prentice brightened. “That’s all right. There are plenty of worms to go around.”

With her paperwork clutched to her chest, Marion headed down the hallway and peeked into Dr. Bernstein’s office on the way by. He was there, of course, bending over a pile of paper and squinting through thick glasses. Almost ten years past retirement age, he was slowly losing his sight, but he was as stubborn as he was old. Dr. Bernstein was polite enough, but he clearly disliked her. She was confident that was due to her sex, since she had never knowingly offended him.

There were 136 beds in this new building, ten more than what the builders had planned for. Of those, Marion was responsible for twenty-six women. She checked her notes then knocked on the door of the first patient room on her left.

“Good morning, Barbara. It’s Dr. Hart. May I come in?”

A muffled groan came from within, which Marion took as an invitation. Barbara Voss was twenty-eight years old with neurotic depression. She and her husband had admitted her a few months ago, after she suffered multiple miscarriages and plunged into despair, becoming emotionally unstable. She’d lost her job, stayed in bed for days without eating, and terrified her husband by entertaining suicidal thoughts. After an admittance interview, Marion had given Barbara a room at the hospital. It was exactly what she wanted and needed, but even then, her anxiety had fought her on it.

“How much is this going to cost? I don’t have any money. My husband is worked to the bone. I can’t—”

“Barbara, do you remember what Prime Minister Pearson introduced last year? The Medical Care Act? All your expenses here are covered by Medicare.”

The relief that had come over the woman’s face was a beautiful thing to see.

Marion understood that question, though. She was doing relatively well these days when it came to finances, but she was still a penny-pincher. Her parents had raised their daughters in a small house, and while they had never gone hungry, they certainly didn’t splurge. It was a mystery to Marion that her parents, on their very limited income, had been able to send her to university, let alone medical school. Many times, seeing them in obvious need, she had threatened to quit school, feeling sick with guilt, but her father had not permitted her to consider it.

“We have the money,” he had assured her, over and over. “It’s been put away so you can be what you always wanted to be. Do your best and make us proud. That’s all we ask.”

So she had done exactly that.

At a recent meeting, the general consensus between the doctors was that Barbara’s dosage of 75 mg/day of Tofranil should be increased. Marion believed 150 would be too high in this case, so she upped it to 100 mg instead. She wanted to observe and be certain. Barbara was also undergoing counselling, including group therapy. She’d improved tremendously under that course of treatment, to the point that she was now labelled “domiciliary.” That meant she required a safe place to live, three meals a day, and some treatment, but for the most part she was able to administer self-care. That was a relief to Marion, considering the future plans for the hospital.

Marion’s next patient, Alice Sumner, was twenty-two. She was a diagnosed schizophrenic who had lived there for six years, and, as Marion had discovered firsthand, she was sometimes dangerous. The second time Marion had met with her, she had taken a seat at her bedside, and Alice had punched her in the face. Marion fled the room and rushed toward the washroom with a hand cupped over her bleeding nose. On her way to cleaning herself up, she’d accidentally bumped into Dr. Bernstein.

“What happened?” he asked flatly, squinting at the mess on Marion’s face. “Did you fall? Did your patient hit you?”

“The latter, but I’m not sure why,” Marion replied. “We were having a pleasant conversation about how she was feeling, and she punched me.”

He folded his arms. “Do you have unresolved disagreements with the patient?”

“I’ve only met her once before, Dr. Bernstein. That meeting was uneventful and cordial.”

“The Stanton-Schwartz phenomenon suggests otherwise.”

Marion had read Stanton-Schwartz and did not agree with it, but she was in no position to argue with her boss. Besides, she didn’t have time. She needed to get past him, wash her face, and see if the bleeding had stopped.

“Are you familiar with the phenomenon?”

“Yes, sir.”

“Then you know that it is likely Miss Sumner punched you because the two of you disagreed on the planned treatment. That bothered you, and when the patient struck you, she was acting on an impulse that you, yourself, felt.”

“I’m sorry?”

“She punched you because, unconsciously, you felt the urge to punch her.”

The urge to roll her eyes almost won, but she kept that in check.

This morning, Alice was quiet and on guard, squeezed into a ball at the end of her bed with her back against the wall. Occasionally, her right hand rose, and she pointed at something unseen on the ceiling. Marion followed her finger. Nothing was there but a light fixture.

“Good morning, Alice,” Marion said gently. “How are you feeling today?”

The patient shook her head violently, then she pressed a finger to her lips. “Shh! He’s listening.”

“Who is listening?”

“I don’t know. I don’t know, I don’t know, I don’t know,” she whispered, eyes bulging. She stretched her legs out in front, and her ankles rotated so that her feet drew circles in the air. “Can you hear that?”

All this quick chatter and movement told Marion that Alice was more worked up than usual. A quick check of her medications, then Marion made a notation on her chart, raising Alice’s daily dosage of chlorpromazine to 500 mg. Recent studies had proved that effectiveness of the antipsychotic improved noticeably once that threshold was reached.

Marion kept her expression open. “Can you tell me what I am listening for?”

Alice dropped her chin and flung her arms out to either side. “It’s very loud in here,” she murmured. “I have tickets for the opera in my purse, you know.”

Some appointments went more smoothly than others, and Marion clung to the good ones. In particular, she liked to remember a young woman named Deborah. Deborah had lived at the hospital for four years, suffering from acute anxiety and never speaking a word. By the time Marion had graduated, Deborah was attending daily art therapy classes at the hospital. As she expressed herself through art, she began to verbalize words, one at a time. The last time Marion had seen Deborah, she was smiling and pointing out two of her paintings displayed on the wall of the Administrative Building. Deborah’s was the kind of success story for which they all strove.

This morning, after Marion finished seeing her last patient in the new building, she sat in on a short meeting with some of the other doctors on their rounds and two of the senior nurses, comparing notes. Then it was time to visit the last fourteen of her assigned patients. Those were all men, and they lived in the original building.

To Marion, stepping into the old asylum was like entering a different world. It was one of the saddest places on earth; she could feel it in the walls. Layers of misery and neglect had seeped in then hardened into the brick and mortar. Some of the treatments and abuse that had happened in the original hospital—even as recently as five years ago—were shameful and often inhumane. Even today, the building was over capacity by two hundred inmates. That meant less personal care, more overworked nurses and staff. A recipe for disaster.

When it came to deinstitutionalization, the building made a good case against itself. Demolition and delegating psychiatric services to community centres certainly seemed like common sense.

But how could it be rational or practical if a good percentage of these patients could barely feed themselves, let alone live independently? The most severe cases would have extended in-hospital treatment, but what about those on the cusp?

Marion visited with three patients in the old building, all of whom seemed content, then she squinted through the window of Ward 6B, where the “incurables” lived. Most were gathered in their common room for now, and she spotted her patient, Big John, in one corner, playing checkers with another man named Ian.

Marion took a final breath of fresh air then stepped through the door and was instantly assaulted by the reek of the place. The nurses and staff tried to stay on top of the problem, but it was a Sisyphean task. Most of the men in 6B were incontinent, and they didn’t use utensils when they ate. This area was as close to medieval times as Marion ever wanted to get.

“Good afternoon, Dr. Hart,” a stout, bald man called loudly, giving her a toothless grin. “I know it’s afternoon because we had lunch.”

“Hello, Burt. Good for you for remembering.” He had given her the same sort of update almost every day for six months now. It had been sweet at first. “How are you feeling today?”

“Today’s a happy day,” he reported.

“I am delighted to hear that,” she replied, still walking toward the checker match. “Can you think of another word to describe how you feel?”

She saw in his expression that he’d anticipated the challenge. “Cheerful.”

“Excellent, Burt.” She shared her smile with the room, purposefully meeting each man’s vacant expression, always hoping for some kind of recognition or acknowledgement that she was there. Not for her own gratification, but as a sign of a patient’s improvement. “Hello, Francis. Hello, George.”

“Hello, Dr. Hart. Dr. Hart. Dr. Hart.”

“Hello, Mr. Thicke,” she said to the stooped man by the window. Mr. Thicke had been brought here by his family ten years before, when they could no longer deal with his senility. He had a sweet, uncomplicated face, and the messy white wisps of his hair looked as confused as he was. On some days, the old gentleman turned with a vague smile to greet her. Today, he did not recognize his own name.

“Good morning, Bruce,” she said, watching a redheaded fellow with akathisia pace up and down the edge of the room, twitching and talking to himself. She knew he wouldn’t respond, but she said it just in case.

“Good morning, John,” she said, reaching her patient. “Are you having a good day?”

As usual, Big John did not register her presence. He was thirty-one, but he looked much older. As his nickname suggested, John was a large, lumbering man. He had the size, the strength, and the sense of a bull, but a gentle one. Marion recalled the tale Ferdinand the Bull every time she saw him. Then again, John’s gentle nature had a lot to do with the medications he was on. Without them, he could be dangerous. Ferdinand had been a natural pacifist.

“How about you, Ian? Who’s winning the game?”

Both men stared at the board. She wondered if either had moved the pieces at all or if someone else had just left them in place. Neither knew the answer, but she could tell from a slight shift in their expressions that they had heard her.

John’s empty gaze gradually rose, shifting in small, jerky movements due to his nystagmus. The motion left him dizzy and with a kind of double vision, trapped in a sliding world of vertigo. He could see, but everything was blurry. Besides that, he had catatonic schizophrenia with both negatism and mutism, meaning John rarely acknowledged stimuli, nor did he speak. His checkers partner looked equally lost. Neither of them was aware that anything was wrong with them.

“Looks like you both are winning,” Marion said, leaning over the board. “Who is red and who is black?”

After a couple of long breaths, Ian gingerly picked up a black piece and gripped it to his chest.

Big John’s eyes widened, but he said nothing. Other than his eyes, he did not move.

“My mistake,” Marion intervened gently. “I should not have asked. May I have the piece, please? There, that’s it. It was right here before I interrupted.”

Once everyone was calm again, and Marion had finished her examination of Big John’s status, she signed his chart, left it with the weary nurse, then left the ward. Her happy mood from the morning had dissolved, and she blamed herself. If she could manage to switch her schedule around, she could get past this most discouraging ward first, then move onto brighter, more manageable cases. But Marion was a creature of habit, like many of the patients. And like them, she might never change.

As she headed toward the exit, a man’s slurred voice travelled down the corridor. “Help. Help, please.”

Marion was done for the day. She picked up her pace and strode past his door, certain that whatever it was, a nurse would take care of him.

“Doctor. Help!”

She hesitated then backed up to regard the man in his room. Not too many people immediately identified her as a doctor. Most assumed she was a nurse.

The patient was unfamiliar to her. She frowned slightly, wondering at the restraints binding the young man’s wrists and ankles to the bed. Nothing to cause bruises, just soft sheets tied tight, but it was enough to hold him down. Every part of him was contained except for his head, and he’d lifted that off his pillow to watch her. She tried not to react when she saw the disaster on his face. He’d obviously been in some kind of brawl or accident, because it was terribly cut and swollen. She noticed with a clinical interest that he wore a black eye patch over the place where his right eye should have been. The left side was purple with bruising.

“What do you need?” she asked, remaining in the doorway at a safe distance. The restraints were on him for a reason.

“Let me loose.” His voice was thick, like cold syrup. “I don’t need to be locked up.”

“Somebody thinks you do.”

His file hung on the door, so she lifted it off and read through. Daniel Neumann. Born in 1945, so twenty-two years old. His eye was gone due to trauma, she read, and the left side of his face, chest, and shoulder were badly burned from an explosion. The initial surgery had been done long before, but the site had gotten infected. As a result, he’d spent a day at the Toronto Western Hospital getting antibiotics, then he’d checked himself out. Two days later, the police picked him up from a fight outside a bar. That’s where he’d gotten all the bruises, she surmised. They didn’t charge him with anything, because according to witnesses, he had been the victim, not the instigator. Nevertheless, he’d hospitalized two men and left three others injured. He refused to return to the hospital, but he was still behaving wildly—shouting profanities, swinging fists—so the police had brought him here. Two nurses stated they felt threatened, and the decision was made to restrain him. Only the most senior nurse, Thelma Goodwin, had been able to medicate him when he arrived.

No one messed with Thelma.

“Daniel Neumann,” Marion said. “My name is Dr. Hart. I’m reading your history here. It appears you don’t like hospitals. You left the last one against your doctor’s advice.”

“I didn’t need to be there.”

From this distance, she sensed intelligence, though he was clearly heavily medicated. “You seem to know a lot about what you need and don’t need.”

“You can come in.” He jerked his wrists up an inch, yanking the sheets against the bed frame, then he dropped his head back onto the pillow. “I’ll behave.”

She stepped inside the room, intrigued despite common sense. Most of the patients in this building were doubled up in a room, with a small bed on either wall and a window and nightstand in between. Or else they were in group rooms, which held eight or more beds. This patient was on his own. His room was tiny, made even more so by his large size.

“Were you drunk last night, Mr. Neumann?”

“Major.”

“I see.”

“No. Major Neumann.” He had to turn his head slightly farther when he faced her to compensate for his missing eye. “And no. I was not drunk.”

“Why did the police bring you here, then?”

“They got the wrong guy,” he said lamely.

“Oh?”

“I don’t want to talk about it.”

“Why did you call me in here, then? I can’t untie the bindings because I’m not your doctor.”

She approached the bed, inspecting him. A deep cut across his swollen lip seemed to be healing on its own, but it threatened to open again when he spoke. His brown hair was swept loosely over the right side of his brow in an attempt to conceal his eye patch, and he wore what she guessed was a scruffy four-day-old beard.

“What are you staring at?”

“I’m looking at the damage on your face. I’m a doctor. It’s what I do. What happened to you?”

The scar darkened along with the rest of his face. “Untie me.”

“No. What happened?”

He turned away, so she lowered her gaze to his chart and flipped through more pages. The notes on his chart said he was aggressive. Delusional. Violent. Volatile. She turned back further into his history, seeking more details. When she found the answer, she tried not to change her expression, but her interest was piqued. He’d been fighting in Vietnam.

The subject of wartime trauma had intrigued her for years because of her father. Twenty years after the end of the last war, he still suffered from “battle fatigue,” which some textbooks referred to as “combat stress reaction.” She didn’t know if either of her grandfathers had been affected, but she had her suspicions. They had both served in the Great War. Her maternal grandfather had died over there. Her father’s father was more of a mystery. The story was that he got sick and died, but after grilling her parents for more answers, Marion speculated that his life had ended in suicide, as it did with so many veterans. After the Great War, medical professionals labelled similar symptoms as “shell shock” or “war neurosis,” and the exponentially growing number of affected men returning from battle demanded more research be done. Over the past thirty years, doctors had studied survivors from World War II and the Korean War, including veterans who had been taken as prisoners of the Japanese, and some who had survived Nazi persecution.

And yet, despite Marion’s searches, she had found little solid literature explaining either the phenomenon or any definitive treatment.

Based on the knowledge that Daniel Neumann had fought in Vietnam and suffered a terrible, life-changing injury, followed by his recent violence and his refusal to discuss the reasons, Marion strongly suspected he suffered from the disorder. She wasn’t surprised. She’d seen photographs and watched footage of what was happening over there. She couldn’t imagine what he had survived.

“Water?” His voice was gruff. His face was still turned away.

“I will send in a nurse.”

“No nurse. No more needles. Untie me.”

“It’s for your own good. For your pain, for your mental stability, and for other people’s safety.”

“No more.” He took a shuddering breath. “I can’t think.”

“I’m afraid the treatment isn’t up to you. Your doctors will discuss your case on Wednesday morning.”

“When’s that?”

“Tomorrow.”

“How can they talk about me when I’m stoned like this? They don’t know me.”

It was a valid question. “They have your hospital records and police statements.”

Nurse Thelma, on her rounds through the ward, entered behind her. “Beg your pardon, Doctor. I’m a little behind. How are we today, Mr. Neumann? Calmer than last night, I hope?”

Marion stepped out of the woman’s way. He was secured so tightly to the bed he could hardly move, but as the nurse approached with a syringe, Marion saw him try to evade her. His sleeves pulled taut against his biceps as he struggled against the restraints, then his face tightened as the needle penetrated his vein.

“There we are, Mr. Neumann. Right as rain again. Dr. McKenny is your doctor. He will come see you in a few hours, and he’ll decide what to do with you. In the meantime, you have a nice sleep.” She smiled tightly at Marion, who was clearly overstepping, and held out her hand for the clipboard. On her way out, she hung it on the door where it belonged and wished Marion a good evening.

Daniel was silent. He closed his eye, and Marion wondered if the drugs had put him to sleep already.

“Mr. Neumann?” she said softly. “Major?”

“Go away.” His voice dropped to a heavy whisper. “Just leave me alone.”