by Nancy Geary
“Your best interests were put first and foremost. Don’t think the decisions weren’t difficult,” Dr. Ellery had suggested. “Faith and Bill love you. They wanted to give you and your sister the best possible life, to make you both feel secure”—a prospect that had about a-thousand-to-one odds, and they hadn’t been in his favor.
He lifted the gun and pushed the nose into his chest. Just the hard metal pressing against his skin hurt. He waited. The pounding inside him increased. Perhaps he could will himself to have a massive cardiac explosion so that he’d die of seemingly natural causes. But his heart kept up a ferocious beat, unwilling to quit. If he wanted to end his life he would have to pull the trigger.
Throughout his last night he’d contemplated his options—the body part to target: head, mouth, chest. As the first light of the sun came through his window he’d decided on his chest. One bullet straight to the heart. It was a somewhat impulsive selection, but at some point he had to make a decision. The heart seemed the most lethal. He wouldn’t want to end up in a persistent vegetative state from a misfire to the brain. Sucking on the end of a gun seemed a particularly pathetic last gesture.
Having made his decision, he’d survived the day without changing his mind.
He inhaled deeply, then blew the breath out in a noisy exhale. He wished he had a cigarette. Having never been a smoker, he craved what he imagined was the taste of nicotine, the calming effect of an unfiltered Camel.
He positioned his index finger on the trigger and wiggled it slightly. Come on, Foster. Do this. End this. You’ve said your good-byes.
Then he applied pressure.
The explosion blew out his eardrum. He felt warm liquid run down his neck even before he experienced the excruciating pain, the intense sensation of heat, and the smell of his own charred flesh. The force of the shot had toppled him sideways onto the grass. With his left arm pinned under his body, he couldn’t move. Blood spurted from his chest in a crimson arch. He coughed but no sound came from his throat. He sensed a slight breeze as he struggled unsuccessfully to breathe, but the chill inside him had nothing to do with the frigid temperature.
Don’t fight it, he said to himself. This is what you’ve wanted. This is what you want. And it’s too late to change course anyway.
Jumpstart whinnied, but the familiar sound seemed miles away. He stared up at the night, now a blur of gray and gold. He’d dropped his gun somewhere, and his right hand twitched. He fingered what remained of the front of his shirt, now saturated with blood. There was no longer any air in his lungs.
He scanned the northern sky, hoping to catch a last glimpse of Gemini, his favorite constellation, but the stars twirled, eluding his gaze. The stellar twins—the rectangular arrangement of Almeisan, Mekbuda, Wasat, Pollux, Castor, and Gemini Mebsuta—stayed hidden. Please, he begged, although to whom he didn’t know. Let me see you. Let me know you’re there. Show me that you’re real.
He gasped. His body convulsed involuntarily. Then everything went black.
3
Monday, January 13th 4:12 p.m.
David Ellery shut the door to his office, closed the Levelor blinds, sat in his ergonomic chair, and pounded his fists into the forest green blotter on his desk. Part of him wanted to cry, but he hadn’t done that in fifty years and wasn’t about to start now. Half a century before, his mother had accidentally run over his dachshund in her Cadillac convertible. He’d been only eight, but he still remembered holding the limp creature in his arms and realizing it was no longer breathing. That day his emotions had gotten away from him and he’d vowed it would never happen again. He’d survived medical school, his father’s death, a psychiatric residency, and a divorce, all without shedding a single tear. Now he would have to add having lost his first patient in thirty years of private practice to the list of adversities he’d faced and overcome in his personal and professional life.
“How could this happen? How come you didn’t stop him?” Faith Herbert had screamed over the telephone, her voice hysterical. “You should have saved him. That was your job. You told us you could help him. We trusted you!”
He’d tried to talk to her, tried to find out what happened, but her words had been incomprehensible. Tears, gasps, and coughs swallowed whatever explanations or details she’d offered. All he’d understood was that Foster was dead, and the Herbert family thought he was to blame.
After what seemed an interminable time, Bill finally had taken the receiver from his wife. His voice was low and controlled, although David had thought he noticed a tremor in the cadence. No surprise. From the several times they’d met, and from what Foster had told him of William F. Herbert, Jr., the man was unlikely to expose his vulnerability. Any sorrow, anger, or other extreme emotion that he was experiencing would be carefully hidden behind the Pennsylvania fieldstone of his mansion.
“We wanted to apprise you of Foster’s death,” Bill had said. “He died of a self-inflicted gunshot wound. The police tell us that the time of death was approximately nine o’clock on Saturday night. We didn’t find him until late afternoon yesterday.”
“Is there anything I can do?” David had asked.
“No. We’ll handle this ourselves,” Bill had replied.
“Maybe you’d want to come in. We could talk,” he’d persisted. Foster had been his patient for nearly two years. They’d spent fifty minutes together three times a week, plus endless nights on the telephone when Foster, experiencing anxiety, depression, or irrational fears, called without an appointment. He’d met him on Saturdays when he needed an extra session. He’d consulted with Foster’s pediatrician and several different psychopharmacologists as he’d struggled to find the right mix of antidepressants. He’d agonized over ways in which to deal with an adolescent who he recognized early on was in trouble. There wasn’t anything he hadn’t done, and he didn’t appreciate the insinuations to the contrary.
“The police may try to contact you,” Bill had reported, ignoring David’s suggestion. “Faith and I ask that you say nothing. We want our privacy. We want to protect Foster’s memory. This is absolutely painful enough without having his difficulties made public.”
“Would you like me to meet with his sister? This must be exceedingly difficult for her.” Even though he’d never met Foster’s twin, David had heard enough about her and the nature of their relationship to know that the news of his death would be an enormous trauma. Sibling loss was difficult; twin loss could be devastating. At least one study in identical twins showed that, if one committed suicide, there was a 40 percent likelihood that the other would at least attempt it, too.
And from what Foster had said, his sister wasn’t without her share of issues to begin with. He’d spoken numerous times about a particularly troubling incident when his sister had flown into an uncontrolled rage at their father, who had failed to remember and honor Mother’s Day. Her screaming, crying, and carrying on had lasted for more than an hour. She’d even thrown his golf clubs out the window before her tirade ended. Maybe such acting out was typical of any adolescent but, given her genetic connection to Foster, maybe not.
There had been a pause, and then Bill had cleared his throat. “Avery was at school when it happened. She hasn’t been told. Faith and I are driving up there tonight.”
“I’d urge you to at least consider the possibility of professional help. I could—”
“Dr. Ellery,” he’d interrupted. “I don’t want you to speak to anyone in my family ever again, least of all my daughter. Please send any outstanding bill to my office. My secretary will make sure you are paid promptly. Now I have to excuse myself. Good-bye.” The line had gone dead.
David stared at the certificates and diplomas that hung in bird’s-eye maple frames on the walls of his office, then at the comfortable leather couch and club chair where he sat day in and day out, helping people who suffered from all sorts of emotional problems—bipolar I and II, major depression, anxiety, personality and mood disorders, even sexual dysfunction. He’d treate
d dozens of men and women in his career, many of whom stopped therapy because they felt—and from a clinical point of view were—better. He’d achieved success; his former patients, his honorary degrees, the substantial grant money awarded to him, and the Jaguar parked outside were testaments to that. And yet a suicide meant he’d failed, failed in the most fundamental way.
What had he missed? Although Foster had discussed killing himself, it had never seemed to be a true threat. The references were sporadic; there was no plan. You should have saved him.
He put his face in his hands. The pressure in his head was intense. He should never ever have taken the referral of this boy who’d been to three different therapists before the Herberts came to him and implored him to get involved. But he’d been lured by the challenge of trying to succeed where no one else had, and by Bill’s offer to pay one and a half times his regular hourly rate. His own arrogance and $225 an hour even if Foster failed to show for his appointment had convinced him.
His thoughts were interrupted by a knock. Looking up, he realized he had no idea of how much time had passed since Faith’s fateful call. Dusk was beginning to fall. Who was still around? His office was part of a suite of three that shared a secretarial station, although the sole support staff—Betty Graham—had called in sick again with a claim of seasonal allergies. He’d heard her excuses and alleged ailments so many times that the lies bored him, but she was too competent when she did show up to dismiss her. Nancy Moore, a psychiatric social worker, had given up her Monday hours to have more time to spend with her family. That meant it had to be Morgan Reese, working late as usual.
“David,” she called through the door, as she knocked again, louder this time. Her concern and apprehension masked the normally melodic quality of her voice. “David, may I come in?”
He quickly pulled a tissue from the box he kept for his patients and blew his nose just as the door opened. He swiveled his chair and saw Morgan standing on the threshold. She had sandy brown hair that she wore pulled back from her face in a thick braid, blue eyes, and smooth, pale skin, except for the dark circles that seemed her trademark. He’d never known anyone who kept the professional schedule that she did—patients, primarily children and adolescents, ten hours a day, often six days a week, a full-time research grant to study some sort of reactive attachment disorder in early childhood, plus full faculty responsibilities at the Medical School of the University of Pennsylvania. Despite what must have been chronic exhaustion, she never seemed to lack either energy or concentration.
“I heard about the Herbert boy. I’m so sorry.”
“I can’t believe it, honestly,” he said. Then he registered the import of her comment. “You heard? How?”
“It was just on the news.”
But she didn’t have a television in her office. And he’d never shared the names of his patients.
His confusion must have shown on his face because she offered, “The radio commentator reported that he’d been under psychiatric care, and . . . and identified you as his therapist.” Then she walked over and laid her hand on his shoulder. “I can only imagine what you’re going through. Do you want to talk?” The physical contact felt odd; they’d been colleagues for nearly ten years and had a professional friendship but nothing more. Even after his marriage ended he’d never asked her out. Although attractive, she’d struck him as unapproachable.
“What else did the reporter say?” He felt an emotion akin to panic and clamminess in his palms. How could his name have been mentioned publicly? How dare some radio station broadcast that information? What if his patients had heard the same program?
“Very little. Neither of his parents would comment on his death.”
“So who disclosed my name, my involvement?”
She shrugged. “You know how it is. Medical records that are supposed to be confidential never are. God only knows what the police had access to.”
“And the media wants someone to blame. Even his parents blame me, and they of all people know how hard I tried to help,” David said, feeling anger creep into his conscience. He needed to get hold of himself.
“I’m sure you did the best you could. There are limits to what any psychiatrist can do. You don’t need me to tell you that.”
He forced a smile. “I appreciate the vote of confidence.”
Morgan took a step closer to him. “We all second-guess our decisions, personal and professional, but you have to compartmentalize. I’m the first to admit I struggle with issues of distance and boundaries, as if going to medical school somehow taught us not to feel. But when the worst happens, you’ve got no choice but to remember your training. Otherwise the boy’s suicide will destroy you, too.”
He closed his eyes, listening to the sound of her voice but ignoring her words. He knew she was trying to comfort him and he also knew his focus should be on Foster, the tragedy of a life interrupted, but he found himself preoccupied with the scarlet letter that was being publicly affixed to his name, his reputation. He needed to formulate a defensive response to the accusations that were sure to be leveled against him. He needed to gather his supporters, who included Morgan, so that his career would not be tarnished by circumstances beyond his control. Short of locking Foster away in an isolation unit and having him disappear into the hidden world of private psychiatric hospitals, nobody could have done more to keep him alive.
“I’m not sure what steps to take next. I offered to help the family. They don’t want to speak to me. Do I notify my malpractice carrier?”
She cocked her head slightly to one side, considering his question. “What do you think happened?”
He thought for a moment, choosing his words carefully. “Foster suffered from recurrent major depressive disorder and had very little coping mechanism. Textbook 296.3x,” he said, referencing the Diagnostic and Statistical Manual of Mental Disorders. Clinical shorthand—his professional code—reminded him that he got paid to know best. And he did. He’d dedicated his life to understanding the workings of the mind. “He was noncompliant with his medication. We’d tried a number of combinations, plus we adjusted dosages constantly, but he often refused to take them as prescribed, so short of daily blood tests it was impossible to know whether we’d achieved therapeutic levels.”
“Had he gone off his meds recently?”
“I don’t know. He canceled both appointments last week. His voice sounded good on the telephone, and I didn’t push because his explanation seemed plausible given his history. His twin sister was home for the holiday break, and he said he wanted the time to spend with her. I knew they were very close.”
“A twin?”
“Yes. Based on what was described to me, their connection was more comparable to what the literature says about identical twins: an uncanny attachment, an almost sixth sense about each other. The eerie part was that, according to Foster, they even both had pits under their left ears. He was obsessed with that physical similarity.”
“Really,” she remarked, furrowing her brow.
“I can’t say I know much about a pit, but it did seem odd.”
“Pits are small indentations, common dermatological phenomena in the population at large, but most doctors would tell you they are statistically very improbable in fraternal twins. So your instinct was right. It is very unusual.”
Morgan never ceased to amaze him. Were there any medical minutiae that she didn’t know? No wonder she had virtually the entire psychiatric faculty, as well as a sizable percentage of the regular faculty at the Medical School, thinking she walked on water.
“In any event, when his sister went to boarding school last fall, Foster fell into a downward spiral,” David continued. “He felt abandoned. In my view, his parents simply did not provide the support they should have known he would need when his sister left.”
Morgan sat in a high-back chair opposite his desk. She was smaller than he’d realized, more delicate. She clasped her bony fingers together in her lap. “Are you concerned for the
girl?”
“I’ve never met her, so from a professional point of view I suppose I can’t say one way or the other. But if I were her father, I would be. You’re familiar with all the twin studies.”
“I am, but there’s a big difference psychologically between identical and fraternal. As far as I can recall, nobody’s suggested there’s an elevated risk of suicide or attempted suicide in nonidentical twins,” Morgan replied.
Leave it to Morgan to remember the clinical details better than he.
She paused for a moment and then cocked her head to one side. “Why would you be concerned for the sister?”
He shrugged. “The girl just sounded volatile, that’s all. Probably nothing. She’s sixteen, off to boarding school, asserting her independence. No doubt some defiance is part of any healthy detachment process. My concerns—to the extent they’re justified—should be more generalized. It’s a terrible trauma for the whole family.”
“And the parents are undoubtedly lashing out right now,” Morgan interrupted. “Imagine what they are going through. But that doesn’t mean when the smoke clears they are truly going to hold you accountable. Anyone who knows you could vouch for your dedication and commitment to your patients.”
“From your lips to God’s ears,” David said, rising from his chair. He moved to the window, opened the blind, and glanced out at the alley behind his building. An old man bundled in layers of blankets, the same poor sot who showed up virtually every evening making rounds in search of recyclables, pushed his grocery cart filled with empty cans. The rattle of the wheels echoed.
“Were you surprised?” Morgan asked after a moment.
“Absolutely. If I hadn’t been, I would have done something to try to stop it.”
“Do either of the parents have depression?”