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Elizabeth's Story

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Anne weeps in the morning. She stands in her blue bathrobe, holding a valentine from Elizabeth, saying, "Look . . . look what she wrote me."

On the back of a photocopied unicorn, printed within a crooked heart, I read,

I love you

I will you

I will love you always

My first feeling is sort of an ache. That's for Anne, a blind echo of empathy. My next response actually makes words in my mind: "So even raped children write valentines."

"Look," says Anne again, touching the vacant place on the page. "She can't write 'miss'--'I will miss you.' If she does, then she's admitting she has to leave the hospital. . . . Twelve, she wrote me twelve valentines . . . she is leaving and I can't believe it either."

That's called "denial." Call the love "transference," presuming that it's a feeling provoked by therapy; Elizabeth, ten years old, is a patient in a psychiatric hospital for children. Anne is Elizabeth's primary caretaker on the nursing staff. A PhD candidate and a two-year veteran of the ward, Anne's about 30, with no kids of her own, "yet."

If Anne did have children, they'd be mine. Instead, I'm the one who listens and watches, who saw this moment aborning months ago, when Anne came home at midnight from her evening shift.

"Are you awake?"

I was. But I thought my back was making an eloquent statement: "I don't want to be. Stop making so much noise."

"Sit up. Talk to me."

"No."

"Yes. We have a new little girl on the unit."

"Uh-huh. And I was up at five, so go make yourself a drink."

"No thanks. She's tiny, and pretty. So proper and polite and completely filthy--covered with lice. The strange thing is, she's almost mute."

Hadn't I heard her say proper and polite? "What do you mean, mute?"

"She talks, but . . . she doesn't seem to feel anything."

"Emotionally mute?"

"Yes! That's it. Emotionally mute."

I stayed very still, made my back a rigid wall. I could sense Anne musing behind me. "Well," I snapped, "was she raped?"

It seems to me they all are--Anne's patients, aged 4 to 11--sexually or physically abused. I know it's just seven or eight out of ten, but it seems like all; and I have a tough time with rape. A favorite relative of mine was, and a high school girlfriend--she was also beaten and paralyzed--and scores, maybe hundreds of the mentally ill adults I've met in my jobs, raped or molested. I believe in the death penalty.

Anne shrugged into the back of my neck. "I haven't seen the records. But the admitting note says she keeps the curtains closed in every room, that she eats under the table and sleeps under her bed . . . I'll tell you one thing, she's really grateful to be in the hospital. She seems so relieved. I think I will have a drink. You go back to sleep."

Of course, right.

"Oh, I forgot to tell you. Her name's--"

"Elizabeth." I'll call her Elizabeth. Anne's a pseudonym too, because everything's confidential here: I don't actually know Elizabeth's last name. But even without the pseudonyms, I could reveal a great deal, because short of reporting birthmarks no one could establish Elizabeth's identity. Her story is simply too similar to thousands of others'.

So is Anne's, I think. Certainly the kinds of feelings Elizabeth evoked in her during the following months are shared by her workmates on the ward. Like Anne, these people are mostly young--in their mid-20s to early 40s--and profoundly dedicated. Some are nurses, others study psychology. Partly because of their educational commitments, few have children of their own.

That's important to the scene: Young, childless professionals care for and about disturbed, needy, sometimes abandoned or brutalized children. Patients arrive damaged and, one way or another, leave.

But not, sometimes, before learning a little above love. Transference, I mean.

A week later I heard Elizabeth's history as it appeared in the records: Mother's a junkie; Elizabeth was born addicted. No father Elizabeth's ever known. Mother didn't care much for parenting, left Elizabeth alone all night, or with Grandma for weeks at a time. Elizabeth didn't speak words until she was four years old.

When she was six, Grandpa raped her. "But that's according to Grandma, and we're not sure of her yet," said Anne the next week.

"You don't think it happened?"

Anne stared off into the middle distance. "Yes, I believe it."

"And?"

"I don't know. Something else. But Elizabeth won't even talk about Grandpa yet. Except 'He is a very nice man' and 'Everything's fine.'"

I watched Anne; Anne was not watching me. Finally, she turned with a sad smile. "She's a very special girl."

Three weeks later, midnight, and it was: "We're playing together now."

Since I was trying to sleep, "we" didn't mean me.

"She has this wonderful fantasy world, you know. She's very regressed, verbally, but her fantasies are so rich, so intelligent--not psychotic at all. . . . I'm her primary; I'm writing her treatment plan."

"Very nice."

"I think she wants to trust me; I think we have rapport."

It was time to roll over and inspect an expression. I did so.

"What?" Anne demanded.

"'What' yourself?"

"She . . . won't say anything about her life! What she does . . . she takes everything out of the dollhouse, then she puts everything back, very ordered, totally controlled. And she says, 'Everything's fine, fine--everything's fine.' What am I supposed to do?"

Anne's a little bit of a genius with children. She already knew the answer to this question, but here's what I was supposed to say:

Wait. Develop a little distance. You're a professional, and we know that a professional offers compassion and understanding without giving away the store. So remember reality. Accept limitations. Don't rescue. Identify feelings--counter-transference--and use them. This is about the patient's needs, not yours. And you are not her mother.

That's the party line. Here's what I was thinking:

And what if this patient needs a mother? You know, like a child--as in children need mothers? And what if your own heart and mind resonate to this child's terrible need so strongly you can practically feel it in your body--

And God, doesn't this child deserve somebody somewhere, to love her and let her love?

Well then, in a case like that, you--

Well, then, you--

One of Anne's friends is a pretty Prussian woman, psychoanalytic in perspective. If she were a physician, she'd be a surgeon; if a lawyer, then a judge. Forthright, direct: this is a woman who will acknowledge an emotion even as she seals it tight in a mitered box. And on the sly, this orderly woman sees a discharged patient, an abandoned boy, on holidays and weekends, giving him a respite from his group home, providing him with someone special all his own. When she speaks of him her face lights, her voice rounds the edges of words. She looks warm . . .

Professionally speaking, she should leave him alone. As in alone.

Another of Anne's associates has gone well beyond these Prussian borders: she's adopted the child.

I didn't say what I was supposed to say and I didn't say what I was thinking. I didn't even say, as I would have with an adult patient, "Step back." Anne knew that to begin with; and she wouldn't have listened to me if I had said that. Four years after a breakup, I still take an ex-girlfriend's children to dinner every week, demand to see their report cards, tell them more about the world than they believe, worry . . . I'm not considered an expert at developing distance with children.

So I said nothing, and Anne answered herself. "I'm not going to push her."

That meant: "I will hold me back."

Over the next several weeks, I try to build an image of this child. Anne's characterizations are vivid: Elizabeth is now "very much a little girl," whom I see in a pink dress carefully arranging the arms of her doll. But that's only part of the time--she's also a wild thing, racing about at play with other children. And yet, something about her is so carefully arranged . . . she avoids adults' eyes. Everything's always "fine."

It's a baffling image, stiff and secretive. In the isomorphic model--a psychological theory of which Anne is fond--I'm responding to Anne's own emotions, which in turn reflect Elizabeth's. But on another level I watch Anne from a distance, sense her growing investment. She waits to enter an inner cell.

Always at midnight--"She holds me, she holds me tight, like this."

"Priest, your hands are cold! I'm sleeping!"

"No, you're not . . . it started with me holding her, but now she holds me back, asks for hugs. She says she doesn't know why she holds so tight. I told her it's because she gets scared, but she says she doesn't know what I mean. In play, her Grandma holds her, protects her . . ."

Anne's nails suddenly grip the back of my arm. "Do you know something? In her play, she can't talk. Only other people can talk. And listen to this: we've had her nearly a month, and she has never cried. Not for pain, not for missing anyone. . . . She never feels enough to cry."

"Anne."

"Why aren't you awake?"

"Because I was up at--"

"You remember last week, how she's making me a part of her games? How she's making me the guesser, who has to figure out what's going on? Well, guess what I guessed right in play tonight--a tiger ate Grandma!"

"Then maybe she got some rest."

"And the hugs--tonight she told me she had a name for them, but I had to guess what the name was. The word started with an s . . . go ahead, guess."

"Sleep."

"Don't be silly. 'Safe.' She calls them 'safe hugs.'"

As opposed to--

One of the interesting things about abused children is how little we know about them--how they cope, how we can help them. Anne's master's thesis is a review of the literature. What she discovered was that most studies address the problems of the abusing adult, or of the abusive family. The children themselves are tricky to assess so they receive shorter shrift. What evidence there is suggests serious problems: damage to children's emerging sense of self, to attachment behaviors, to their capacity to trust and their ability to learn. The children often need the very people who are hurting them. Double bound, they're prone either to self-mutilation and suicide or to aggressive, violent behaviors. Here's a Mr. Spock-like description by somebody named A.H. Green: . . . overall impairment of ego functioning . . . intellectual and cognitive deficits, acute traumatic reactions, pathological object relationships, impaired impulse control, poor self-concept, masochistic and self-destructive behavior, impaired object constancy, and severe academic and behavioral difficulties . . .

These are very bad things. But Anne has made a connection with Elizabeth: as the "guesser" of fantasy games, Anne serves as a benign contact with reality. She has been allowed to witness Elizabeth's attempt to separate from the grandmother ("eaten"). Grandma has said she cannot have Elizabeth return to her home.

And soon, Anne will come to fill Grandma's guardian role in Elizabeth's life.

"Don't get up."

"I wasn't getting up."

"Listen--I'm in her fantasy now. The doll she chose for me is Wonder Woman. I have wings. I can talk for her. And I can protect her from a monster, who now is sometimes also a man."

"What happened to the tiger?"

"The tiger? Oh, the tiger . . . he's gone. Elizabeth says he wasn't real."

As it happens, Wonder Woman also coleads "gender group," a sort of sex-ed class for children. And it is during one of these classes that Elizabeth sacrifices some of her eerie emotional control.

"She was so excited. She kept saying 'I have to tell you! I have to tell you!' But she couldn't, so she'd start shouting 'I have to tell you!' again. . ."

She did eventually tell, because she could; Elizabeth had just learned the words to describe what Grandpa did to her.

Actually, John did it first. John--do you know who you are, John? Because this is your real name--was a boyfriend of Elizabeth's junkie mother. John told Elizabeth he would kill Mom if Elizabeth told on him; during John's fourth or fifth attack, Mom walked in.

Well, Mom wasn't having any of that; she kept the boyfriend, but got rid of Elizabeth. Sent her to live with--

Grandma and Grandpa.

When Anne tells me about this, there is distance between us in our bed. Partly, it is that I am a man, like John and Grandpa. But it is also because we deal with outrage in different ways: Anne grieves for Elizabeth, lies still feeling sadness. I flex and twist, hold my breath as I imagine gutting John with a short blade.

We can't help each other here. Eventually we fall, quite separately, asleep.

For the next two weeks, at dinner and the odd brunch, I heard about adventures in the hospital's playroom. Elizabeth delighted in developing rescue scenes, carefully controlling the actions of her loyal heroine, to whom she extended the power and voice her own doll was denied. But Wonder Woman also had an agenda: Anne taught Elizabeth to name those sensations we locate in our hearts or minds. Anne literally took her through the mechanics and manifestations of emotions--"Last night we did 'happiness,' making smiles with our fingers. . ."

I'd like to think this was a happy time for Elizabeth. It was for Anne: she believed she was leading Elizabeth into a reality that didn't include pain and betrayal. When Anne discovered that Mom had beaten Elizabeth for using the words "I want," and that Elizabeth's response to desire--for ice cream, a new blouse--was silent mourning, Anne made her practice "Please may I have." Anne even swore to Elizabeth, over and over, that crying would not be punished.

Anne, daring Anne, even hoped that soon Elizabeth might find strength in herself; find faith in that strength; and discover that she need not always wait, passively, for rescue or rape.

One night's success is worth waking me for.

"She didn't want to use dolls and I wasn't Wonder Woman. She was Elizabeth and I was me and she was very scared because Grandpa had locked her in the room again. Now he was coming for her."

I switch on the lamp. I don't listen to shit like this in the dark.

"So she said something like, 'Now he's coming for me, what will you do?' And I said, 'What should I do?' because I really didn't know."

"And she said?"

"'You get a ladder--'"

"We're upstairs?"

"Upstairs. 'You get a ladder, and you push it to the window. And you say, "Elizabeth, Elizabeth, come quick!" And I do! I come, and I jump in your arms! And you hold me tight!'"

Anne's so good at this that I'm not breathing again. "Yeah? So? Now?"

"We get away!"

"You get away!"

We grin at each other. Anne's a genius. I tell her so. I imagine first Elizabeth's scene, with Anne carrying her away; and then Anne's, as she's held tight by a child who's righting the wrongs of her world. I do this six or eight times, deep in my head, as Anne turns off the light and curls up beside me. Then I realize that something is wrong with Anne.

"You did say you got away."

Anne's breathing into the middle of my back.

"Yes."

I wait until I can't anymore. "Well?"

"I asked her what happens next. . . . She looked at me a long time. She took my hand and she pressed it against her cheek. And she closed her eyes like . . . she was praying."

Anne's voice was very shaky.

"And she whispered . . . 'Then you'll take me home and I will be your little girl, forever and ever and ever.'"

Everybody lay still.

Everything began to happen quickly. Now Elizabeth's fantasies nearly represented reality, and she'd started accepting reality's image. If her world wasn't a nightmare from which she need flee, then it was the rarefied environs of the hospital ward.

This was good. Elizabeth quieted in her manic play, made eye contact. For quite some time she had glued herself to Anne; but now, with Anne's encouragement, she slowly found friends among the other children on the ward, ventured off on her own. She learned that she could ask to play a game of Ms. Pac-Man; learned also that she could survive the consequences of an answer, whether yes or no. If she could not, would not ever cry, she had at least learned to trust someone enough to love, and to want this someone to love her forever.

This was bad. Elizabeth thought her new reality could last.

In early January, after Elizabeth had been at the hospital nearly three months, her treatment team announced to her that she was much better now. It was time to begin her new life in a group home.

Elizabeth had heard this kind of "leaving" talk before. From the treatment team, from Anne. Someone was always saying that one day they would find her a nice place to live--as if there were nice places to live outside the hospital.

Elizabeth had figured this out: these threats were just the staff's way of making sure she behaved. The only difference was that this time they gave her a date.

Elizabeth assured Anne that she would be good. Better than ever--she would act right and ask for what she wanted and name emotions and answer questions and--

Some people can actually keep other people awake by worrying near them. I can prove this.

"What? What?"

"I wasn't going to wake you. But . . . she doesn't believe us. About leaving. She thinks--I don't know--that she can convince us to keep her. She's trying to figure out what it is, exactly, that we want her to do."

Think about living a life so frightening that only fantasy's safe, a life full of rapes and beatings, lice and chaos and neglect. Then see yourself, a child, waking in a bright hospital ward full of Anne-like people who make you very happy, whom you come to love--

Who tell you that you have to leave.

"Why does she have to leave?"

"Because. We're a . . . a hospital. Her medicaid's run out. She can't live with us--she's better. It's a good group home, I've checked it; she needs to find a life . . ."

By my silence I suggest: these things are merely true. Anne knows. She is losing another battle.

Elizabeth was just beginning hers: "I'm not going."

She said this politely but firmly. She was making her position known, as she'd been taught. Then Elizabeth dug in: she simply refused to discuss the matter. When Anne or anyone else insisted, Elizabeth would simply walk away, go sit on her bed, talk to her dolls about anything but leaving.

Anne insisted most often. Anne, whom she loved. Elizabeth could not bear it.

So she hid when Anne came on shift. Hid, ignored her, covered her ears--

And, beginning weeks in advance, wrote Anne valentines. One after the other, in her awkward hand: "I love you," "Be mine," "I'm yours . . ."

And finally, with a desperation that increased as the date approached, "Please be my Mom."

She would not give up, would not relent. She clung to the hospital as her home, to Anne as the woman who would be Mom.

So it was that I woke one morning to find Anne by the window, weeping, with the unicorn valentine in her hand. "I asked the hospital, they said it's all right. . . . Next week, I'm driving her to the intake interview."

"You think you should do that?"

"Yes."

On the drive to the group-home interview, Elizabeth is alternately raging and mute. To the social worker who interviews her she insists, "My name is Anne." When Anne leaves the room, Elizabeth will not speak.

Back in the ward, Elizabeth maintains silence for most of the next week, as the group home deliberates. She will not forgive Anne. Anne is saddened but understanding. "She's making the separation. This is hard, but it's healthy. She needs to do this."

I wonder what Anne needs to do.

The group home answers: despite Elizabeth's oppositional behavior, yes. Elizabeth is given the news.

Anne calls me at 10 PM. "I need you to be awake tonight." Her voice sounds like breaking glass.

In the TV-movie version, Anne and I realize that we must adopt Elizabeth, that she is the child for us. One of us will quit work or school to give her the quantity and quality of time she will need for years to come. She loves us enormously, grows up to become a leading psychologist dedicated to abused children.

In real life, Elizabeth could not go to sleep that night. Anne went to tuck her in, to once more explain leaving. She spoke gently and reassuringly of all the fears she knew Elizabeth must be having. Elizabeth would not answer; in sad silence, Anne patted Elizabeth into bed, and left her.

I'm awake, listening to this description. Anne and I are sitting on the couch in the living room. Anne stares straight ahead. Her hand lies in my hand: it appears to have lost something.

"I think it was about an hour later, I'm not sure. I heard her calling me in the hallway. Just this tiny little sound, but I heard her and I went into her room. . . . She just ran to me, and she threw herself into my arms--and I could feel her, sobbing against my face, crying so hard she couldn't speak."

I can't tell you how lost Anne's hand looks.

"And I held her until she could say to me . . . that she loved me, that she would always love me . . . that she couldn't help the way she felt, couldn't stop that feeling--"

Poor Elizabeth.

"But that she would go, go to this home, because that was what I wanted her to do . . . because she knew that I loved her, I loved her too--"

Poor Anne.

"And would never do anything to hurt her. So this must be best, but I shouldn't ask her to stop crying."

At least Anne and I had each other to cry with.

The next day, Elizabeth left to begin the rest of her life.

Postscript: Months after Elizabeth's discharge from the hospital, Anne still calls her often. After a "grace period," she has been allowed to visit, to bring gifts to Elizabeth on her birthday. Recently, Elizabeth found a man on the staff whom she wants as her father.

She wants Anne to marry him.

Art accompanying story in printed newspaper (not available in this archive): illustration/Russ Ando.

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