“IS IT A CLOCK?” SARAH ASKED, A PUZZLED EXPRESSION ON HER face.

“It’s both a clock and a calendar,” Laura said, still pleased with her purchase. She was hanging the white plastic device on Sarah’s kitchenette wall, while the older woman watched her, perplexed. It was quite large. On its right side was a clock with large black numbers. On the left side, the month, the date and the day of the week were displayed.

“All you have to do every morning is push this button and it will change the date,” Laura said as she began pushing the button. “See? Now I’ve got it up to today’s date. And it says Wednesday. So, if you push the button every day, you’ll know when Wednesday comes and that I’ll be here to take you for a walk. Or if it’s raining, like last week, I’ll bring a movie.”

The previous Wednesday had been stormy, so Laura had picked up African Queen at the video store, remembering that Sarah had mentioned the movie when she spoke of her courtship with Joe Tolley. Sarah seemed to thoroughly enjoy the movie, though Laura missed hearing her talk about her life.

“You ready?” Laura asked now, but the question was unnecessary. Sarah already had the door open and was walking into the hall.

Outside the retirement home, Laura tried to steer Sarah in the other direction for a change, but the older woman stood glued to the sidewalk. She wanted to take the familiar route, it seemed, so Laura gave in and joined her.

“Remember I told you that Dylan wanted to meet Emma?” Laura said as they walked.

“Dylan?” Sarah asked.

Of course she didn’t remember. Laura wasn’t sure why she tried talking to Sarah about her own life. It seemed pointless, but it was a way to start the conversation.

“Yes. My little girl, Emma’s, father. Biological father. They met for the first time the other night.”

“My,” said Sarah. “How old is…the little girl?” Emma’s name was lost in the tangle of Sarah’s memory already.

“Five. She was pretty shy with him, but I think it went well for a first meeting.”

“Does she like him?”

“Well, Emma doesn’t speak, so I’m not sure how she feels about him. She had a terrible scare a few months ago and it left her mute.” Laura was about to explain the meaning of mute, but Sarah seemed to understand.

“Ah,” she said. “Who is…the girl, again? Your daughter?”

“Yes,” Laura said.

“How old is she?”

“Five,” Laura repeated patiently.

“And she’s mute. Must be very frustrating for you at times.”

“Yes. It sure is.”

Sarah looked into the distance, toward the clock tower several blocks away. “I had a patient who was mute once.”

“Did you?” Laura asked, sincerely curious.

“She about drove me to become a patient myself,” Sarah said.

Laura laughed. “Tell me about her,” she said.

Sarah, 1956

“That’s Saint Margaret’s?” Sarah asked Joe as he turned the car into the long drive. Ahead of them, at the crest of a broad, grassy hill, stood a huge building constructed of stone, which had grown dark and dirty with age.

“That’s it,” Joe said, pointing. “See the sign?”

Sarah’s eyes followed his finger to the small white sign wedged into the side of the hill. Saint Margaret’s Psychiatric Hospital. Hard to believe.

“It looks more like a house of horrors,” she said.

She was there for an interview as a nurse. She and Joe had moved to the Maryland suburbs shortly after getting married and were now living in a darling little house next to a park. Saint Margaret’s would be much more convenient to their new home than Mercy had been, and Sarah was thrilled to have this interview. Saint Margaret’s was a top-class facility. From the outside, though, one would never guess.

The driveway curved around in front of the main entrance, and Joe stopped the car. “Are you sure you’ll be all right taking a taxi home?” he asked.

“Of course. I’ll be fine.” She leaned toward him for a kiss.

“Good luck, then,” he said. “Call me at the office to let me know how it went.”

She stepped out of the car and waved after him as he headed down the driveway. Then, smoothing the skirt of her uniform, she took a deep breath and pushed open the huge, intimidating wooden door of the house of horrors.

She was in a large square foyer, three stories high, rich with dark wood trim. Light poured through glass panels in the ceiling high above her, forming golden columns in the air. Voices echoed softly around her. The floor was formed of large, black-and-white, diamond-shaped tiles. There was a sense of aged elegance, and she could not detect the pervasive hospital smell she was so accustomed to at Mercy.

The reception desk was at one side of the foyer.

“I have an appointment with the nursing supervisor,” Sarah said to the clerk seated behind the desk. “Mrs. Love, I believe her name is.”

She was told to take a seat, and she waited for nearly ten minutes on a lovely floral-patterned couch before Mrs. Love arrived. The supervisor was a young, attractive woman in a nurse’s uniform. Her smile was engaging, and there was a bounce in her step as she ushered Sarah down a long, dim corridor and into her office.

Sarah took a seat across the broad desk from the supervisor.

“What a beautiful pin!” Mrs. Love said.

Sarah touched the collar of her uniform. Joe had suggested she remove the pin for the interview, but she couldn’t bear to take it off. As she had promised, she wore it every day.

“My husband gave it to me as a wedding gift,” she told Mrs. Love. “My supervisor at Mercy didn’t mind me wearing it. But if you—”

“Oh, it’s not a problem. We all have special little things we do here to individualize our uniforms. This is mine.” She touched the delicate gold chain at her throat.

“It’s stunning,” Sarah said.

“Well.” Mrs. Love glanced at the papers on her desk. “I’ve looked your résumé over,” she said, “and I’m very impressed. The work you did at Mercy should prepare you well for what you’ll do here.”

What you’ll do here. She made it sound as though Sarah already had the job. And indeed, the interview that followed was more a friendly chat than any sort of interrogation. Mrs. Love did most of the talking, telling Sarah about the innovative programs at Saint Margaret’s, about the state-of-the-art equipment in the hospital, and about the hospital’s director, Dr. Peter Palmiento. Mrs. Love’s cheeks glowed a vibrant rose color when she spoke about the director. “Surely you’ve heard of him,” she said.

Of course Sarah had heard of him. Everyone wanted to work with Peter Palmiento. He was changing the face of psychiatry. “Yes, I have.” She smiled.

“He’s put Saint Margaret’s on the map,” Mrs. Love said. “He’s a man of incredible power, yet a lovely human being, and he’s the reason we have all the equipment you could ever hope for. There’s a great deal of very exciting research going on here, and Dr. P. is a wizard at getting funding to keep it alive. Everyone adores him.” It was difficult to tell if Mrs. Love was talking about a man or a god. “This is an extraordinary place to work,” she added.

“It sounds like it,” Sarah said, a little overcome.

Mrs. Love took in a long breath, composing herself. “So,” she said. “Let me tell you about your salary and the hours you’ll be working.”

“Are you saying I have the job?” Sarah asked.

Mrs. Love laughed. “Yes, of course. That is, if you want it.”

“Oh, I do!” She couldn’t wait to tell Joe.

After discussing the work schedule and salary, Mrs. Love took Sarah on a tour of the hospital. The huge, glowing foyer was only the beginning of the surprises. Mrs. Love showed her an empty patient room, and Sarah thought it looked more like a room one would see in a charming old hotel than in a psychiatric hospital. There was even a private bath. Not all the rooms had them, Mrs. Love hastened to say, but there were many rooms just like that one.

Down the hall, there was a sunny patient lounge with game tables and a television set in the corner. Some of the patients glanced up when Sarah and Mrs. Love peered into the room, but they quickly resumed their activities. Next to the lounge was a small theater, and next to that, a beauty parlor. “The better the patients look, the better they seem to feel,” said Mrs. Love. “It does wonders for those suffering from depression.”

“This is an extraordinary facility,” Sarah said, nearly breathless with wonder. Mercy was woefully behind the times compared to Saint Margaret’s.

They took the curved staircase to the third story—ward three, Mrs. Love called it—and there was an almost palpable difference in the air as soon as they opened the door to the hallway. There was a leaden silence, broken occasionally by some mumbled sounds and, at one point, a piercing scream.

“The isolation room.” Mrs. Love pointed to the door from behind which the scream had emanated.

Sarah nodded. She’d heard those piercing screams of sheer loneliness coming from the isolation room at Mercy. That was nothing new. What was new to her was the EEG lab, the room where they could painlessly assess a patient’s brain waves. They hadn’t even had an EEG machine at Mercy, much less a whole lab. Sarah was truly impressed.

“May I learn how to operate these machines?” she asked.

“Absolutely, dear,” Mrs. Love said. “That’s one thing you’ll discover about Saint Margaret’s. You’re encouraged to expand your skills and to learn just as much as you desire.”

Across the hall, Mrs. Love allowed her to peer through a small window cut into a door. In the room beyond, several beds were lined up against the walls, and in the beds lay sleeping men and women. “We call this the slumber room,” Mrs. Love said.

“Are they drugged?” Sarah asked, voicing her suspicion.

“Yes. We’re using experimental drugs in here to see what medication works best on which type of patient. This is part of Dr. Palmiento’s research.”

Sarah felt a twinge of discomfort. Human guinea pigs. Yet, what else had she expected in a research facility?

They walked past the electroshock treatment room. It, too, was larger and had far more elaborate equipment than Sarah was used to. She had detested the idea of treating patients with electroshock therapy back when she was a nursing student, but after she’d seen the dramatic difference it could make in some of her most depressed patients, she’d changed her mind. It would often leave the patients with partial memory loss, but that was temporary—usually—and as their melancholia lessened, they became functional human beings again. In most cases. Not all. And it was impossible to know who would respond and who would simply get worse. Maybe that was something worthy of researching. Maybe she could talk to Dr. Palmiento about it. She smiled to herself, caught up in the excitement of working in such a dynamic institution.

“Here’s our surgery,” Mrs. Love said when they’d reached the end of the hall.

“Surgery?”

“Lobotomies, mainly,” Mrs. Love said, and Sarah hoped the supervisor didn’t see her cringe. Although lobotomies were being performed at many hospitals around the country, they had not been done at Mercy, and Sarah could not shake her feeling that they were barbaric. She knew she was out of step with the times. The procedure had won the Nobel Prize, for heaven’s sake.

“This is Dr. Palmiento’s office.” Mrs. Love pointed across the hall. “Oh, look! He’s in. Would you like to say hello to him?”

“Uh…I don’t want to disturb him.” Sarah felt intimidated by the man after all she’d heard about him.

Mrs. Love knocked on the door and poked her head inside. “Good morning, Dr. P. Would you like to meet our new nurse?”

Through the glass window in the door, Sarah saw a man in his late fifties look up from his desk. “Of course,” he said. “Bring her in.”

She stepped into the office behind her new supervisor.

“This is Sarah Tolley,” Mrs. Love said. “Mrs. Tolley, this is Dr. Palmiento. Or Dr. P., as we call him around here.”

He stood up and walked around the side of his desk, a warm smile on his face.

“Hello, Doctor.” Sarah reached her hand toward him, and he pumped it with enthusiasm. He was unabashedly handsome. No wonder Mrs. Love had a crush on him.

“Good to have you on board, Mrs. Tolley.” His hair was light brown and only beginning to gray, and his face was softly lined. There was a gentleness in his features—except for his eyes, which were green, riveting and disconcerting. They did not fit the rest of his demeanor. Sarah had experienced that sort of impaling eye contact before—from several of her psychiatric patients. Patients who looked perfectly healthy otherwise, but whose eyes gave away the psychosis within. She withdrew her hand from his as quickly as she could without seeming discourteous, disturbed by her own reaction. Here was a brilliant doctor, by all accounts a caring human being, who simply happened to have piercing eyes. She was being silly to think it was anything else.

“And where will Mrs. Tolley be working?” He spoke to Mrs. Love, but his gaze was still locked on Sarah, and she had to look away.

“Ward three,” Mrs. Love said.

“Aha!” He sounded overjoyed, a man who clearly loved his work. “You must be a highly skilled nurse, Mrs. Tolley. Joyce wouldn’t put just anyone on ward three.”

Sarah smiled at the supervisor. “Thank you for the vote of confidence,” she said.

“I put her there because she’s excited about research and she has some surgical experience.”

“Not really,” Sarah said quickly. “Not since nursing school, anyhow.” She didn’t want to find herself assisting at lobotomies.

They ignored her weak protest. “I do most of my work in ward three,” Dr. Palmiento said. “That’s where our more seriously disturbed patients are housed.”

“I’ve heard wonderful things about you and the work you’re doing.” Sarah hoped she didn’t sound quite as reverential as Joyce Love.

Palmiento nodded with a smile and rested his hand on Sarah’s shoulder. “You’re going to be a fine addition to our team,” he said.

Once back in the corridor, Mrs. Love turned to Sarah.

“Isn’t he something?” she asked.

“He seems very excited by his work,” Sarah said, still unnerved by her mixed reaction to the director. He was a doctor, not a patient, she reminded herself. A nationally recognized psychiatrist. And she should know better than to think she could diagnose anyone from the quality of their eye contact.

Her first week at Saint Margaret’s went smoothly enough. She was assigned to just two patients, women, both of whom suffered from depression, and she found them likable. She was drawn to her patients, and she firmly believed that a positive relationship between patient and caregiver was the catalyst for healing whatever was wrong with the mind. She often talked lovingly with her patients or even held them when they needed comforting.

Toward the end of Sarah’s first week, a new patient, Karen, arrived on ward three and was assigned to her. Forty years old, mother of three children and the wife of a politician, Karen had been completely mute for the past six years. It was the first time Sarah had encountered such severe, pervasive mutism. Karen’s husband denied remembering any triggering event. One spring day, Karen had simply stopped talking, he said. To him, to their children, to the neighbors. She even stopped singing, and she had sung in the church choir for ten years.

Sarah was determined to get to the root of Karen’s problem. She spent hours with the woman, day after day, talking to her, trying gently to unearth the trauma that had led her to lose her voice. She was patient and very, very kind, hoping that Karen would one day realize she could trust her and open up to her.

Dr. P. had an entirely different approach. On the third day of Karen’s hospitalization, Sarah was talking to the mute woman when Dr. P. suddenly burst into the room.

“You hideous wench!” he shouted.

Sarah’s jaw dropped. Which of them was he talking to? Karen looked at him with her big, sad eyes.

“Your husband told me you neglected your children,” Dr. P. said, his green eyes flashing wildly. “You’re the sort of woman who should be fixed. Shouldn’t ever have been allowed to have children at all!” With that he was gone, leaving Sarah trembling and Karen’s face as blank as before.

Sarah touched Karen’s arm and stood up. “I’ll be right back,” she said, walking toward the door.

She found Dr. Palmiento outside the slumber room. It was the first time she’d spoken to him since their initial meeting in his office, and she rued that their first real contact was to be a conflict. But she was angry.

“Excuse me, Dr. Palmiento,” she said. “I don’t understand why you broke into Karen’s room that way. She’s very fragile.”

A warm smile came to his lips, and he touched her shoulder. “Are you questioning my methods?” The words were combative, but it almost sounded as if he were teasing her.

“No…I mean, yes. I think she needs support, not—”

“You handle her your way, and I’ll handle her mine,” he said, as though engaging her in friendly competition. “We’ll see which of us wins.”

For several weeks, Sarah continued to sit for an hour each day with Karen, talking to her, sometimes holding her hand. And during those same weeks, Dr. P. yelled at and berated the patient. If he spotted Karen walking down the hall, he would flood her with insults.

On one occasion, Sarah was walking toward the lounge with Karen when Dr. P. passed them in the hall. Once he was a few steps behind them, he called to them, loud enough for those in the foyer to hear. “I hope you’re taking her down to the beauty parlor, Mrs. Tolley,” he shouted. “Though I’m not sure what they’ll be able to do for her there. Better try a plastic surgeon first.”

Karen swung around, and for the first time Sarah saw life in the woman’s eyes. “Leave me alone, you goddamned son of a bitch!” she said.

Sarah stood frozen, stunned at hearing Karen’s voice. Down the hall, Dr. Palmiento laughed as he walked away.

“I believe I win that round, Mrs. Tolley,” he called over his shoulder.

Everyone loved him, and Sarah grew increasingly confused by her feelings about him. He was mercurial—warm, fatherly and immensely human one minute, clinically detached, even cruel, the next. Everyone thought he’d been very clever in getting Karen to talk. Once her silence had been broken, Karen continued to make progress, although much of her language was peppered with blasphemy and evidence of delusions. Yes, Sarah had to admit, Palmiento’s approach had worked. But at what cost? What did it do to someone’s spirit to be insulted and treated like a project instead of a human being?

The rest of the staff thought it was exciting that Dr. P. was experimenting with new drugs on his patients. “If my mother needed to be in a psychiatric hospital,” Sarah heard one of the nurses say, “I’d want her to be here so she could get the latest treatment.” But Palmiento’s experimentation made Sarah nervous. He’d inject depressed patients with something called LSD, day after day, in an attempt to “break down their walls.” The LSD scared Sarah. Patients reacted to it in unpredictable ways. They’d scream, or try to climb the walls of their rooms, literally, or they’d attempt to throw themselves through their windows. Others slept for days at a time, tossing from wild, unimaginable dreams. And Dr. P. observed it all from his clinical perspective, writing copious notes on the patients’ reactions and applying for yet another grant to fund more research into the next drug possibility.

There were other patients, some of them Sarah’s, on whom he performed electroshock treatments. Sarah, herself, had suggested it for one patient who was so depressed she tried to hang herself from a doorknob with her underpants. But at the time, Sarah had not known about Dr. P.’s experimental approach to ECT. He used 150 volts several times a day instead of the usual 110 volts every few days. Instead of one shock, he would fire off eight or more of them, right through the patient’s convulsions. The patients no longer knew where they were or even who they were. Then Dr. P. would combine that treatment with his unique brand of drug therapy. He was after “extreme confusion,” he explained. His approach would wipe clean the slate of the patients’ old maladaptive ways of thinking and behaving. Then he and the staff could teach them healthier ways to live. The theory was sound enough, yet it seemed to Sarah that few patients were actually getting well.

She finally went to Mrs. Love with her concerns.

Mrs. Love smiled at her, condescension in her expression. “Dr. P. is way ahead of his time,” she said. “You’re a smart woman, Sarah. You know people tend to laugh at geniuses. Or berate them. Look at Einstein. People thought he was retarded. And Copernicus. They thought he was crazy.”

“I’m concerned that his methods might be making some of the patients worse rather than better,” Sarah said.

“You haven’t been here long enough to see the real progress yet,” Mrs. Love said. “You must keep the big picture in mind. The things we’ll learn from Dr. P’s treatments here at Saint Margaret’s will one day be applied to other patients in other hospitals in the future. You’ll see.”

“I’ve just…it’s so different from what I was used to at Mercy,” Sarah said.

The condescending smile again. “I don’t want to say anything negative about Mercy,” Mrs. Love said. “It’s a fine hospital. But the truth is, their approach to mental illness is rather antiquated. Don’t stand in the path of progress, Sarah.”

She wondered if Joyce Love might be right. Everyone seemed so enamored of Dr. P., so respectful of the “important work” he was doing. Was she the type of person who would have laughed at Copernicus? She would have to keep a more open mind.