“How did Olivia respond?”
“She became angry, Mr. Kenge. She told me that she would find another way.”
I sit back in surprise. Dr. Menon told me that Olivia wanted MAID—medical assistance in dying, under the law—but he didn’t tell me this. And the implications aren’t good for Vera.
“By which you understood?” Cy prompts.
“Another way to end her life,” Dr. Menon replies.
“Did Olivia ever ask you about MAID again?”
“Not that my notes reveal.”
“She continued to see you once a month?”
“Yes, her daughter brought her in for a check-up every month.”
“Did her daughter, Vera Quentin, ever speak to you about MAID for her mother?”
“Not that I recall, not specifically. But I believe she was with her mother in the consulting room when we discussed the issue that first time.”
“Anything else you want to tell the jury, Dr. Menon?” Cy is almost turning away when Dr. Menon answers.
“I don’t know if it’s relevant, but a few weeks before her death, Olivia asked to be tested for dementia.”
In the prisoner’s box, Vera stiffens. We’d discussed this revelation, but the wound of being left out of her mother’s confidence is fresh and the pain palpable.
Cy, too, is nonplussed. He swings back and stares at Dr. Menon, then shoots Jonathan a malevolent dagger. Jonathan flushes; he knows he’s failed his mentor, knows Cy won’t be using him again. Still, armed or not, Cy, having opened this can of worms, has no choice but to explore the contents.
“Tell us about that.”
“She told me she was having episodes of confusion—mixing things up, forgetting. So I sent her to a specialist, Dr. Sharma. The tests came back with a clear indication of the beginnings of dementia. I called her in to discuss the results.”
“Did she come?”
“Yes, she came in on August ninth, in the morning. I gave her the results, discussed the implications. She wanted to know how long she had before she would lose her ability to make decisions and control her affairs. I told her it was difficult to predict, that she would have good days and bad days for some time, but the good days would become fewer and fewer until they no longer came.” Dr. Menon’s voice catches. “It was a very difficult conversation.”
Cy’s in that scary situation that counsel strives to avoid at all costs—needing to ask questions but not knowing what the answers will be. But if he doesn’t follow up on Dr. Menon’s difficult conversation the jury may conclude he’s avoiding putting the whole truth before them. And in any event, we’re sure to follow up in cross-examination. Cy decides to walk out on the limb Dr. Menon has proffered.
“How did Mrs. Stanton react to what you told her?”
“She said she was not surprised. Now you really have to help me die, before I don’t have the capacity to make the decision. We went all over the assisted dying issue again. This time it wasn’t about how long she had to live; it was about dementia. I said no, incipient dementia was not a basis for MAID. She asked me about a living will—a friend had talked to her about this—but I said I didn’t think the law allowed for that either. She became really angry. What use is a law like that? she said. I had no answer.”
Vera is leaning forward. As Dr. Menon parses out the details, her head bows and she reaches for her handkerchief to wipe her eye. At the end, after all Vera did for her mother, Olivia chose to exclude her.
“I tried to calm her down, but I had other patients waiting and I was way behind schedule. I asked her where her daughter was to take her home, but she said she came in a cab. She took my hand and made me promise that I wouldn’t tell anyone about her diagnosis. Of course, I agreed, then I asked a nurse to make sure Mrs. Stanton was placed in a cab and that the cab had the address of her home.” He checks his file. “My note shows I also asked the nurse to call the caretaker, Maria, to tell her Mrs. Stanton was on the way.”
Olivia had the opportunity to tell Vera, Joseph, and Nicholas about her diagnosis, but she didn’t. Once again, her secrecy nags at the edge of my mind. Perhaps this woman, so open about everything else concerning her health, could not accept the final sentence of dementia and chose to deny it. Or perhaps she didn’t want to distress the family until she had worked out precisely what she would do next. Yet again, perhaps she was planning moves—like her death—that would make it unnecessary to ever tell them. Or perhaps, if she were going to change her will to give a large portion of Nicholas’s inheritance to the Society for Dying with Dignity, she didn’t want anyone challenging the change after her death on grounds she lacked the mental capacity to manage her affairs.
Dr. Menon’s concluding words interrupt my speculations. “That was the last time I ever saw Olivia Quentin,” he says sadly.
There is only one thing left for us to do in cross-examination—clear up the confusion about the effect of the sleeping medication Vera admits she gave her mother the evening of her death. Jeff does the honours.
“I prescribed a very mild sleeping pill, a Zopiclone pill under the brand name of Imovane,” Dr. Menon says in response to Jeff’s first question. “The usual dose of one pill is 7.5 mg, but I am very conservative when it comes to sleeping medications and prescribed the 3.75 mg pill. I told Mrs. Quentin that the dose in each pill was very mild, and that if her mother was extremely agitated, she should give her mother two pills.”
“How would two pills affect a one-hundred-and-twenty-pound woman, Dr. Menon?” Jeff asks.
“It would put her into a sound sleep for a number of hours.”
“Would it render her unconscious?”
“Oh, no. If you wanted to do that you would have to give her many more pills. Two pills of the dosage I prescribed would be a normal dose for most people and just make them sleepy.”
For good measure, Jeff decides to shore up Vera’s devotion to her mother. “Dr. Menon, you told the jury that apart from the last day when Mrs. Stanton came alone in a cab, her daughter, Vera Quentin, always brought her for her monthly appointments.”
“Yes.”
“Mrs. Stanton was never late, always on time for her appointments?”
“Never late.”
“Over the course of the years you cared for Mrs. Stanton, did you get to know Mrs. Quentin?”
“Oh yes. Quite well,” Dr. Menon says. “As I mentioned, often Mrs. Quentin would stay in the examining room with us.”
“Is it fair to say that Mrs. Quentin was very concerned for her mother’s welfare?”
“Yes. She was very concerned. She worried a lot about her mother. She would even phone me at the office.”
“But on the whole, you were you happy that Mrs. Quentin’s daughter was so concerned for her welfare?”
“Very happy. It’s a very good thing for patients to have supportive family.” He smiles. “I admit that at times Mrs. Quentin seemed excessively concerned about her mother—my staff would come in and say it’s Mrs. Quentin on the line, and I would roll my eyes—but I had no doubt that her concern was a good thing. Much better for an older person to have too much concern than too little.”
The jury is looking kindly at Vera. Even Vera has the grace to smile at the doctor’s droll acceptance of her pestering calls. A good moment. We’ll need it for the next witness. Thank you, Dr. Menon.
CHAPTER 42
DR. PINSKY IS A SMALL man with receding hair, a beak nose, and blue eyes that dance with intelligence behind his rimless glasses. I stand to tell the judge that we admit Dr. Pinsky’s credentials—better to admit them than have Cy roll through his myriad degrees and professional awards. Dr. Pinsky is, quite simply, the best at analyzing and breaking down the complexities of psychiatry for a general audience. I use him as an expert on my own cases whenever I can. My only regret is that this time, Cy got to him first.
Cy moves directly to the heart of the evidence. “Dr. Pinsky, you have been called today to give the jury your expert opinion on the state o
f Vera Quentin’s mental health on August 10, 2019. Can you tell the jury what you base your opinion on?”
Dr. Pinsky folds his hands in his lap. “I have been provided with a series of documents, first and foremost, a medical history of Vera Quentin that includes her psychiatric history and a report from her psychiatrist, Dr. McComb. I have also read a transcript of the evidence given earlier this week by Joseph Quentin as to her behaviour in the days immediately preceding August tenth.”
“And what have you concluded from that material?” Cy asks.
“I have concluded that the accused, Vera Quentin, most probably suffered for a number of years prior to the death of her mother from GAD—general anxiety disorder—related to underlying depression. GAD is a recognized mental illness. Indeed, that is the diagnosis that her own attending psychiatrist arrived at.”
“Could you define depression and GAD, Dr. Pinsky?”
“Depression refers to feelings of severe despondency and dejection,” Dr. Pinsky replies. “GAD refers to a related condition of chronic anxiety and irrational worrying. Worrying about lots of different things to a far greater degree than expected. Both are associated with feelings of helplessness, inability to cope. When these conditions persist for more than six months, we refer to them as mental disorders.”
“Can you give the jury examples of how GAD might manifest itself?”
“People with GAD might talk constantly about things they fear. If they do something, they imagine everything that could possibly go wrong and verbalize those feelings. To use a homey example, if the person is baking a cake, they will worry irrationally that they didn’t put enough baking powder in the cake or that they didn’t set the oven at the right temperature or a dozen other things. It’s not going to turn out, they say again and again.”
Cy nods. “You have read accounts of Vera Quentin’s behaviour with respect to her mother’s illness. Does that behaviour fit with GAD?”
“Yes, it fits. An irrational fixation on what would happen to her mother.”
“How may GAD affect those around the person suffering from it, Dr. Pinsky?”
“It can be very hard for them. They understand the good intentions of the anxious person, but also see that the person is torturing herself needlessly. They have to live with irrational anxiety around them all the time. No quiet, no peace. This can be very difficult.”
“And what can this constant anxiety lead to?”
Now we’re getting to the point. I stare straight ahead, bracing myself.
“It varies, but people with GAD may become afraid to do things, like going outdoors or engaging in certain activities. In extreme cases, they may get to the point where they feel entrapped in depression and anxiety, and cannot go on. That is why there is a high correlation between acute anxiety disorders and suicide. Or other damaging conduct.”
“Please explain what you mean by other damaging conduct, Dr. Pinsky.”
“Anxiety can manifest itself in panic disorder. The panicking person may do something that he or she would not normally do.”
“Do you see any connection with what you have said and what may have happened in this case?”
Dr. Pinsky looks at Vera, so calm, so quiet, and hedges. “Let me be clear—I’ve never met Mrs. Quentin. I am relying on the diagnosis of her psychiatrist and the documentation that I have read.”
“Let me put it this way,” Cy persists. “Is it possible that a person suffering from the symptoms that you have read were ascribed to Vera Quentin could arrive at the point that she did something she would not ordinarily do, like try to take her own life?”
“Yes, that is possible. In fact, it happens all too often.”
“And is it possible that such a person might become so overwhelmed by feelings of worry and anxiety that they would decide not to commit suicide, but to kill the person they see as the cause of the unbearable situation?”
“That is possible. There are cases in the literature of parents suffering from extreme anxiety disorder becoming so terrified for the future of their children that they kill them. Hard to fathom, until you understand the torture their anxiety puts them in.”
“Such conduct is not confined to opera, then?” Cy asks.
Dr. Pinsky smiles. “Ah, so you know I am an opera buff. One of the great operas, Norma, grapples with this. Norma kills her infant sons. Whether she did it from acute anxiety or not is left for the listener to conclude—the better view is that she just wanted to spare them the barbarity of a Roman invasion. But to answer your question, such conduct is sadly not confined to opera.”
“And in your opinion, when the person does this, do they know the nature and quality of their act—what they are doing and that it is wrong?”
“Yes, indeed. The person knows what they are doing and that it is morally wrong. But their suffering overcomes that knowledge, and they commit the act despite this intellectual understanding.”
“Interesting,” Cy says. “I have one last question for you. Can GAD also be associated with denial—the person denying their conduct?”
Dr. Pinsky pauses. “Yes.”
Damn you, Cy, I think. That’s one step too far.
Cy turns. “Thank you, Dr. Pinsky.”
As I stand to cross-examine, Jeff slips me a note. He’s opened the door for the defence of insanity. Don’t close it.
I push the note aside. Unless Vera tells the jury that she put that needle in her mother’s arm—an act she adamantly denies—we can’t run the defence of insanity. Still, no harm in trying.
“Dr. Pinsky,” I say. “You would agree that GAD is a fairly common mental illness?”
“It is quite common. So common that it often isn’t recognized as a disease. People say, She’s a perfectionist, or She worries too much, things like that. But in its extreme form, it becomes clinical and most people would recognize that the person has an abnormal condition.”
“Was Vera Quentin in that clinical, abnormal state at the time Olivia Stanton was killed?” I ask.
Dr. Pinsky nods. “The conduct described in the documentation was consistent with extreme general anxiety disorder, GAD.”
“A recognized mental illness.”
“Yes.”
“You spoke about GAD and panic disorder. You testified that when a person is in the midst of a panic attack, they may still know what they are doing. To put it in legal terms, they still know the nature and quality of their acts?”
“Yes,” he concedes.
“I put it to you, Dr. Pinsky. In cases of extreme panic, the person may simply react, reason diminished to the point that the person is not in control?”
He’s thoughtful for a moment. “I suppose that is possible. The person blanks out. Acts instinctively.”
“Can an extreme panic attack last for some time?”
“There are recorded cases of panic attacks lasting for some minutes. Rare but it seems it may happen.”
“And during those minutes, the person might do something without knowing what they were doing?” I press.
Cy is waiting for him to say no; I want him to say yes. Dr. Pinsky’s gaze goes to the prisoner’s box. Vera is looking good today, a dark jacket over a pale blouse and pearls. Her lustrous brown hair angles over her cheekbones in a way that accents her luminous eyes. You know I could never have killed my mother, not knowingly.
Dr. Pinsky swivels back to me. “I agree, Ms. Truitt. During the panic attack the person might not be aware of the nature and quality of their acts.”
I glance at Jeff, who inclines his head. We have enough for an insanity defence, in the unlikely event that our client lets us take it. Now I need to take care of the rest. “Thank you, Dr. Pinsky. Just a few more questions. Would you agree with me that cases where a person with GAD kills the person they are worrying about are extremely rare?”
“Extremely rare.”
“Can you put a number on how rare—one in a thousand, one in ten thousand, one in a million? You give me the figure.”
> “I can’t. They are so rare that they have not been scientifically documented. Suicide is the real risk, not killing someone you love.”
I drive home my point. “What you’re saying is that there aren’t enough cases to determine with any sort of scientific accuracy if killing someone you love is even related to GAD?”
“Well, you can find some mention of a possible connection in the literature.”
“A possible connection, Dr. Pinsky?” I arch an eyebrow. “Sounds like speculation to me.”
“It may be, Ms. Truitt.”
“No science to back it up?”
“No, I must concede that. No real science to back it up.”
“And the cases where a parent has killed a child, for example, there hasn’t been any rigorous study into whether there were other disorders at play, other reasons for the act?”
“No, no rigorous study.”
“Could just be opera, Dr. Pinsky?”
He laughs. “You’re right. Could just be opera.”
“No further questions,” I say, and sit down.
Cy stands. He’s seething at Dr. Pinsky’s admission, but too smart to show it. “No re-examination,” he tells Justice Buller. He bends to consult with Jonathan, who seems to have wormed his way back into Cy’s confidence, then straightens. “That concludes the Crown’s case.”
CHAPTER 43
JEFF AND I HEAD TO our witness room and ask the sheriff to bring Vera to join us.
Cy has erected a powerful circumstantial case. He has proved beyond a reasonable doubt that Olivia was killed by a lethal injection of morphine, Vera was in the house with Olivia at the time of the injection, and she knew that the morphine and syringe were in the cupboard upstairs. He has established that Olivia begged her daughter to help her die, right up to the day before her death. And he has shown beyond doubt that Vera was suffering from anxiety, frustration, and worry on or about the time of the death. We can’t shake these propositions; our only hope is to work around them. We have scored a few points here and there, but our efforts have not produced what we need.
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