“Is there a father in the picture?”

“No, she’s a widow. It happened when Melissa was a baby. Heart attack. I got the impression he was a much older man.”

“Sounds like you learned a lot from a brief visit.”

Her cheeks colored. “One tries. Listen, I don’t expect you to disrupt your life and drive out there on a regular basis. But getting a referral closer to home wouldn’t make any difference. Mom never leaves to go anywhere. For her, half a mile might as well be Mars. And if they do try therapy and it doesn’t work, they may never try it again. So I want somebody competent. After listening to you I’m convinced you’re right for the case. I’d greatly appreciate it if you could accept less than optimal. I’ll make it up to you with some solid referrals in the future. Okay?”

“Okay.”

“I know I sound overinvolved and maybe I am- but the whole idea of a seven-year-old calling in like that… And that house.” She raised her eyebrows. “Besides, I figure it won’t be long before my practice really gets crazy and I don’t have the time to give anyone this kind of individual attention. So I might as well enjoy it while I can, right?”

Another reach into the Gladstone. “Anyway, here’s the relevant data.” She handed me a piece of note paper topped with the logo of a pharmaceutical company. On it she’d printed:

Pt: Melissa Dickinson, DOB 6/21/71.

Mom: Gina Dickinson.

And a phone number.

I took it and put it in my pocket.

“Thanks,” she said. “At least payment won’t be a hassle. They’re not exactly Medi-Cal.”

I said, “Are you the physician of record, or do they have someone they’ve been seeing?”

“According to the mother, there’s a family doctor in Sierra Madre that Melissa’s seen occasionally in the past- immunizations, school physicals, nothing ongoing. Physically, she’s a very healthy girl. But he’s not really in the picture- hasn’t been for years. She didn’t want him contacted.”

“Why’s that?”

“The whole therapy thing. The stigma. To be perfectly frank, I had to do a sell-job. This is San Labrador we’re talking about; they’re still fighting the twentieth century. But she will cooperate- I got a commitment out of her. As to whether or not I’ll end up being their regular doc, I don’t know. Either way, if you want to send me a report, I’d sure be interested in finding out how she does.”

“Sure,” I said. “You just mentioned school physicals. Despite the fears, does she attend classes regularly?”

“She did until recently. Servants drove her and picked her up; parent-teacher conferences were conducted over the phone. Maybe in that neck of the woods it’s not that strange, but it can’t have been great for the kid, the mother never showing up for anything. Despite that, Melissa’s a terrific student- straight A’s. The mother made a point of showing me the report cards.”

I said, “What do you mean by “until recently’?”

“Lately she’s been starting to exhibit some definite symptoms of school phobia: vague physical complaints, crying in the morning, claiming she’s too scared to go to school. The mother’s been letting her stay home. To me that’s a big fat danger sign.”

“Sure is,” I said. “Especially with her role model.”

“Yup. The old biopsychosocial chain. Take enough histories and all you see is chains.”

“Chain mail,” I said. “Tough armor.”

She nodded. “But maybe we can break one this time, huh? Wouldn’t that be uplifting?”

I saw patients all afternoon, finished a stack of charts. As I cleared my desk I listened to the tape.

FEMALE ADULT VOICE: Cathcart help line.

CHILD’S VOICE: (barely audible) Hello.

ADULT VOICE: Help line. How may I help you?

Silence

CHILD’S VOICE: Is this (breathy, inaudible).. hospital?

AV: This is the Cathcart Hospital help line. What can I do for you?

CV: I need help. I’m…

AV: Yes?

Silence

AV: Hello? Are you there?

CV: I… I’m scared.

AV: Scared of what, dear?

CV: Everything.

Silence

AV: Is there something- or someone- right there with you, scaring you?

CV:… No.

AV: No one at all?

CV: No.

AV: Are you in some kind of danger, dear?

Silence

AV: Honey?

CV: No.

AV: No danger at all?

CV: No.

AV: Could you tell me your name, honey?

CV: Melissa.

AV: Melissa what?

CV: Melissa Anne Dickinson. (Starts to spell it out)

AV: (Breaks in) How old are you, Melissa?

CV: Seven.

AV: Are you calling from your house, Melissa?

CV: Yes.

AV: Do you know your address, Melissa?

(Tears)

AV: It’s all right, Melissa. Is something- someone or something bothering you? Right now?

CV: No. I’m just scared… always.

AV: You’re always scared?

CV: Yes.

AV: But there’s nothing there bothering you or scaring you right now? Nothing in your house?

CV: Yes.

AV: There is something?

CV: No. Nothing right here. I… (Tears)

AV: What is it, honey?

Silence

AV: Does someone at your house bother you other times?

CV: (Whispering) No.

AV: Does your mommy know you’re calling, Melissa?

CV: No. (Tears)

AV: Would she be mad if she knew you were calling?

CV: No. She’s…

AV: Yes, Melissa?

CV:… nice.

AV: Your mommy’s nice?

CV: Yes.

AV: So you’re not scared of your mommy?

CV: No.

AV: What about your daddy?

CV: I don’t have a daddy.

Silence

AV: Are you scared of anyone else?

CV: No.

AV: Do you know what you are scared of?

Silence

AV: Melissa?

CV: Darkness… burglars… things.

AV: Darkness and burglars. And things. Can you tell me what kinds of things, honey?

CV: Uh, things… all kinds of things! (Tears)

AV: Okay, honey, just hold on. We’ll get you some help. Just don’t hang up, okay?

Sniffles

AV: Okay, Melissa? Still there?

CV: Yes.

AV: Good girl. Now, Melissa, do you know your address- the street where you live?

CV: (Very rapidly) Ten Sussex Knoll.

AV: Could you please repeat that, Melissa?

CV: Ten. Sussex. Knoll. San Labrador. Cal. Ifornia. Nine-one-one-oh-eight.

AV: Very good. So you live in San Labrador. That’s really close to us- to the hospital.

Silence

AV: Melissa?

CV: Is there a doctor who can help me? Without shots?

AV: Of course there is, Melissa, and I’m going to get you that doctor.

CV: (Inaudible)

AV: What’s that, Melissa?

CV: Thank you.

A burst of static, then dead air. I turned off the recorder and phoned the number Eileen Wagner had written down. A reedy male voice answered: “Dickinson residence.”

“Mrs. Dickinson, please. This is Dr. Delaware, regarding Melissa.”

Throat clear. “Mrs. Dickinson’s not available, Doctor. However, she said to tell you that Melissa can be at your office any weekday between three and four-thirty.”

“Do you know when she’ll be available to talk?”

“No, I’m afraid I don’t, Dr. Delaware. But I’ll apprise her of your call. Is that time period suitable for you?”

I checked my appointment book. “How about Wednesday? Four o’clock.”

“Very good, Doctor.” He recited my address and said, “Is that correct?”

“Yes. But I would like to talk with Mrs. Dickinson before the appointment.”

“I’ll inform her of that, Doctor.”

“Who’ll be bringing Melissa?”

“I will, sir.”

“And you are…?”

“Dutchy. Jacob Dutchy.”

“And your relationship to-”

“I’m in Mrs. Dickinson’s employ, sir. Now, in the matter of your fee, is there a preferred mode of payment?”