Kaylie's shock treatment

In this deleted scene from Stealling Faces, Dr. Cray has Kaylie in his custody at the Hawk Ridge Psychiatric Center. He tries to plant the idea of suicide in her mind. When she lunges at him, he orders electroconvulsive therapy.

My editor found the ECT material unnecessarily disturbing. Since the scene did not advance the plot, I omitted it. But having put a fair amount of work into this little episode of Grand Guignol, I’m happy to present it here.

* * *

 "Oh, but I forgot." Cray smiled at her with icy solicitude. "Your brain's sick, isn't it? Then I guess I'll have to do your thinking for you. Well, consider."

He leaned forward, propping himself on the bed with an outstetched arm.

"We've had no escapes from the institute since you were our guest. But we have had one almost equally unfortunate incident."

Kaylie waited.

"The patient in question was a young man who found a most creative way to release himself from his torment. It involved a bed sheet, like this one here." Cray snagged a fold of the rubber sheet between two fingers. "And that air duct I mentioned. Those iron bars, so securely fastened to the wall, and just high enough above the floor ..."

She understood.

Suicide.

This was the gift Cray offered her.

It wasn't enough that he had put her in this room, ravaged her life, made her a pariah and a fugitive.

No, he wanted to finish the task of destruction he had begun -- to finish it not by his own hand, but by hers.

Anger cleared her mind for the moment, and she saw why Cray had allowed the nurses to unstrap her from the bed, the wheelchair. He needed her ambulatory, at liberty within the cell, so that no artificial restraint would prevent her from taking her own life.

"You piece of shit," Kaylie hissed, fury cresting in her like a hot, boiling wave.

"No need for indelicacy." Cray smiled. "I'm merely passing the time with a harmless anecdote --"

Harmless.

There was nothing harmless about this man.

He was madness.

He was death.

She knew it, grasped this one idea with a clarity that had eluded her for hours, and with a rush of hatred she sprang at him.

Her fingers hooked into claws, hands coming up fast, taking him by surprise, and she caught him in the cheek and raked four deep grooves in his skin.

Cray shouted, a hoarse, inarticulate sound.

He had shouted in the desert when she sprayed him with ice to save her life. She'd hurt him then. Wanted to inflict a new and worse hurt now, and she swiped at him again, but missed, and then he swung her around, pitching her sideways off the bed onto the hard shock of the floor.

She struggled to rise, couldn't, because already he was on top of her, straddling her hips as she lay prostrate, and over her groan of panic she heard him yell, "Nurse!"

Commotion in the hall, and suddenly there was another presence in the room.

"My bag," Cray snapped. "The syringe. Now!"

Kaylie beat her fists against the floor, hating to cry, but crying anyway, as the long needle sank into her arm.

Her every muscle unclenched. She couldn't make a fist anymore. She couldn't do anything.

"Doctor" -- the nurse's voice -- "you're bleeding."

"She attacked me," Cray answered from great distance. "There's disinfectant in my bag."

Shuffling sounds, the nurse looking for the ointment, while Kaylie watched the floor recede, watched the world grow big and vague all around her.

"Here you go." The nurse, applying salve to Cray's cheek.

"You were right," Cray said. "She's decompensating badly. She always did exhibit an unusually high level of resistance to pharmacological treatment. We'll have to try the alternative approach."

Alternative ...

Kaylie wanted to understand this, but her mind couldn't wrap itself around such a complicated word.

"Isn't it too soon for that?" the nurse asked.

"I don't think so. Let's try it. Let's try it now."

"Now? But we can't. I mean -- she needs to be prepped ..."

"She hasn't eaten all day. And she had a standard blood workup when she was admitted. There were no anomalies. We'll do it today, at once. Maybe we can arrest her disintegration before we lose her entirely."

"Are you ..." A beat of hesitation. "Are you sure this is a good idea?"

"Goddammit, Dana, I'm tired of hearing you question my instructions. Call Chavez. Tell her to prep a scrub team for E.C.T. Do it now."

The nurse left in a hurry, and Kaylie heard Cray catch his breath.

Her head drooped. She pressed her cheek to the floor.

There was a question she wanted to ask, a desperately important question, but one she had forgotten.

Oh, yes.

She moved her tongue in her mouth, rediscovered speech.

"What's E.C.T?" she whispered.

Cray leaned close. She could hardly see him. He was only a blur, a living warmth. But she felt his hatred.

"Let me put it this way, Kaylie. You want to live? Very well, then. Here's how you'll live. Here's what lies in store for you. Here's a preview of the rest of your life."

* * *

Kaylie was nearly unconscious by the time Cray got her to the O.R. at the far end of Ward B. Her head was lolling, and he had to sling an arm around her waist and half carry her through the door.

The room was small, no larger than an examining room in a dentist's office, with a similar array of clean, functional machines that looked vaguely ominous.

Two orderlies waited for him, wearing green scrub suits, and Nurse Chavez, who ordinarily supervised the day hall.

"Put her on the table," Cray said.

The orderlies took Kaylie from him and with gentle hands eased her onto a gurney under the cold glare of the overhead lights.

"Don't," Kaylie murmured. "Don't do this, please don't, please don't."

Cray washed his hands and donned rubber gloves, his actions brisk and assured.

When he turned away from the sink, he found the two younger men watching Nurse Chavez, and the nurse, in turn, watching him.

"Well?" Cray snapped.

Chavez coughed. "Doctor, don't we require the patient's consent?"

Cray took a folded slip of paper from inside his jacket. "She signed the consent form. Here." He showed Chavez the scrawl of a signature on the bottom line.

"No," Kaylie murmured. "Never did, I never did ..."

"The Brevital's kicked in by now," Cray said. "But she was alert when she signed it."

There was a moment of stillness. Cray was lying, of course. He had forged Kaylie McMillan's name. Even if he hadn't, Kaylie McMillan was plainly incompetent to be trusted with such a decision. Everyone in the room knew this.

"Okay, Doctor," Nurse Chavez said quietly.

She did not meet his gaze, and neither did the orderlies.

Kaylie moaned.

The nurse inserted a catheter in the back of Kaylie's left hand. Cray filled a syringe with succinylcholine, then injected the muscle relaxant into the intravenous line.

"Don't," Kaylie whispered.

"It'll be all right," Cray said in his most comforting voice.

Her eyelids flickered, steadied. She stared up at him.

"I hate you," she said, the words so low that no one but Cray could hear.

Cray mouthed: I know.

Kaylie turned away and allowed her eyes to close.

Nurse Chavez lifted Kaylie's blue cotton blouse to reveal her smooth belly, rising gently as her breathing slowed. Carefully the nurse pasted three electrodes to the patient's abdomen, and the heart monitor at the other end of the wires began to beep.

Cray himself applied electrodes to Kaylie's forehead. An electroencephalograph displayed a pattern of normal brain wave activity.

But not for long.

When more than one hundred joules of current flashed through Kaylie's brain, sparking every neuron in an orgy of rapidfire ignition, then the display on the monitor would be anything but normal.

It would be a graphic record of a grand mal seizure.

Cray felt the sting on his cheek where her nails had cut him. Well, it was his turn to sting her now.

E.C.T. -- electroconvulsive therapy, or what had been known as shock therapy in less euphemistic times -- was a procedure that remained in remarkably wide use, despite extensive and unresolved controversies.

In the treatment of depression, E.C.T. was said to be effective. It was employed less often in cases of schizophrenia, but in acute cases its use was not unorthodox.

Not a few of Cray's peers attested to the efficacy of the technique. Others, less sanguine, called it a medically sanctioned method of inducing brain damage.

Cray was inclined to the latter viewpoint. Flash an electric current through a brain, and it would follow the path of least resistance -- the blood vessels, fragile structures, easily traumatized. A single operation might leave only minor damage, which would prove self-correcting over time.

But repeat the procedure three times a week, shock the patient a dozen times or twenty times or more, and the blood vessels would swell and rupture and leak.

No recovery after that. Only a permanent "memory deficit," in the charming language of the psychiatric profession. And with the deficit, a deficiency in thinking skills, a sense of alienation and perpetual confusion, an erosion of the self.

Strip away the mask, Cray thought.

A knife was one way. This was another.

He stood back and watched as an orderly smeared conductive jelly on Kaylie's right temple.

"Both temples," Cray said.

Chavez glanced at him. "Bilateral?"

"It's more effective."

"And more dangerous."

"I know what I'm doing, Gloria." To the orderly, he repeated: "Both temples."

When that job was done, Cray parted Kaylie's lips and slipped a rubber bite block between her jaws.

"Ready, Doctor?" Nurse Chavez asked.

With a rubber mallet Cray tapped Kaylie's left knee. The leg did not jerk. The succinylcholine had taken effect, bringing on a temporary, partial paralysis.

"Ready," he said.

On the gurney, the slender, sleeping woman murmured a somnolent sound of protest and lay still.

Cray picked up the paired ECT wands, each one a large round plate designed to effect a maximum impedance pathway, and pressed them to Kaylie's temples, covering both cerebral hemispheres.

With a squeeze of his thumbs, he released a surge of current into Kaylie McMillan's brain.

The current pulsed at sixty hertz per 0.75 millisecond. Cray let it flow for a full two seconds, the longest shock that could be safely administered to a patient.

There was no sizzle of electricity, no dimming of the lights, no Hollywood theatricality, simply a heavy percussive thump, then silence.

Kaylie did not stir. Her sleep was undisturbed.

The beeping of the heart monitor slowed. Bradycardia and hypotension were the initial effects of the treatment.

Cray replaced the wands in a cabinet under the EEG, and then everyone waited for the patient's delayed reaction to the shock.

It was strange to watch the seizure happen. The event came on without drama, signaled only by a flood of gooseflesh that rippled over Kaylie's arms and shoulders.

Then abruptly an invisible vise contracted around her throat, jerking her neck muscles taut with strain.

The heart monitor slammed into frantic, tachycardic overdrive, beeping in staccato distress as Kaylie's heart rode a wave of disrhythmias. The EEG became a seismograph, its needle tracing the peaks and valleys of an earthquake.

Kaylie's skin changed color. Her face turned livid, her freckles standing out in purple relief against a scarlet flush. Snakes of color coiled across her belly. Her blood vessels were straining with sudden hypertension

"Fifteen seconds into tonic phase," Nurse Chavez said. She was running a stopwatch.

Kaylie jerked her head to one side, pressing her cheek to the sterile sheet. Cray could see the bunched muscles of her jaws, the desperate grinding of her teeth against the bite block. A thread of saliva unspooled slowly from her parted lips. Her eyes flashed open, and he looked into their blueness, wondering if some unconscious part of her could see him. He hoped so.

Then her eyes squeezed shut, and she flipped her head in the opposite direction. Now he could see only the nape of her neck, glossy with sweat.

"Thirty seconds. Entering clonic phase."

"Give her oxygen," Cray said.

One orderly turned Kaylie's head to face the ceiling, and his partner cupped a mask to her mouth, feeding her pure oxygen from a positive pressure bag.

The rapidfire bleep-bleep-bleep of the ECG went on, its rhythm unsteady, its pace almost impossibly fast.

"Forty-five seconds."

Her feet jerked, as if searching for solid ground, finding only air.

Cray took a step closer. Her face was beet red now, a darker shade than before. Her closed eyelids shivered.

He thought of Sharon Andrews as he'd last seen her, in the moment before his knife blade stripped away her face. She had been flushed like this, shivering and twitching like this, her higher consciousness at least temporarily erased -- like this.

He wished he had his knife now. Wished he could use it here, in the O.R.

This was a killing ground, no less than the wilderness of the White Mountain range. It would be proper for him to claim his trophy here and now, if only the imbeciles around him could understand.

"Sixty seconds."

A note of worry in the nurse's voice. The seizure ought to be subsiding by now.

Then, almost instantly, it ended.

Kaylie went limp, her head lolling, bright color fading. Her heart rate began to slow, the monitor quieting.

The orderly held the oxygen mask in place for a few moments longer, then carefully removed it.

"Good job, everyone," Cray said in answer to the sudden stillness in the O.R. "Now just give her an hour or so to recover from the sedative, then escort her back to her room."

He pulled off his gloves, discarded them in a wastebasket, and took a last look at Kaylie. Her face looked almost normal again, and she was breathing on her own.

"She'll be fine," he said. "Just fine."

This was true. Kaylie had not been harmed by today's session.

But he would see that there were other sessions, many of them.

How long before there were gaps in her memory? Before her thought processes were hopelessly scrambled?

The cumulative effect of shock after shock after shock would be at least as damaging as the megadoses of methylamphetamine now circulating in her bloodstream.

So let her go on living, if she insisted on it. She would be no threat to him in any event. She would be only a sad, hollowed-out remnant of the person she had been.

Half psychotic. Half lobotomized.

That's your future, Kaylie, Cray thought with grim resolution as the orderlies wheeled the gurney away. That -- or a mahogany box in the hospital graveyard, under scoops of shoveled dirt.

You decide.

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