I fielded questions for a quarter of an hour and was on my way out of the lecture hall when a young woman stopped me. I recognized her as one of the frequent questioners, thought I’d seen her somewhere else as well.

“Dr. Delaware? Eileen Wagner.”

She had a pleasant full face under cropped chestnut hair. Good features, bottom-heavy figure, a slight squint. Her white blouse was mannish and buttoned to the neck; her skirt, knee-length tweed over sensible shoes. She carried a black Gladstone bag that looked brand-new. I remembered where I’d seen her before: last year’s House Staff Roster. Third-year resident. M.D. from one of the Ivy League schools.

I said, “Dr. Wagner.”

We shook hands. Hers was soft and stubby, bare of jewelry.

She said, “You gave a lecture on fears to the Four West staff last year, when I was PL-three. I thought it was quite good.”

“Thank you.”

“I enjoyed today, too. And I’ve got a referral for you, if you’re interested.”

“Sure.”

She shifted the Gladstone bag to another hand. “I’m in practice now, out in Pasadena, have privileges at Cathcart Memorial. But the kid I have in mind isn’t one of my regular patients, just a phone-in through Cathcart’s help line. They didn’t know how to handle it and sent it over to me because I’m listed as having an interest in behavioral pediatrics. When I heard what the problem was, I remembered last year’s talk and thought it would be right up your alley. Then, when I read the Grand Rounds schedule, I thought: perfect.”

“I’d be glad to help, but my office is on the other side of town.”

“No matter. They’ll come to you- they have the means. I know because I went out a few days ago to see her- it’s a little girl we’re talking about. Seven years old. Actually I came here this morning because of her. Hoping to learn something that could help me help her. But after listening to you it’s clear her problems go beyond office management. She needs someone who specializes.”

“Anxiety problems?”

Emphatic nod. “She’s just racked with fears. Multiple phobias as well as a high level of general anxiety. I’m talking really pervasive.”

“When you say you went out there, do you mean a house call?”

She smiled. “Didn’t think anyone did them anymore? At Yale Public Health they taught us to call them “home visits.’ No, actually I don’t make a habit of it- wanted them to come into the office to see me, but that’s part of the problem. They don’t travel. Or rather, the mother doesn’t. She’s an agoraphobic, hasn’t left her house for years.”

“How many years?”

“She didn’t get any more specific than “years’- and I could see even that much was hard for her, so I didn’t push. She really wasn’t prepared for being questioned at all. So I kept it brief, focused on the kid.”

“Makes sense,” I said. “What did she tell you about the kid?”

“Just that Melissa- that’s her name- was afraid of everything. The dark. Loud noises and bright lights. Being alone. New situations. And she often seems tense and jumpy. Some of it’s got to be constitutional- genetics- or maybe she’s just imitating the mother. But I’m sure some of it’s the way she lives- it’s a very strange situation. Big house- huge. One of those incredible mansions on the north side of Cathcart Boulevard out in San Labrador. Classic San Labrador- acres of land, huge rooms, dutiful servants, everything very hush-hush. And the mother stays up in her room like some Victorian lady afflicted with the vapors.”

She stopped, touched her mouth with a fingertip. “A Victorian princess, actually. She’s really beautiful. Despite the fact that one side of her face is all scarred and there appears to be some mild facial hemiplegia- subtle sagging, mostly when she talks. If she weren’t so beautiful- so symmetrical- you might never notice. No keloiding, though. Just a mesh of fine scars. I’d be willing to bet she had top-level plastic surgery years ago for something really major. Most likely a burn or some kind of deep flesh wound. Maybe that’s the root of her problem- I don’t know.”

“What’s the little girl like?”

“I didn’t see much of her, just caught a glimpse when I walked in the front door. Small and skinny and cute, very well dressed- your basic little rich girl. When I tried to talk to her she scampered away. I suspect she actually hid somewhere in her mother’s room- it’s a bunch of rooms, actually, more like a suite. While the mother and I were talking I kept hearing little rustles in the background and each time I stopped to listen, they’d stop. The mother never remarked on it, so I didn’t say anything. Figured I was lucky enough just getting up there to see her.”

I said, “Sounds like something out of a Gothic novel.”

“Yes. That’s exactly what it was. Gothic. Sort of spooky. Not that the mother was spooky- she was charming, actually. Sweet. In a vulnerable way.”

“Your basic Victorian princess,” I said. “She doesn’t leave the house at all?”

“That’s what she said. What she confessed- she’s pretty ashamed. Not that shame’s convinced her to try to leave the house. When I suggested she see if she could make it to my office, she started to get really tense. Her hands actually started shaking. So I backed off. But she did agree to have Melissa be seen by a psychologist.”

“Strange.”

“Strange is your business, isn’t it?”

I smiled.

She said, “Have I piqued your interest?”

“Do you think the mother really wants help?”

“For the girl? She says she does. But more important, the kid’s motivated. She’s the one who called the help line.”

“Seven years old and she called herself?”

“The volunteer on the line couldn’t believe it either. The line’s not intended for kids. Once in a while they get a teenager they refer to Adolescent Medicine. But Melissa must have seen one of their public service commercials on TV, copied down the number, and dialed it. And she was up late to do it- the call came in just after ten P.M.”

She lifted the Gladstone bag chest-high, popped it open, and pulled out a cassette.

“I know it sounds bizarre, but I’ve got the proof right here. They tape everything that comes over the line. I had them make me a copy.”

I said, “She must be pretty precocious.”

“Must be. I wish I’d had a chance to actually spend some time with her- what a neat kid, to take the initiative.” She paused. “What a hurt she must be going through. Anyway, after I listened to the tape I phoned the number she gave the volunteer and reached the mother. She had no idea Melissa had called. When I told her, she broke down and started to cry. But when I asked her to come in for a consultation, she said she was ill and couldn’t. I thought it was something physically debilitating, so I offered to go out there. Hence, my Gothic home visit.”

She held the tape out to me. “If you’d like, you can have a listen. It’s really something. I told the mother I’d be talking to a psychologist, took the liberty of giving her your name. But don’t feel any pressure.”

I took the cassette. “Thanks for thinking of me, but I honestly don’t know if I can make home visits to San Labrador.”

“She can come to the other side of town- Melissa can. A servant will bring her.”

I shook my head. “In a case like this, the mother should be actively involved.”

She frowned. “I know. It’s not optimal. But do you have techniques that can help the girl at all without maternal involvement? Just lower her anxiety level a bit? Anything you did might reduce her risk of turning out totally screwed up. It would be a real good deed.”

“Maybe,” I said. “If the mother doesn’t sabotage therapy.”

“I don’t think she will. She’s antsy, but seemed to really love the kid. The guilt helps us there- think how inadequate she must feel, the kid calling in like that. She knows this isn’t the right way to raise a child but can’t break out of her own pathology. It’s got to feel horrible for her. The way I see it, this is the right time to harness the guilt. If the kid gets better, maybe Mom’ll see the light, get some help for herself.”