Dante's Poison

by Lynne Raimondo

  Levin, it appeared, wasn’t one of them.

  “And Danny’s parents could afford it?” Rusty asked, apparently judging Levin loosened up enough to move on to the subject we were there for.

  “Yes, at least initially. He was referred to me last winter after fainting in the middle of a swim meet. It was a big one—New Trier’s first of the season against Evanston—and it cost his team the four-hundred-meter relay. Poor kid went down while he was waiting on the starting block. His pediatrician did a whole battery of tests—MRI, thyroid, etcetera—but couldn’t find a physiological cause, and the boy was complaining of sleeplessness, so he sent him over to me.”

  “What was his age then?” I asked.

  “He’d turned nineteen a few months before, in September.”

  “Isn’t that old for a high-school senior?”

  Levin laughed cynically. “You’re obviously not familiar with the Illinois school year—or North Shore parents. To enroll in kindergarten here you have to be five by September first or petition specially to get in, and that’s the last thing families in the New Trier feeder schools want. Most of them ‘redshirt’ their kids—hold them back for as long as they can get away with, so the kid can be bigger, stronger, and smarter than the rest of their classmates. Danny had been swimming since he was three, and his father, who’d made it all the way to the Olympic trials, wanted the boy to follow in his footsteps—or, if you prefer, swim strokes.”

  “So the boy was under a lot of heat to succeed,” Rusty said.

  “Naturally, though in that respect no different than most of the kids in that pressure cooker they call a high school. Danny was also the oldest of three children. The other two were girls, so as far as the father was concerned they didn’t count. It’s amazing people still have these attitudes, but I see it all the time.”

  “What kind of business was the father in?”

  “Trader at the CBOE and as overbearing and insufferable as they come.”

  “And the mother?”

  “Homemaker. But not the usual trophy wife you find in Winnetka. Kind of mousey, actually, and planted firmly under her husband’s thumb. According to Danny, the father bullied her, and I’d bet good money he abused her physically too. Anyone who thinks domestic violence is limited to the poor should spend a few days in my practice.”

  “Was the father abusive to the boy, too?”

  “Danny didn’t say so explicitly, but I guessed it was going on. I think he was frightened of what might happen to him—as well as his mother—if he ratted out his dad. It’s in my notes. Have you had a chance to look at them yet?” he asked, before remembering about me. He stopped in embarrassment. “My apologies. That was insensitive of me.”

  Rusty came to my rescue. “Don’t worry about his tender feelings,” he said, clapping me on the back. “Next to Mark, the new mayor is a shrinking violet.”

  “And he’s only missing a finger,” I said.

  Levin let out the barest of chuckles. “OK, OK, I get it. Nothing but gallows humor around here.”

  I thought I ought to explain. “I did see your notes, in a manner of speaking, before coming here.” Yelena had come through with the transcription that morning. “But I was surprised you’re still doing it the old-fashioned way.”

  “I know. I know. I should have gone paperless long before now. My staff would certainly thank me for it. But somehow I can’t see myself tapping merrily away on an iPad while I’m talking to a seriously depressed patient.”

  “Was Danny in that category?” I asked, seeing an opening.

  “Not in my opinion, though he was presenting with a number of symptoms of moderate depression—anxiety, insomnia, a falling off of interest in his usual activities—when he first came to me. I started him on Placeva and adjusted the dosage a few times until his mood stabilized. He responded to it well, and we started doing forty-five-minute sessions once a week.”

  It was time to get down to business.

  There are about thirty thousand suicides in the United States each year, not a figure to be taken lightly yet still low enough to make suicide a comparatively rare event, as well as notoriously difficult to predict. Certainly a patient who has made several attempts before, lives alone or without supervision, and has expressed a persistent wish to die should be hospitalized. But between that extreme and someone who tests positive for ordinary depression, the possibilities abound. Even the most skilled clinician may find it hard to differentiate between benign and lethal suicidal thinking. And locking up every person who ever entertained a suicidal thought would not only stigmatize a large portion of the population but also quickly overwhelm the system.

  My personal experience with suicide questionnaires (taken purely out of curiosity, you understand) should have had me running forthwith to the nearest emergency room. But despite what many might consider ample provocation, I had never seriously—or very seriously—considered taking my own life. For that reason I tended to doubt it when someone claimed that a psychiatrist should have seen it coming. Most experts on the subject agreed, saying the issue wasn’t whether the patient’s death was foreseeable—in hindsight it would always seem that way—but whether the psychiatrist had done a thorough-enough assessment of the risk factors.

  I started down this road, asking Levin whether he had screened Danny for suicide risk when he first came in.

  “Absolutely,” Levin said. “And I wasn’t concerned. For starters, he denied any suicidal intent or plan. I asked him all the standard questions: whether he had ever tried to hurt himself, whether he had ever wanted to die, whether he’d ever thought about or tried to commit suicide, etcetera, etcetera. All negative answers. I also got him to agree to a ‘no harm’ contract.”

  That much was standard and in Levin’s notes. But it wasn’t nearly enough, since as many as a quarter of patients deny suicidal ideation to their mental health provider, particularly when they’ve already made up their minds and don’t want their plans interfered with. And “no harm” or “safety” contracts—where the patient signs a written agreement promising not to harm themselves—often create a false sense of security, leading practitioners to overlook other troubling signs.

  “What other factors did you consider?” I asked.

  “On the plus side, Danny hadn’t made any previous attempts, wasn’t a substance abuser, and had a strong social-support system in his swim team. He had reasonably good self-esteem and was hopeful about his future. As I mentioned, he was responding to the antidepressant and wasn’t withdrawn or aggressive. Also, his activities were for the most part heavily supervised. He had a stay-at-home mom and there were no firearms in the house, nor so far as he knew a family history of suicidal behavior.”

  “And on the negative side?”

  “He was male and over sixteen, which put him in the worst statistical grouping. As I’ve mentioned, his family situation was less than ideal, and he may have been physically abused by his father, although the literature suggests the last isn’t all that significant.”

  Levin paused here, as though he had something else to add but couldn’t make up his mind whether to say it.

  “Anything else?” I prompted.

  “Yes. Something I didn’t put in my notes at Danny’s request. I’m not sure I should be talking about it.”

  Rusty jumped in then, pointing out that we needed to know all the facts, both the good and bad. “And anything you say in this room will be covered by the attorney-client privilege.”

  “It’s not a bad fact,” Levin said. “Oh, all right, some say it is, but I didn’t think so. Not in Danny’s case, anyway.”

  I thought I knew what he was about to tell us, but I wanted to hear it from him.

  “He was gay,” Levin said finally, slowly and uncomfortably. “And very anxious that his parents not find out about it.”

  “Understandable,” Rusty observed, “given the family situation you’ve described.”

  “We talked about it extensively,” Levin continued
. “When he first came to me, Danny was fairly sure of his sexual orientation, but hadn’t acted on it yet. Over the years he’d seen enough male eye candy in the locker room to know that’s what he was attracted to, but hadn’t yet found the courage to come out. I didn’t encourage him in that direction—I understood his concerns about his parents—but I did suggest he get in touch with a local support group for gay teens. He followed my advice, and before you know it, met someone. If I had to guess, that’s what the song on Facebook—Don’t Fear the Reaper—was about.”

  It made sense. The band had always said it was more about undying love than a suicide pact, and the frequent references to Romeo and Juliet, whose suicides were, if anything, unplanned, backed them up.

  “So you think it was a coded message?” I said.

  “Yes. I think he must have posted it as a love note to his friend, who hadn’t come out yet, either. They both planned on waiting until they got to college—at least before they were discovered.”

  “When was that?” Rusty asked.

  “It couldn’t have happened at a worse time. It was toward the end of April, right after dad had suffered a big trading loss—don’t ask me for the specifics, what I understand about options you could fit on a postage stamp—and there was talk of needing to sell the home. Typical McMansion by the way, on a lot barely big enough to hold the ranch they tore down to build it. That was when the other boy’s folks found some pornographic material in his room and badgered him into a confession. They went straight to Danny’s parents to complain that their precious offspring was being ‘turned’ by Danny.”

  “How did Danny handle it?” I asked.

  “As well as can be expected. Frankly, I think he was relieved to finally have it all out in the open.”

  “And the parents?”

  “Just what you’d expect,” Levin said bitterly. “Naturally, Carpenter senior couldn’t believe that a son of his might be a ‘pansy-ass,’ to use his charming term, so he needed to pass the blame, and there I was, with a big bulls-eye on my forehead. He accused me of having tricked Danny into exploring his otherwise-nonexistent homosexual feelings and threatened to report me to the state board. He even had the gall to come to my office and threaten me physically. It’s one of the reasons I have no intention of ever settling this matter. And of course, they pulled Danny from therapy.”

  Danny’s supposed suicide had occurred in August. “So between late April and the accident, Danny wasn’t receiving any psychiatric care,” I said, thinking that this could easily account for his wrapping a car around a tree.

  “Wrong,” Levin replied. “He was on the road to recovery but still needed my help, and I wasn’t about to cut him loose mid-therapy. He was over eighteen, so I didn’t need parental consent to continue our sessions, which I did free of charge. I also continued to write his prescriptions.”

  “And this went on right up until he died?” Rusty asked.

  “The last time I saw him was a week before the accident, on August tenth. He had to be at his university early to start swim practice. I’d put him in touch with a Twin City colleague and given him some free drug samples to tide him over until he could begin therapy again. It was an emotional parting, but not a sad one. He seemed so excited about going away and starting a new life, one where he’d finally have the freedom to be himself.” Levin’s voice had grown thick. He stopped and blew loudly into a handkerchief. “Honestly, if I’d had any idea, I would never . . .”

  I realized with a jolt of sympathy that he had begun to weep.

  “So what do you think?” Rusty asked me. It had taken some minutes for Levin to recover, and when another half hour of questioning had failed to add anything to our inventory of facts, Rusty had let the psychiatrist go, telling him not to worry, we’d get the case straightened out without much trouble. But beneath the gung-ho demeanor, I could tell Rusty was concerned.

  “Based on what we know right now, I’d say he’s pretty clean. I’m not happy that he left the boy’s homosexuality out of his notes—or about his excuse. Since Danny was over eighteen, his parents could be denied access to his medical records, so why the worry? But I suppose if my young patient begged me, I might have taken my chances and done the same thing. The trouble is we now only have Levin’s word for it.”

  Rusty agreed it wasn’t a helpful fact. “Plus the parents’ attorney will surely try to make it sound like he was hiding something. Does the fact of the boy’s sexual orientation matter from a medical point of view?”

  I shrugged. “It’s definitely another risk factor. There’s a lot of evidence that LGBT adolescents attempt suicide at a much higher rate than their peers, especially when they’re facing stiff disapproval at home. It adds to the mix, but it doesn’t tip the balance one way or the other. The trouble is, these situations are always so nuanced.”

  Rusty sighed. “I expected as much. Well, we’ll work with what we have. The biggest problem will be getting him to relax enough to testify on his own behalf. You couldn’t see it, but he had a face on like he’d just eaten a sour cherry the whole time, especially when we were talking about Carpenter senior. That’s not going to go over well with a jury. And he barely took a bite of his sandwich.”

  “Ugh,” I said. “I thought so. It’s typical of physicians accused of malpractice to experience extreme stress: they usually blame themselves more than they blame the party suing them. There’s even a name for it—Medical Malpractice Stress Syndrome. If you can, try to get him into therapy. I can give you some names.”

  “Please do,” Rusty said. “And I’ll do my damnedest to get him to agree. I’d hate to see the poor fellow wrap his own car around a tree.”

  When I got back to my office, there was an e-mail waiting for me from Melissa. I wasn’t sure I could control the shaking of my hand long enough to tap it open, so instead I went over and flopped on my couch, taking belly breaths to slow my heart rate. All it did was remind me of long-ago Lamaze classes, which resurrected the reason I’d volunteered for this insanity in the first place.

  I thought once more about my conversation with Josh. How exactly would I feel if nothing happened? And was I really doing it for Louis’s sake? Now three and a half, my son seemed remarkably unfazed by my blindness. Like most small children, he hadn’t yet been conditioned to think that disability was strange or scary, and appeared to accept me as if all fathers came that way. The situation would probably change as he grew older, but weren’t all adolescents embarrassed by their parents’ shortcomings? And according to the library I’d collected on the subject, sighted children were no worse off for the experience of having a blind parent. If anything, it made them into more tolerant, well-rounded human beings.

  Annie, of course, was an entirely different story, but given our history she had every reason to be suspicious of my parenting skills. And therein lay the crux of the problem. How much of my eagerness to be a test subject came down to the one thing I could never fix or make better? Was healing myself physically just a way of paving over the guilt that had stalked me like a velociraptor since the day our first son died? No matter what way you looked at it, I was responsible, if not for causing the infection that killed Jack, than for not diagnosing it in time.

  Harvey, my therapist, thought I should go easier on myself. “In its early stages, meningitis easily passes for the common cold. Any doctor could have made the same mistake.” But, of course, I hadn’t been just any doctor, and my excuse for being gone that night made my neglect all the more unforgivable. Harvey’s therapeutic ministrations to one side, there was no way to put a positive spin on a man who had cheated on his wife multiple times and then failed to save his child because he was miles away in another woman’s arms. Some might say I’d been justly punished for my sins, but I couldn’t go there either. Josh was right about me. Despite my desire to move ahead, I still hadn’t come close to anything like acceptance—of either my shameful past or my mortifying present. At best, I was hanging on from day to day like a survivor of t
he Titanic clinging to a scrap of flotsam. Was I really prepared to gamble my shaky equilibrium on the slim chance that I could score a letter or two on a Snellen chart?

  After several more rounds of internal wrangling, I decided to declare the match a draw. Where was it written I had to like being a gimp? No one in their right mind would turn down the opportunity I was being offered. Even if it didn’t pan out, at least I could tell myself I’d tried. And if it turned out to be nothing but false hope—if I really was destined to be a cripple for the rest of my life—then there would be plenty of time to deal with it. Later.

  I rose from the couch, crossed the room, and nearly dislocated my index finger driving it into the Enter key.

  Afterwards I needed a drink, but I didn’t think Josh would find Melissa’s e-mail a cause for celebration, so I set out for the Double L on my own. Still feeling a bit unsteady, I thought I could use extra help getting there, so when I got downstairs I put my Bluetooth in my ear and opened my phone’s GPS app. Unlike the ones you’re probably familiar with, mine was essentially a talking map. It didn’t just tell me where I was, it gave me detailed information about my surroundings. I could move my finger around a virtual compass on the screen and be informed of what was ahead of and behind me, right down to numbered addresses, street names, and points of interest, like restaurants, stores, and professional buildings. I could also “save” favorite destinations whose proximity would then be relayed to me as I moved along.