That was another reason I’d decided to work at the hospital—I’d wanted to be part of a team. Private practice can be lonely at times. There’s also a bigger risk of connecting with your patients because you might relate to their issues. There’s less chance of that in a hospital, where you work with people who are more acutely ill. At least that was the plan until I met Heather. But watching her get better reminded me of why I’d gone into psychiatry in the first place. I was profoundly pleased that I was able to have some impact on Heather’s life and believed she had a strong chance of making it.
Then we got news that her parents had been killed.
* * *
It was Michelle who phoned me at home that Sunday evening. Daniel had called the unit, saying he had some bad news to tell Heather, and he needed help. I called him back right away.
“They were asleep in their RV when it happened,” he said. “Apparently, fumes from their propane stove had leaked in. A hunter found them—they’d been dead for several days, and he noticed the smell.”
It was a terrible image, their bodies rotting alone in the woods, but without the smell it might have taken days longer.
“The police want me to tell Heather.” Daniel sounded frantic. “Do we have to?”
“She’s in the best place to find out. Would you like me to tell her?”
“I think I should do it—she’d want to hear it from me.” A long pause. “But what if she tries to hurt herself again?”
It was a very real concern and something that had worried me the instant he told me the news. “We’ll put her under close observation and move her back up to PIC, where we can keep an eye on her until she’s over the worst of it. But we shouldn’t tell her tonight. Let’s wait until tomorrow. Try to get some rest.”
“Okay, thanks.” He sighed into the phone. “I just wish I could take away the pain for her.”
“I know.” I felt the same way. I wished I could take away Heather’s pain, and Daniel’s.
* * *
In the morning, we met in the visiting area. He was pale and obviously nervous, constantly rubbing his unshaven jaw or running his hands through his hair, his whole body keyed up. He met my eyes and said, “This is going to be the hardest thing I’ve ever done.”
“Would you like me to be with you when you tell her?”
“Thanks, but I think I should do it alone.”
“I’ll be close by in case you need help.” I held his gaze. “I know you’re scared, but she’ll get through this, okay?”
He took a deep breath and squared his shoulders. “Okay.”
The nurses had already placed Heather in one of the interview rooms, and she thought she was waiting for our morning session. When we walked in, she was reading a book, sitting cross-legged on the chair, her feet tucked under her jeans-clad legs. The book was a course guide for the university. She was making plans for her future—a future we were about to turn upside down.
She looked up with a smile. “Daniel! I didn’t know you were coming in.”
Daniel sat in the chair beside her and held her hands. He tried to smile back at her, but his lips were tight, his eyes sad. She searched my face, then Daniel’s. She said, “What’s wrong?”
I said, “Daniel would like to speak with you. I’ll leave you two alone.”
Just as I sat nearby at the nurses’ station, where I could observe on one of the monitors, Daniel leaned close to Heather. I couldn’t hear anything, but his face was gentle, and I could tell that he was explaining what had happened.
Heather’s body rocked backward, her hands across her mouth, which was opened in a silent scream.
Daniel was still talking, his hand on her shoulder. He was obviously trying to comfort her, but right now Heather wasn’t able to absorb anything. She was just shaking her head back and forth, trying to block him out. Daniel pulled her in for a hug. She pushed him away, then pressed her hands against her ears.
Daniel looked up at the camera in the corner, his face helpless.
I knocked on the door and walked in. Heather turned to me, her expression beseeching. “They’re dead?”
“I’m very sorry, Heather.”
“Maybe it wasn’t them. Maybe it’s a mistake.”
“The police are positive, or they wouldn’t have notified Daniel,” I said.
She stared at me for a moment as my words sank in, then she started to sob, in loud, choking gasps. She doubled over, clutching her stomach. Daniel rubbed her back while I handed her the Kleenex.
When her sobs had finally eased, and she was sitting back up, I said, “I know you’re hurting right now, and this must be very overwhelming, but we’re going to support you through this. You’re not alone.” I explained that her parents would want her to focus on her treatment and reassured her again that she would have help through this difficult time. Then I left them alone for a while and got the nurse to give Heather some Ativan. When I came back, Heather was still sitting beside Daniel and holding his hand, the occasional shiver vibrating her body. She looked like a storm had swept through her: tear tracks down her face, hair half pulled out of its ponytail, the expression in her eyes dark and empty.
I said, “How can I help you, Heather?”
She looked up at me. “It’s too late. They were right. If you leave the commune, everything falls apart.” Her voice was so sure and calm, almost prophetic. The hair on the back of my neck stood up. This wasn’t good. She sounded like she was giving up. Something I didn’t want to see happen.
Echoing my thoughts, Daniel said, “It’s not too late. You’re going to keep getting better, and we’re going to have a wonderful life together.” He bit out the last words, not angry, but desperate to convince her, to cement her in this world.
I said, “I understand that it feels like things are stacked against you right now, but you can get through this. It will just take some time—”
“It doesn’t matter anymore.” Her voice was flat, resigned. “The baby, my parents. They all died after I left.” She rubbed at her arms.
Did she think she was being punished? I said, “You haven’t done anything wrong, Heather. What happened to your parents isn’t your fault.”
She just kept shaking her head and repeating, “They were right.”
I waited for a moment. Beside her, Daniel was also silent, his body rigid and his face concerned, but she didn’t say anything else. I was still worried, but it was obvious she wasn’t going to share anything further, so I moved on. “Your parents’ death was a terrible tragedy, but you will get through this. We’re going to put you in another room, okay? It’s closer to the nurses’ station.” I’d wanted to put her back up in PIC, but all the beds were taken. Each floor had a seclusion room, though, so she’d still be on camera and closely monitored. “If you have any thoughts about hurting yourself, I want you to tell somebody.”
She nodded, but her expression was bleak, her chest heaving with the occasional sob. Daniel sat with her until the Ativan started to work, and I finished my rounds. By the time Daniel left, and the nurses moved her into the seclusion room, she was calmer, though still shell-shocked, her face pale and her eyes vacant. While I made my notes on the charts, the nurses kept a close eye on her, and I peeked in again before I left for Mental Health. She was curled into a tight ball, sleeping. The next day, the nurses told me she’d slept fitfully for most of the day, waking up crying and wanting to talk, which meant she was at least processing her emotions. But she’d become upset and agitated when Daniel arrived later, sobbing that he was going to die next, so the nurses had given her another dose of Ativan.
When I met Heather in the interview room the next morning, I said, “You had a bad blow yesterday. How can I help you? Is there anything you need?”
Her voice hollow, she said, “I still can’t believe they’re dead. I hadn’t talked to them for months. The last time…” She caught her breath, started to cry. “The last time I spoke to my dad, he was mad at me for getting married when they
were away. I hung up on him. I didn’t even say good-bye.”
She began to sob again, big, painful gasps that shook her whole body. It was hard to watch without crying myself, especially when I remembered Lisa and Paul. Toward the end of his life, Paul had shrunk to a shadow of himself. It had been awful seeing him like that, and Lisa and I usually left the hospital in tears. The day Paul died, Lisa hadn’t wanted to come up to the hospital. I’d let her go to a friend’s, thinking it would be good for her to have a break. Paul took a turn for the worse and died in my arms. When I told Lisa, she screamed, “I never got to say good-bye!”
I forced my mind back to the present.
“It’s natural to think of things you could’ve done differently, but this isn’t your fault, Heather. Your parents would want you to be happy. The best thing you can do for them now is to continue with your care plan and live a good life.”
“I always thought that my dad would be proud of me one day, once I got myself together, you know? That’s why I was starting to feel better last week. I was thinking that I could go back to school, maybe for design, get a good job, and show my dad that I was married to this amazing husband. Now there’s no point.”
“Those are still great goals, Heather. Continue doing them for yourself.”
She shook her head. “There’s no point. I’m never going to be happy.”
“I know it feels like that right now, but trust me, you will feel happiness again in your life, and things will get better. You just have to give it some time.”
She stared at her feet, her eyes filling with tears. “I don’t care if it gets better. I just don’t ever want to feel like this again.”
* * *
The rest of the session I worked on reassuring her that the pain would pass, but she was still despondent and wanted to go back to bed. Sleep was probably the best thing for her right now, so I didn’t push her to engage too much. The next day she was sad, but not as lethargic and depressed as she was when she’d first entered the hospital. She’d been in the ward for more than three weeks at that point and was on the full dose of Effexor, which seemed to be helping her cope. When I asked if she’d been having any thoughts of hurting herself, she said no, even repeating it while she looked me in the eye. That was a good sign.
Over the next couple of days, they kept a close eye on her at the hospital. I was off for the weekend, but I called in and asked about her a couple of times, relieved to hear that she was managing. Though she was obviously grieving about her parents, she was willing to come out on the floor and watch TV with the other patients, and three days after we’d given her the bad news, she participated in one of Kevin’s meditation groups. I ran into him out in the hall at lunch on Monday.
He said, “I was happy to see Heather made it to my group today.” Along with MMPI testing, which is figuring out personality types, as well as IQ testing, Kevin also worked with anxiety groups and did some “one-to-one” counseling.
“Yes, the poor thing’s been through a lot.”
“I’d say, but she’s processing her feelings well.”
I was glad for the validation, and my shoulders unknotted. I didn’t realize until that moment just how worried I had been about her. “You think so?”
“We talked after group, and she thanked me, said it helped.”
“That’s wonderful!”
When I saw Heather the following morning, she was still lethargic and speaking slowly, but she told me that Daniel was going to bring some vacation brochures that afternoon because they’d never had a honeymoon.
I said, “That’s exciting. Maybe you can put up some photos of where you’d like to go on your trip and things you’d like to do, like a vision board.”
“Maybe.” She met my eyes. “You’re a good doctor.”
Surprised by the comment, I said, “Thanks.”
I waited for her to explain, but she didn’t say anything else. I asked a few more questions: How was she managing? Was there anything she needed? Anything she wanted to talk about? Had she any thoughts about hurting herself?
She stared at her feet and just kept answering “No” to everything, so we finished the session there. She was grieving, but in proportion to her recent loss, and I was hopeful that in time the supportive environment of the hospital would bring her back to where she was before. Then we could continue her treatment so she could go home and finally take that honeymoon with her husband. When I said good-bye, I added, “I’m going to want a postcard from your trip.”
She smiled wistfully and gave me a little wave.
CHAPTER TWELVE
I went home after work that night, pulled on my overalls, threw my hair into a careless topknot, and worked in my potting shed for a while. Normally I loved the snip, snip of my pruning shears, keeping beat with Leonard Cohen’s “Hallelujah” playing in the background—it was my therapy. But today tears dripped down my cheeks as I thought about Heather, my daughter, and Willow—all the lost girls of the world. I rubbed at my face, leaving streaks of dirt behind, and stared at the bonsai tree I’d been trying to shape. I gave up and went inside for a shower, but first I checked the cardboard box I’d left under the back steps for the cat, noticing that there was a fine coating of black hair on the blanket.
After watching some TV for a while, I talked on the phone with Connie about how I was starting to overidentify with Heather’s emotions, which was making it harder to remain a compassionate observer. Being there when she was given the news about her parents had also reminded me of the agony of telling Lisa her father had passed. I felt more at ease by the time I went to bed. I’d grown fond of Heather over the last couple of weeks and was glad she was doing better, but it would be good for both of us when she was released.
I read for a while, then I switched off the light. My heart started pounding, but I continued with the calming self-talk—You’re okay, just keep breathing, this won’t kill you—until the panic eased.
Though it was still early, I drifted into a sound sleep.
* * *
Two things happened at once: There was a loud clatter like the garbage can had been knocked over, and the phone rang. I bolted up in bed, my heart crashing into my rib cage as I tried to figure out what was happening. I heard a couple of cats screeching and realized they were fighting. The phone shrilled again. I turned on the lamp and grabbed the handset on my night table, noticing it was nine forty-five.
It was Michelle. She was trying to tell me something, but she broke off crying. Still half-asleep, I was confused for a second, thinking my worst fear was coming true, and she’d phoned to tell me Lisa was dead.
Then Michelle gathered herself together long enough to say, “Heather Simeon committed suicide tonight.” My blood roared in my ears as Michelle tried to describe the brutal scene, but she kept dissolving into tears, and I’d only catch snippets of phrases. “There was blood everywhere—we didn’t know she was in the utility room. I called code. But it was too late. She was already dead.”
“What happened? How did she get in there?” My own voice sounded high and strained as I tried to make sense of what I was hearing.
Michelle, calming down a little now that she was being asked direct questions, explained that a fight had broken out among some patients on the ward when they were having their evening snack. All the nurses were needed to break it up, and the janitor, in the middle of gathering supplies, had left the utility room unlocked while he went to clean up the dining room, where some trays and drinks had been thrown. In that brief fifteen-minute span, Heather had entered the utility room and, finding a coffee-can lid on the janitor’s cart, which he’d been about to take downstairs with some other items, had slashed her wrists. Perhaps remembering that she was interrupted before completing her last attempt, she then drank cleaner. When that still didn’t work fast enough, and she’d vomited liquid, comprised of bile and tissue from her burning esophagus, all over herself, she shoved rags down her throat. She had finally suffocated to death, her body’s l
ast struggle for air drowned out by the sounds of the fight on the floor.
Michelle said, “Everything happened so fast—after I found her. I just saw the blood. It was awful.” Her voice changed from a frantic, shocked tone to a hushed and eerie resolve. “I’m never going in that room again.”
* * *
As soon as I got off the phone with Michelle, I pulled on some clothes and rushed to the hospital, where the nurses were trying to calm the patients down. Michelle was sitting in the nurses’ station, pale and shaking, as another nurse handed her a mug of tea. Until the coroner had finished his initial investigation, Heather’s body was still in the utility room. Noticing that the door had been left ajar, and not wanting anyone to peer inside, I went to close it. Before I got it shut all the way, my eyes were assaulted with the brutal image of Heather’s body on the floor, her back still leaning against the wall, and her thin, pale legs and arms all akimbo, like a broken doll. Her face was to the side, so all I could see was her hair. Thick, red blood pooled around her wrists, a bucket was kicked over by her feet, and there were smears of blood over her nightgown.
Then my eyes were drawn to the wall above her head. Written unevenly in blood were the words: He’s watching.
I quickly closed the door.
* * *
The coroner was already interviewing everyone, including me. I sat through his questions, numb, my mind spinning. How had this happened? There’d be an inquest and a quality care assurance, as there always is when there’s a death on the floor. I would have to call MCAP, my insurance provider, and they’d advise me on what to say and how to say it. There’d also be group grief-counseling sessions in the coming days, but I didn’t care about any of that right now.
All I could think was: How am I going to tell Daniel? I would rather have done it in person, but I couldn’t risk Daniel arriving in the morning before anyone had a chance to tell him. There was still too much chaos on the ward, so I walked over to my office at Mental Health, delaying for a few more moments. Then I sat at my desk, staring at a photo of Lisa, thinking that at least Heather’s parents were spared this call, feeling sad that so much tragedy had befallen one family. I couldn’t stop going over my last conversations with Heather. What had I missed? Was I clouded by my own feelings about the commune? Should I have referred her to someone else? I remembered seeing the utility door unlocked weeks before, remembered thinking I should mention it to one of the nurses. But I’d been so upset after hearing Aaron’s name that I forgot.
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