The work she did had a certain moral ambiguity even at the best of times. The State Care system had been mandated by Congress in the messy aftermath of the Spin, when homelessness and mental illness had risen to epidemic levels. The legislation had been well intended, and it was still true that for anyone with a full-blown psychiatric disorder State Care was better than life on the street. The doctors were sincere, the pharmaceutical protocols were finely tuned, and the communal housing, while basic, was reasonably clean and well policed.

Too often, however, people were swept into State Care who didn’t belong there: petty criminals, the belligerent poor, ordinary folks who had been driven to chronic bewilderment by economic hardship. And State Care, once you were given involuntary commitment status, wasn’t easy to leave. A generation of local pols had campaigned against inmates being “dumped back on the street,” and State’s halfway house program was forever under attack from NIMBY activists. Which meant the State Care population was continually rising while its budget remained fixed. Which led in turn to underpaid staff, overpopulated residential camps, and periodic scandals in the press.

As an intake physician it was Sandra’s job to short-circuit those problems at the front end, to admit the genuinely needy while turning away (or referring to other social welfare agencies) the merely confused. In theory it was as simple as checking off a patient’s symptoms and writing a recommendation. In fact her work involved a great deal of surmise and many painful judgment calls. Turn away too many cases and the police or the courts would get testy; accept too many and management began to complain about “overinclusiveness.” Worse, her cases weren’t abstractions but people: wounded, weary, angry, sad, and occasionally violent people; people who too often saw State Care as a kind of prison sentence, which in a real sense it was.

So there was a certain inevitable tension, a balance to be maintained, and within the institution itself there were invisible wires that vibrated to the right or wrong notes. Coming into the wing where she had her office, Sandra noticed the nurse at the reception station giving her covert looks. A vibrating wire. Wary now, she paused at the warren of plastic cubbyholes where staff kept paperwork on pending cases. The nurse, whose name was Wattmore, said, “Don’t bother looking for the Mather chart, Dr. Cole—Dr. Congreve has it.”

“I don’t understand. Dr. Congreve took Orrin Mather’s case file?”

“Isn’t that what I just said?”

“Why would he do that?”

“I guess you’ll have to ask him.” Nurse Wattmore turned back to her monitor and clicked a few keys dismissively.