by G. H. Ephron
“We have her stabilized. Rapid pulse rate, dilated pupils, high blood pressure, cold sweat.” He tilted his head to one side and squinted at Drew. “Do you know if your daughter is taking any drugs or prescription medication? Diet pills?”
Drew looked dazed. “Nothing that I know of. Beyond the occasional No-Doz. You know kids.”
The doctor sniffed, waited a beat before saying “Mr. Temple, we found about a half-dozen Ritalin tablets loose in her pocket.”
“Ritalin?” Drew seemed genuinely astonished. “I thought that was for hyperactive kids.”
“Drew, perhaps her psychiatrist was prescribing it?” I suggested.
“If she was, then I knew nothing about it. And I don’t think my wife did either.”
The doctor added, “She also had about a half-dozen physician’s sample packs. Ritalin, Ativan, Prozac.” He made some notes on his clipboard. “We haven’t got her blood work back yet, but it looks like she should be admitted to the Drug and Alcohol Rehabilitation Unit.”
I tried not to explode. I’d explained the circumstances when I’d checked her in. Couldn’t they communicate one thing from the front desk to back here? I swallowed my irritation. “We can’t do that,” I said. “Her mother ran that unit. And her mother just died. Can you admit her to the Neuropsychiatric Unit?”
“Neuropsychiatric?” Drew asked.
“We were going to evaluate her anyway”—I paused—“to rule out Asperger’s.” I was improvising. She didn’t need to be admitted to rule out Asperger’s, but that was the kind of verbiage we needed. “Now, she’s made a serious suicide attempt and needs to be in a safe place where she can get the help she needs. She should be admitted under the care of Dr. Kwan Liu.”
“Suicidal depression. Rule out Asperger’s.” The doc wrote as he said the words. Then he shot me a questioning look. “I suppose. If that’s what the family wants, given the circumstances.”
Drew seemed at a loss for words. Finally, he said to me, “Whatever you think is best … .” His voice faded out. “Can I talk to her?”
“You can try,” the doctor replied. “She’s heavily sedated.”
Drew pulled a chair up to the bed. He ran his hand gently across Olivia’s face, sweeping back a few strands of hair stuck to her forehead. He leaned close and whispered, “Olivia? Can you hear me?”
There was no response.
He bowed his head. “Oh, Livvy. I’m so sorry all this is happening. I’m so—” His voice broke. He put his hands to his face and shuddered. “It’s going to be okay, baby.” He pulled a handkerchief from his pocket and blew his nose. “Everything is going to be okay,” he said into the handkerchief.
I put my hand on his shoulder. “Do you need anything?” I asked him. “Want me to call anyone?”
He shook his head. I left him sitting there with her.
6
I WALKED back across the hospital grounds, unaware of anyone or anything except the anger and disbelief roiling inside of me. Why was this happening? I couldn’t help wondering, if Channing hadn’t shown up at our lecture at the Medical School last week, who would have found her?
When I got to my building, I took a look back across the rolling lawns to the Drug and Alcohol Rehabilitation Unit. The lights atop the emergency vehicles were flashing—police blue, ambulance red and white. I winced as two white-suited men emerged from the building, carrying what looked like a body bag. That’s how they’d taken Kate out of our house. Ralston Bridges had gone out on a stretcher, and Kate in black plastic. I’d nearly killed him when I rushed upstairs belatedly to find her already gone, her throat slit. I struck him with an iron rod from Kate’s work table. Then I kicked him, over and over. If it hadn’t been for my mother, I’d have still been kicking him, long after he was dead.
I turned and pushed my way through the crowd of gawkers standing on the steps. “Do you know what happened?” a woman in a dark coat asked as I squeezed past.
I didn’t trust myself to speak, so I just shook my head. They’d all find out, soon enough.
I went upstairs. I wanted to go into my office, close the door, and be alone. But Daphne was in the hall waiting for me, pacing up and down. She was ashen-faced, her eyes rimmed with red. “How’s Livvy?” she asked.
I found my voice. “Stabilized. Drew is with her.”
I opened my office door and followed her inside. Even though the room was overheated, Daphne shivered as she took a seat and pulled her sweater around her. “It’s too awful,” she said. “Too bloody awful.”
She reached into her skirt pocket and came up with a package of cigarettes. “Do you mind?”
With a trembling hand, she edged a cigarette from the pack. I went around behind my desk to sit, ducking so I wouldn’t hit my head on the sloping ceiling. I opened the little window an inch.
Daphne held the cigarette between her lips, took out a lighter and lit up. The tip of the cigarette quivered, then it glowed red as she inhaled. She held her breath and closed her eyes, then exhaled gently. It had the same effect as the shot had for Olivia. Instant calm.
“Olivia didn’t do it,” Daphne said.
“She was holding the gun,” I said.
“Codswallop.” The word exploded in a puff of smoke. “There’s got to be another explanation.” She took a long drag and coughed.
I pushed over an empty mug. “Such as?”
“It seems perfectly obvious. Channing killed herself. Olivia came in, found her. For some reason, she took the gun. We found her holding it by the barrel.”
I wanted to scream at her, “Channing would never commit suicide.” It wasn’t possible. But shoddy research methods and improper behavior were equally impossible. Daphne’s explanation did account for the scene I’d stumbled into. “You really think Channing committed suicide?” I asked, keeping my expression bland.
Daphne looked past me.
“Has she seemed distraught?” I asked.
“We talked yesterday.” Daphne stared at the cigarette. “I was all wrapped up in my own problems. Nattering on about moving from my house into a flat, now that …” She waved the cigarette in the air, leaving behind a scribble of smoke in the air. “It’s just the sort of thing Robert used to manage … .” She hardened her face, but a tear trickled down her cheek. “Of course, if Robert were still with us, I wouldn’t be having to move.” She stopped suddenly, as if embarrassed by the stridency in her own voice.
“I’m sorry,” I said, feeling as if there should be something more I could say but not knowing what.
“When Robert died, I felt like I’d lost one of my arms,” Daphne said. “Now I’ve lost the other.” Smoke pooled at the ceiling. “I should have seen it coming. If only I’d been paying attention.”
“Seen what coming?”
“You haven’t spent much time with her lately, have you, Peter?” It wasn’t an accusation. “Channing was very good at making the world think she’d got everything battened down. But underneath it all … she was in crisis. The pressure of her work. The hatchet job they did on her research in JAMA—that was a profound shock to her. Olivia possibly headed for a psychological break. Drew …” Daphne left the name hanging. “She asked me to prescribe some Ativan to quiet her nerves.”
It was typical Channing. She could easily have prescribed it for herself, but consulting another doc was more aboveboard. “Lots of people need help once in a while,” I said.
“But for Channing? To ask for a sedative?”
I agreed. “She’d have to be pretty upset.”
Daphne said, “She clearly was. And perhaps she was taking more than she should have.”
We sometimes talk about Ativan as “dehydrated booze” because it affects the same areas of the brain as alcohol. It disinhibits. Throwing a glass of cognac at a colleague seemed very out of character. A sedative turning Channing Temple suicidal? A week earlier, I’d have dismissed the possibility outright. Now I wasn’t so sure. She was under tremendous pressure. Her daughter was troubled. Add to the mix the r
umors of impropriety. I realized that the hesitancy I sensed in her when we met after the lecture probably had nothing to do with me and my loss.
“Channing.” Daphne breathed the name. She loosened her hold on her sweater and leaned back. “She was remarkable, even as a resident. Bright. Insightful. Honest to a fault.” Daphne laughed. “She’d smite me for saying those words. ‘Can’t be honest to a fault, Daphne. Contradiction in terms,’” Daphne said, her voice flattened out into an American accent. “She’s always been an excellent psychiatrist, and I don’t see why anyone would say otherwise. Her patients will be devastated. Particularly … oh, my.” Daphne took a last puff, and then stubbed out the butt against the inside of the cup. “I wonder—”
“What?”
“Channing was working with a young woman. Suicidal. She came to me about it, afraid she was losing her perspective.” Daphne focused on a spot somewhere in the air between us. “She felt a strong kinship with this woman. But it dredged up a lot of issues for her. Issues I thought we’d put to rest years ago.”
This did make suicide seem a bit more plausible. “You’re suggesting Channing was getting too close to this patient?” I asked.
Daphne’s eyebrows raised. “Was I?”
“She discussed the case with you?”
Daphne picked at her sweater sleeve, pulling away brown pills. “Well, only in general terms.” Maybe Daphne didn’t want to add another boundary violation to the pile of true and untrue transgressions Channing could no longer defend herself against. “Peter, I’ve always had a supervisory relationship with Channing. She was scrupulously discreet, and I have no idea who the patient is. But I can’t help wondering if she wasn’t experiencing the effects of projective identification.”
Projective identification. It was a concept I’d once dismissed as far-fetched—until it happened to me. I was working with a patient who was obsessive about germs. He wore rubber gloves all the time, couldn’t stand to be touched. Every night, he boiled all the doorknobs in his apartment. I was seeing him twice a week when I found myself rubbing my own hands together, wiping them over and over against my trousers, unable to shake the feeling that they were dirty. I’m sure the stress I was under made me more susceptible—Kate had been dead only four months.
It’s something therapists refer to as feeling “lost in familiar places,” when you become enmeshed in your patient’s feelings, even though you know they have nothing to do with you. If I’d been my own therapist, I could have explained it—something about his need to wash his hands connected to my feelings of guilt, which, like the blood on Kate’s studio floor, I couldn’t wash away. Sounds so logical, now that I can hold it out at a distance and examine it. At the time, there was nothing logical about it.
Channing was at about the age when her own mother committed suicide, if I remembered correctly. If she was identifying with a suicidal patient, then perhaps stress, combined with the sedating effects of the drug, altered her judgment, reducing her resistance to suggestion even further. I wondered if the autopsy would find more than therapeutic levels of Ativan.
Everything pointed to suicide. I could chew on the possibility, appreciate all the contributing factors, but I couldn’t make myself swallow.
“Let’s say she was suicidal,” I said. “Why pick that particular time to kill herself, when she knew Olivia was about to meet her at her office?”
“I can’t explain it, I confess.” Daphne rolled a bit of brown sweater fuzz between her thumb and forefinger.
I couldn’t explain it either. I couldn’t accept it. She’d never have left her daughter to find her, the way she’d found her mother.
“As much experience as I have with human behavior,” Daphne said, “there are still moments like this when I find myself at a loss to explain.”
We sat there in silence. I was missing a budget meeting that I’d spent an hour yesterday preparing for. Today that seemed unimportant. I turned on the desk lamp. The little pool of light only intensified the surrounding gloom.
“Has Olivia been admitted?” Daphne asked.
“To the Neuropsychiatric Unit.”
“Neuropsychiatric?” Daphne exclaimed. “Why on earth—”
She was right. There were better choices—the Adolescent Unit or Affective Disorders Unit would have made more sense. I didn’t want to admit that I hadn’t considered any of them. Channing had asked me to take care of Olivia, and that was what I was going to do. “We couldn’t admit her to the Drug and Alcohol Rehabilitation Unit,” I said.
“Still … .”
Channing’s voice came back to me. I want another opinion. She’d been adamant. In the midst of a crisis, Olivia had pulled away from Daphne. I was convinced I’d done the right thing. I just couldn’t defend it.
“I know you’ve been working with her,” I said gently. “Channing told me that when she asked me to evaluate Olivia.”
“She never mentioned she’d asked you for an opinion.” Daphne sounded surprised, hurt.
“To rule out Asperger’s syndrome.”
Daphne snorted. “Asperger’s, my ass.”
“I doubt if she’s Asperger’s,” I agreed. “But I suspect she may have some less serious but related difficulty.” There were plenty of indications that Olivia was having problems relating emotionally. The mood swings. The flat demeanor. The way she used her flamboyant appearance to keep people away. The friendships that were mediated by computer. “Judging from her actions, she is suicidal and needs to be watched. She had drugs in her pocket when she was admitted. Were you prescribing anything?”
“We were trying her on Ritalin,” Daphne said.
“Drew said he didn’t know she was taking Ritalin.”
“Channing may not have told him. We just started trying it.”
“Was it helping?”
“Yes. I think it helped her keep focused. That’s one of Olivia’s problems, you know. She’s easily overwhelmed. She needs structure.”
“I noticed she makes lists,” I said.
Daphne smiled. “That’s one of my interventions, a coping strategy to help her keep track of what she needs to do.”
I wondered if Daphne had seen Olivia’s long lists of items, where large and small activities, important and unimportant, daily and onetime tasks, were thrown together. It was a structure, yes. A linear structure. And if I were Olivia, even one of those lists would have made getting through the day seem even more daunting. I wondered if Daphne had the measure of her patient. Already I suspected she was trying to force-fit Olivia into a preconceived mold. But I didn’t have enough information about Olivia yet to know for sure.
I said, “Of course, we’ll consult you on her treatment—as soon as Olivia is conscious and I have permission to discuss her case with you.”
Daphne’s jaw dropped. Then her look hardened. “You’ll let me know what I can do to help.”
The last thing I wanted was to get into a tug-of-war over Olivia’s treatment. “Of course. Right now, we’re stabilizing her.”
“And the police?” Daphne asked.
“We’ll try to keep them away from her as long as we can.”
“They think it’s suicide. I told them the gun was on the floor by the chair when I got there. You’ll say the same, won’t you?” I didn’t answer. “For Olivia’s sake.”
It made me uneasy. Given a choice between whether Olivia killed her own mother or Channing killed herself, I’d pick neither. But what did that leave?
After Daphne left, my phone rang. It was the hospital CFO, Arnold Destler. That wasn’t so unusual. What surprised me was that he placed the call himself—usually his assistant called you and then left you hanging while Destler took his good, sweet time picking up. “Peter, I wanted to remind you of the protocol in these situations.” These situations? He made it sound like the violent death of a psychiatrist was a routine event. “If the press contacts you, you’re to redirect the call to Public Affairs.”
I held the phone away from my ear. W
here was the caring administrator calling to find out if I was all right? To inquire how Channing’s daughter was doing? His number-one concern was predictable: how to spin the news so it wouldn’t diminish the institute’s reputation.
“Such a shame this had to happen on the hospital grounds,” he said.
“I’m sure Channing’s daughter and husband share your dismay.”
“I don’t mean to sound callous. Wherever it happens, it’s a terrible tragedy, of course.”
“Of course.”
“No one will miss Dr. Temple’s … insights … more than I will.”
Like hell he would. Channing’s so-called insights were a perennial pain in Destler’s butt. She saw managed care as a Dante-esque hell, where administrators stood above, taking pleasure in tormenting the rest of us. Civil disobedience was the only response. She was known to lose paperwork, even misplace the occasional patient, just so she wouldn’t have to discharge him or her when the need for care didn’t conveniently stop when the insurance coverage ran out.
“Just wondering, you were there, weren’t you?” he said.
“I found her.”
“You spoke to the police.”
“Of course.”
“And did you get the impression that it was …”
“That it was what?”
He cleared his throat. “Suicide?”
From Destler’s point of view, suicide was a better verdict than accident. No liability. No messy lawsuits. Far better than murder and all the endless speculation and nasty publicity that would accompany that.
“Beats me,” I said, and hung up.
7
THAT NIGHT I had a restless sleep. At five I was awake, fumbling with the coffeemaker. I must have dozed off sitting at my kitchen table, because I was jolted awake by the sound of Channing’s voice, urging me to “Run, run, run, run … .” Turned out to be the sound of the last of the water, steaming onto the spent grounds.
Run. That’s what Channing always did when she needed clarity. When we met, she was a fitness nut, and I could have been a Charles Atlas “before” ad. But by the time we graduated college, I was running with her every dawn, and I could almost keep up and remain conversational.