The Ninth Session

by Deborah Serani

  Luke’s eyes locked into mine. “Yeah.”

  “How can you possibly know where he is?”

  Luke clutched the arms of the chair and jutted his chin out. “Because I killed him.”

  I heard the words, but they were muffled in my ears. I understood the words but couldn’t make the leap in my mind. I tried to ground myself, but I was going somewhere else. No leads—Foul play—Grieving family.

  When the real and the unreal collide, a moment of denial crashes within a person’s psyche. Though it was only seconds, the shock of it all moved me in slow motion. I put down the paper and focused on Luke. I saw him struggling to breathe. Fighting the pressuring panic, he suddenly doubled over onto the floor. The folder he held fell along with him, scattering the clippings everywhere.

  I wasn’t prepared for anything like this. I thought the panic disorder could be traced to his dysfunctional mother, but this changed everything. A sudden expanse swelled within me, and it took all I had to push aside my fear. I managed to move out of my chair toward Luke and knelt on the floor.

  “Luke,” I called out, struggling to roll him onto his back.

  His body was limp, and his face was cold to the touch. I checked his pulse and shook him again.

  “Luke, can you hear me?”

  Suddenly his eyes flew open. As his pupils dilated, I sat back on my heels.

  “Stay there. Don’t move.”

  I picked up the stream of pages and placed them back into his folder, clearing a path for me to walk.

  “Deep breath in, purse it out.”

  Luke did this without hesitation.

  And so did I.

  I ran into the bathroom and soaked some paper towels with cold water, wondering as I studied my face in the mirror if Prader was right. Maybe this case would be too much for me.

  I’ve heard many sad stories from the patients who allow me into their lives—stories of disgrace, regret, accounts of ruin and humiliation. Stories of pain and trauma. Narratives of personal collapse and loss.

  And death.

  Death, which happens suddenly, from a catastrophe or accident. Or gradually, from illness or disease. But death had never been revealed in this way to me.

  I thought about this young man. I thought about his family. And then I thought about Luke.

  I brought back the damp towels and placed them across his forehead. Luke didn’t react. He was like a lifeless marionette, strings cut. I found a nearby blanket and draped it over him, and then pulled up a chair next to him.

  “You okay?” I asked as he opened his eyes.

  He didn’t move but whispered, “Yes.”

  “You let it out,” I said in a voice expressing both astonishment and reassurance.

  “I d-id,” he said in broken syllables. “You won’t t-ell anyone.”

  “I won’t.”

  Every psychologist has a duty to warn and protect people from patients who pose a serious threat of violence, but that duty applies to foreseeable harm. What’s in the past is not reportable.

  A different kind of silence fell into the room.

  It felt heavy.

  It was profound.

  And we remained in it for the rest of the session.

  Notes

  Luke says he killed a man. Knows where he is. Passes out after disclosure. There was a “struggle.” There was “blood.” Need more details. Do I access the internet—or old school newspaper search in the library?

  Event is in the past so no Duty to Warn ethics apply. Is this death an accident? A murder? Absolutely terrifying session.

  Transference: Luke is still connected to me in a positive way. Trusts me enough to share this secret. I’m worried if he can stay positive when I ask for more details.

  Counter-transference: Incredible terror and fear. Confusion about his story. Connected to patient but now I feel very, very guarded.

  Am I in danger knowing this?

  Can I trust him?

  There was a reason I felt all those unsettling, eerie feelings days ago. My perceptions weren’t off or exaggerated. Luke was holding a terrible secret. That’s what this is. This is a form of projective introjection.

  Relevant issues: Left message with Dr. Prader for immediate supervision on this case. Urgent I see her ASAP. Scheduled session for tomorrow.

  Diagnosis: Presenting diagnosis is Panic disorder, but need to rule out psychopathy, borderline personality, intermittent explosive disorder.

  Prognosis: Uncertain.

  Friday Night

  I

  n this day and age of internet tracking, a search for Donald Gallin’s death might be detected. I stopped the urge to do a Google search, logged off the computer, and clicked the laptop shut. It was also vital to protect the confidentiality of Luke’s disclosure despite the unfolding darkness.

  I walked to the picture window and watched the wind blow the rectangular shaped sailcloth that shaded the lanai in the restaurant next door. It tugged at its trusses in short, taut jerks. A storm was coming, and the strengthening wind threw strands of black and gray across the sky.

  As the rain began to fall, I reminded myself that without the promise of complete confidentiality, psychotherapy can’t work. Doctor-patient privilege protects from intrusions of others—from family members to legal and governmental meddling. Therapists fiercely guard safeguarding personal disclosures so therapeutic work can be done—even if things shared by patients are unforgivable acts of cruelty or evil.

  At times, though, a therapist has to breach the privilege—if a patient is going to hurt himself or another person. It’s called a Duty to Warn.

  I sat on the ledge of the window and let my mind wander to the story responsible for law.

  In 1976, a University of California student, Prosenjit Poddar, was in therapy with a psychologist from the university's health center. His treatment focused on a recent rejection he had from a young woman named Tatiana Tarasoff. During one of the sessions, the psychologist learned of Poddar’s murderous intention to kill Tarasoff and reported to the police his plans. The police questioned Mr. Poddar and found him rational and reasonable—and not an immediate threat. The police made Poddar promise to stay away from Tarasoff. Neither the therapist nor the police department contacted Tatiana Tarasoff though—and two months later, Poddar shot and killed her.

  This murder raised the issue that privilege and confidentiality end when public peril begins. When a patient identifies a third party as being in harm’s way, a therapist must do everything to contact authorities.

  But because Donald Gallin was dead, I could do nothing It was in the past. Not pressing—and I wasn't allowed to break privilege or breach confidentiality. Thinking about these things helped me calm down. I stretched my shoulders and rolled my neck from side to side, feeling the tightness loosen.

  Then I walked back to my desk and took out the article, this time studying the small, set-in picture of Donald Gallin.

  It was a portrait shot, graduation from high school or possibly college. The picture was grainy, but it was easy to see a glow of happiness in his eyes.

  “Goddammit,” I said.

  I shut the file and stuffed it into my briefcase. I tended to the office, closing things down for the weekend. Sorting patient files, locking the file cabinet, clearing the desk.

  Then the plants and trees got their weekly watering. I listened as the soil soaked up the water. Then I removed the dying growths to help the new sprouts thrive. Finally, I closed all the windows and angled the blinds so they could get all the light they needed till I returned on Monday.

  Then I called Dr. Prader.

  Supervision

  Saturday, June 10

  “

  Thanks for squeezing me in this morning.”

  “Your message said it was urgent.”

  “It’s the patient I spoke about earlier this week.”

  “The one you thought showed up at your house?” she asked
. “You were right?”

  “No. It wasn’t him.”

  “You confronted him?”

  “Well, yes. I did. But to be sure, I drove by his house.”

  Prader said nothing, but disapproval was obvious in her hard-boiled stare.

  “We can talk about the meaning behind my drive-by later. There’s something more important, though.”

  Prader took out her file and waited.

  “I don’t even know where to begin.”

  I took a long breath. I wasn’t able to speak the words and readied myself to sign.

  “Don’t, Alicia. If it’s something this big, you need to speak it aloud.”

  She’s right, I said to myself—and agreed not to sign anymore in the session. “I think he killed a young man,” I finally said.

  “First you think he followed you home, and now you think he killed a man?”

  “I don’t think he killed a man. I know it.”

  Prader said nothing but shifted back in her chair.

  “Luke handed me a news article he wrote about a missing man during the session. Then he had a fierce panic attack and passed out on the floor.”

  “What was in the article?”

  I reached into my handbag and retrieved a copy of the article. I grabbed a marker on the desk and carefully blotted out Luke’s name and other identifying information. Prader slid her glasses low on her nose, read it, and remained silent for a moment.

  “He said he knows where he is,” I continued. “I don’t know all the details though.”

  Prader pursed her lips.

  “I realize why I've had all those eerie feelings since meeting him.”

  “Yes, this man may be dangerous,” Prader finally said.

  “I know.”

  “You need to make some decisions here. First, you need to carefully consider if you should work with this patient—and then you need to ask yourself why you would want to work with this patient.”

  She took in a deep breath and leaned closer toward me.

  “Second, if you make the decision to go forward and discover details about this young man, you know none of this can be reported to anyone,” Prader said.

  “I know—”

  “Wait, I’m not finished. You’ll need to set a firm treatment frame with clear boundaries of how the work will proceed.”

  “I’m prepared to do all that.”

  “Okay. Now why do you want to work with this patient?”

  “A case like this could help me move out of the numbness I sometimes feel.”

  “It could,” Prader said. “We choose to work with patients for many reasons.”

  “A difficult case would pull me into the present and away from the past.”

  “And if it’s too much to manage, you’ll refer it out?”

  “Of course,” I said.

  Prader lowered her eyes and studied the article again. I watched as she tracked each word. “A long time ago, when I was a grad student, I worked at Rikers Island doing therapy. All of the prisoners were difficult cases. Some more than others. But I enjoyed the work. It was exciting dealing with pathology that intense.”

  “So, you get it?” I asked.

  Prader nodded. “But, the guards were right outside the offices in the counseling center. If an inmate raised his voice or became physically agitated, within seconds, the door opened.” Prader leaned closer to me. “You don’t have security in your office, keeping you safe if something escalated. It’s only you. And the patient.”

  “True,” I said.

  “I understand the pull a case like has, Alicia. He’s probably verbal and insightful—but you have to think about safety.”

  Safety was something most Coda’s knew in life. When I was young, I’d always take care that Nicole’s needs and feelings were understood by the neighborhood hearing kids. I learned fast to protect her and my parents from the hurtful things many hearing people said by leaving out the cruel remarks as I interpreted.

  Then there were times I’d make sure the house was safe—that windows and doors were locked, that the stove and oven were off. My parents and sister wouldn’t be able to hear if a burglar entered or if a fire broke out.

  “I have my panic alarm. And I’ll ask the security guard on the grounds to keep an eye on my office.”

  “Sounds like you have given this some thought.”

  “I have.”

  “When the internship at Riker’s was offered, I was the first to apply in my class,” Prader said. “At the time, I was interested in Rehabilitation Psychology. The work was immensely profound, but it was more frightening than rewarding.”

  “How so?”

  “The pathology the inmates had. It was so static—so unfixable. For the most part, treatment was a failure there. It was hard to accept that.”

  I nodded and listened attentively. It was always special to learn something about Dr. Prader. She rarely shared personal stories because supervision focused on me and my needs.

  “So, I made my way here,” she continued. “Hospital work as a shrink is more rewarding. And patients go home feeling better than when they arrived.”

  “So, you’ve worked with patients with serious pathology.”

  “Yes. And while the work can be fascinating, I’m on the fence with this one, Alicia.”

  “I understand. I’m guarded too.”

  “Well, maybe you're right. Working a difficult case could be a good thing for you,” she said, jotting down notes. “Don’t hesitate to call before we meet again on Tuesday. Especially if something doesn’t feel right.”

  “I will.”

  Saturday Night

  “

  This is operator 4297 at New York Relay. What number do you want to call?”

  “I’d like to call 555-2080,” I said, getting into the car.

  “I’ll be off the line until the TTY user connects,” she said, placing me on hold.

  After a few seconds, I was reconnected. “This is Nicole, go ahead,” the relay operator said, reading Nicole’s text telephone words.

  “It’s Alicia. Are we still on for dinner? Should I pick up a cheesecake from Mae’s? Go ahead.”

  “Totally. The kids are excited, and Keith’s getting the BBQ all ready,” the relay operator said.

  I heard the soft breathing of the operator as she clicked away on the TTY keys. Conversations like these were never private, but I couldn’t Facetime with Nicole while driving. So, relay services were the next best thing.

  “Where you been anyway? I’ve been trying to track you down,” the relay operator continued.

  “Been dealing with a difficult case. Stressed about it, so I went to supervision. Go ahead,” I said back.

  “Well, the kids baked a cake, so come straight here. SK,” said the operator, letting me know Nicole had stopped keying, done with the conversation.

  “Okay. SK, SK,” I said to the operator, giving the code for I’ve stopped keying too.

  “Your party has signed off, Ma’am,” the operator said.

  “Thank you,” I replied, turning off the Bluetooth.

  I drove to Nicole’s as a light cascade of rain fell on the hot asphalt of the parkway. I noticed the steam rose in strands of sheer mist and then evaporated into nothingness.

  To offset the dreary atmosphere, I popped in a Beatles CD and cranked up the volume. Before long, I was singing with Paul, George, and John and drumming along with Ringo on the steering wheel.

  The sun broke through the clouds as I headed south on Manetto Hill Road, and once I crossed the parkway bridge, it stopped completely. I suddenly found myself hoping everyone would be up for a swim in the pool after dinner. I needed to be in the water, floating lightly.

  As I turned into Quentin Court, the comforting thoughts ended. My adrenaline surged when I saw two Nassau County Police cars near Nicole’s house. I screeched the Saab to a halt, bolted out of the car, and approached the officer sitting in
his vehicle.

  “What’s going on?”

  “Are you Mrs. Rahm? Soraya Rahm?”

  “Uh, no,” I said holding my hand to my chest. My eyes moved from Nicole's house to the adjacent neighbor. “I'm visiting my sister, next door.”

  “There’s been a burglary, Ma’am,” he said.

  I chewed my bottom lip as I looked around the area. The entire cul-de-sac was quiet, no signs of life anywhere.

  Perfect conditions for a crime, I thought.

  Just as I brought my focus back to the officer, I saw Nicole turn the corner with Shasta on her leash.

  “That's my sister,” I said, raising my hand in the air. “She might know where Soraya is.”

  The officer peered at Nicole through his department issued aviators.

  I took in a deep breath, relieved to see her in the distance. “Officer, what’s your name?”

  “Waldman.”

  “Alicia Reese.” I shook his hand. “My sister’s Deaf, but she lip reads. She’s pretty awesome. But if you’d like me to interpret, just say so.”

  “Won’t be necessary,” Waldman said, unconcerned.

  He took off his sunglasses and inserted them carefully in his chest pocket. Then he softened his posture by placing his hands behind his back, feet apart—like a soldier’s fall-out and rest. But something about his demeanor suggested he had experiences with Deaf people before. I always trusted that instinct whenever I felt it.

  Shasta didn’t sense the same because she barked as she trotted closer to Waldman. Immediately, Nicole pulled on the orange lead to hold her back.

  “It’s okay, girl,” she said as they both slowed to a walk.

  I stepped off the curb to meet them.

  “What? What?” Nic signed, agitated.

  I held out my right two fingers, stuck them under my left arm, and pulled them away. “Burglary.”

  “Shit,” she said aloud. “Just now?”

  “I guess so,” I said. Then I pointed to the officer and signed. “This is Detective Waldman.”