The long drive back to Houston took her past a State Care internment facility, one of the places her patients went after they were assigned custodial status. Passing the State camp inevitably tweaked her conscience. Usually Sandra avoided looking at it—it was comfortingly easy to overlook. The entrance was marked only with a small and dignified sign; the facility itself was hidden beyond a grassy ridge (yellow and sere); very little of it showed from the highway, though she glimpsed the tops of the guard towers. But she had been up that road a couple of times and knew what lay beyond it: a huge two-story cinderblock residence surrounded by makeshift expansion housing, mostly sheet-metal trailers donated by FEMA from surplus stock, encircled by wire fencing. It was a community of men (mostly men) and women (a few), carefully segregated from one another and endlessly waiting. Because that was what you did in such a place: you waited. Waited for your turn in an occupational rehab program, waited for the slim possibility of transfer to a State Care halfway house, waited for letters from distant and indifferent relatives. Waited with slowly hemorrhaging optimism for the miraculous advent of a new life.

It was a town made of wire and corrugated aluminum and chronic despair. Medicated despair—she herself had probably written some of the prescriptions that were perennially renewed at the camp dispensary. And sometimes even that wasn’t enough—Sandra had heard that the biggest security problem at the compound was the flow of intoxicants (liquor, pot, opiates, meth) smuggled in from outside.

There was a bill before the Texas legislature to privatize the residential camps. Attached to the bill was a proviso that “work therapy” could be construed as permission to hire out healthy inmates for roadwork or seasonal farm labor, to defray the public expense of their internment. If it passed, Sandra thought, the legislation would mean the end of any tattered idealism still attached to the State Care project. What had been intended as a way of providing comfort and protection to the chronically indigent would have become a cosmetically acceptable source of indentured labor—slavery with a haircut and a clean shirt.

The watchtowers disappeared in her rearview mirror, hidden among the baking yellow hills. She thought about how angry she had been at Congreve, who had taken her off Orrin Mather’s case to prevent her from rendering an inconvenient diagnosis. But how clean were her own hands? How many souls had she committed to internment just because they matched a profile in the Diagnostic and Statistical Manual? Saving them from the cruelty and violence of the streets, yes, saving them from exploitation and HIV and malnutrition and addiction, and there was enough truth in that to salve her conscience; but in the end, saving them for what?