46

Ward B of the Hawk Ridge Institute for Psychiatric Care—the back ward, as it was called—was reserved for the chronically ill, the violent, and those patients known as forensic cases.

The latter cohort consisted of patients held for observation in advance of a criminal proceeding. Wally Cortland had been sequestered here in 1996 after he slit his mother’s throat with a letter opener and blamed it on the Devil. In 1992, shortly after the old forensic ward—Ward C—had been permanently closed, Sylvia Farentino had made an appearance, on charges of poisoning her boyfriend with a cup of lye in the pancake batter.

There had been others, generally less colorful. Drifters arrested for vagrancy, whose thought processes were too disorganized to be called normal. Drug addicts whose brains had been perhaps permanently scrambled by PCP or crack. Petty criminals with IQs so low that it was impossible to determine if they were competent to assist in their own defense.

And now there was Kaylie McMillan. Murderess, fugitive, and the only patient ever to escape from Hawk Ridge.

She’d been away for quite some time. Now she was back. But this time her visit would be briefer than before, and she would leave in a zippered bag.

Cray smiled at the thought as he used his passkey to open Ward B’s exterior door. The door was steel, and like all ward doors it was key-operated on both sides. A turn of the passkey was required both to enter and to exit. This precaution ensured that no patient could slip past an inattentive nurse or orderly and simply walk away.

It meant also that any staff member who mislaid the passkey would be imprisoned in the ward until help arrived. Cray had no problem with this. A certain measure of fear kept the staff alert. And he was pleased to note that in the past ten years not a single key had been lost by any institute employee.

Antiseptic smells, common throughout the hospital, greeted him as he let the door swing shut. The floor and walls of each ward were scrubbed daily. Antibacterial sprays were applied to desktops and door handles. Every metal and tile surface gleamed.

He moved forward, past the alcove that led to the O.R., where nonpharmaceutical methods were occasionally employed on especially recalcitrant patients. Beyond the alcove was the nurses’ station—a desk and a couple of folding chairs, a few file cabinets, and a closed-circuit television monitor that switched between two grainy black-and-white images of the ward’s two intersecting halls.

The nurse on duty was Dana Cunningham, just beginning her three-to-eleven shift. A tall, large-boned woman, she was capable of wrestling a two-hundred- pound patient to the floor. Cray had always thought she bore a certain resemblance to Walter, though he was tactful enough to avoid making the observation.

He waved at her, passing the desk, and she stopped him by rising from her chair. “Doctor? May I speak with you a moment?”

“Of course, Dana. What is it?”

“It’s about Kaylie McMillan.”

“I’m on my way to see her right now. Her daily therapy, you know.”

“Usually you’re earlier.”

“Well, there was Walter’s funeral. And an unwanted visitor who required my attention.”

“I see. It’s just that I don’t often have the chance to consult with you about her. I’m getting concerned.”

“In what way?’

“The dosage she’s on—it’s really very high.”

“Not extraordinarily so, for a loading dose.”

“I’m seeing side effects. Tremors, agitation, restlessness ...”

Cray waved off this objection with a flutter of his elegant hand. “If we lowered the loading dose for every patient who exhibited those symptoms, we’d have a hospital full of unmedicated florid schizophrenics.”

“But we may be overmedicating in this case. And the treatment program doesn’t seem to be having the desired effect. If anything, she’s become more agitated over the past week. I’m told she refused her breakfast this morning, and at lunchtime she threw the tray at the tech who brought it in. She hasn’t eaten anything all day. She’s clearly decompensating.”

“Well, then the dose should be increased, not reduced.”

“We’re already maxing her out. Doctor, what I was thinking was, maybe we should cut the chlorpromazine and trifluoperazine in half. That still ought to be high enough for a loading dose. If her condition continues to deteriorate, we could try a different strategy....”

Cray was growing bored. “I’ll tell you what,” he said smoothly. “Why don’t we continue with the current dosage schedule today, and tomorrow we’ll look at a reduction?”

Cunningham didn’t like it, but she had sufficient sense not to argue. “Okay, Doctor.”

Cray smiled. He had no concern about Kaylie’s treatment tomorrow. For her, there would be no tomorrow. He would see to that.

“Fine, then,” he said, and headed briskly down the hall, glad to escape a discussion that was, after all, not only irrelevant but premised on an entirely faulty supposition. Kaylie McMillan was indeed becoming more agitated and disturbed, but not as a consequence of any antipsychotic drugs.

She was not, in fact, receiving any antipsychotic drugs.

The vials used by the nurses for Kaylie McMillan’s three daily intramuscular injections—vials Cray himself had mixed—contained no chlorpromazine, no trifluoperazine. They contained only methyl amphetamine, the most potent amphetamine available, in an extraordinarily concentrated dose.

Speed, in street parlance. That was the medication dear Kaylie was on.

She had been taking the drug for the past week, receiving more than three hundred milligrams of meth each time she was injected by the unwitting nurses. Three injections daily. Nearly one thousand milligrams in total, day after day after day.

Methyl amphetamine’s psychotropic effects were gradual and cumulative. During the first two days Kaylie had been lucid. For that reason, Cray had kept her strapped down, with a bite block in her mouth. He didn’t want her saying too much, raising doubts among the staff.

On the third day the drug had begun to take hold. By now it had taken nearly full control of her.

The symptoms of amphetamine psychosis were almost identical to those of acute schizophrenia. Kaylie was hearing voices, harsh and accusatory. The close weave of her thought processes had unraveled. She was scared, scared all the time.

Even the most experienced nurses and ward attendants would not be able to distinguish her behavior from that of a genuine psychopath. No one could doubt that she belonged here, in the ranks of the insane.

Cray reached the end of the hall and turned down the intersecting corridor. Rows of numbered doors passed him on both sides. Not every door was locked, even in Ward B, and not every room was occupied. Many of the patients, including a few who had displayed violent tendencies, were allowed to mingle with the others in the day hall, and to return in the evening, just before the lights-out bell.

The policy was humane and modern. Contemporary medical standards discouraged the practice of shutting a patient away in an isolation room. Cray accepted these standards. Hawk Ridge was not a prison, after all.

Except in Kaylie’s case.

The institute would be her prison for the rest of her life.

Still, as matters had developed, she would not be a prisoner for long.