The rest of what I had to say forced its way out, like a child being born. "He couldn’t give you enough by himself. Your father, I mean. No man could — no matter how good he was. And you couldn’t let him know that. That's what I was getting at when I said you weren't
fed
enough. I meant emotionally. A mother's love." I looked straight into her eyes. "I'm sorry you ended up feeling guilty about your needs."
"I feel guilty all the time. About everything. Even..."
"Of course you do. That's why you think everyone's watching you eat. You're not allowed to have an appetite, let alone a big one."
She tightened her grip on her vegetables. "I don't know about all this," she said. She walked to the end of the corridor and around the corner.
I stared after her a few seconds, warmed by the very part of her — the neediness, the capacity to be loved and filled — that she feared letting anyone know. I took a deep breath and started to read more about LaFountaine:
According to scant records sent with the patient, his symptoms were present by November 23 when he sought out a senior officer and reported that assassins were stalking him for ‘crimes of cowardice against mankind.’ He was sedated and observed in the camp infirmary, for an apparent acute stress reaction. His symptoms subsided, and he was allowed to resume his routine.
On November 25, however, Mr. LaFountaine, using a scalpel he had apparently smuggled from the infirmary, took hostage a nurse who had cared for him there, insisting she was involved in the plot to capture and execute him. After holding her in a storage shed for four hours, he released her. He had cut deep horizontal gashes at the corners of her eyes, presumably to investigate his suspicion that she was equipped with robotic surveillance devices.
I read the last sentence three times. My stomach churned. He had done it before. It was all there: the woman, the knife, the search beneath and behind. I let my head fall back. Could I have missed the damn drama Westmoreland was playing out? Did he need to know whether his lover, his Madonna, was a robot under her soft parts? Was he repentant now because he had found only flesh and blood? Even with the Amytal on board, maybe he couldn't tell me what he had done because he feared I was part of the plot to kill him. I didn't want to read any more, but I needed to:
Mr. LaFountaine was apprehended and contained. A court-martial was held November 28 at which charges against him were dropped, as it was determined he was suffering a psychotic disorder. The patient was medically discharged, processed and transported to this facility. Mental-status examination on admission revealed a well-kempt, muscular white male whose speech was rapid, sometimes to the point of incoherence. His affect was labile. Mood was reported by the patient as ‘horrifying.’ He was quite paranoid, continuing to believe others were pursuing him in order to exact revenge for his ‘crimes of cowardice.’ He denied auditory, visual, olfactory or tactile hallucinations (although this report may not be reliable). He is oriented to person and to date, but mistakes the hospital for an ‘experimental lab’ where his brain will be ‘analyzed for radio transmitters’ — the theme of robotics and mechanization again being prominent.
This is the patient's first known psychotic admission. He denies previous psychiatric symptoms.
Developmental history is significant for severe beatings by both parents during childhood. It is not known whether the patient sustained head trauma or loss of consciousness.
I closed my eyes. Every violent person I have ever treated was victimized as a child. I took out my package of coke, snorted what was left and started to pace with the chart.
There are no known serious adult medical illnesses. There is no known alcohol or illicit drug abuse.
Mr. LaFountaine will be treated with antipsychotic medication, most likely haloperidol. The goal of treatment must be to eliminate his paranoid delusions and any other psychotic symptoms and, hence, his potential for violence. Given the patient's recent assaultiveness, we anticipate an extended stay.
Bruce Rightwinder, M.D.
Attending Psychiatrist, 13B
LaFountaine's first admission lasted five months. Haloperidol didn't stop his paranoia. Thorazine didn't work, either. Dr. Rightwinder started to wonder whether his patient's symptoms might be due to an underlying psychotic depression. He had lost a friend, after all. When a six-week trial of the antidepressant imipramine failed, Rightwinder prescribed twelve sessions of electroconvulsive therapy.
The patient improved steadily. He became more trusting. He stopped talking about robots and transmitters. But there was a significant side effect from the shock treatments. "The patient has no memory of events preceding his hospitalization," Rightwinder wrote. "He cannot recall participating in the Son Tay raid. He denies anyone close to him having died. While obviously worrisome, we believe this memory loss to be a temporary phenomenon."
It sounded to me like they had temporarily nuked LaFountaine's trauma into the deepest recesses of his cortex. But psychological conflict always works its way back to the surface. He was admitted with paranoid delusions ten more times over the next decade. On each occasion he was given more antipsychotic medication and more electroconvulsive therapy, and his condition gradually stabilized. Noting the relapses, another staff psychiatrist decided Mr. LaFountaine should return to the hospital every two months for
maintenance
shock treatments. But the patient stopped showing up during November 1985.
Mr. LaFountaine failed to present for his maintenance electroconvulsive therapy. Given his history of violence, and recurrences of intense paranoia over the past several years, a Section 12 commitment has been filed with the court. Boston and V.A. police have been notified to locate the patient and bring him to the emergency room. They have been provided with his address in Charlestown and with a description.
The police apparently hadn't found him — until now. I closed the chart and walked around the corner to find Rusty. She was working on some filing two aisles away. I held the chart out to her.
She didn't take it from me. "You look awful," she said. "Are you alright?"
"Tired. That's all."
"I'm not sure I got everything you told me, but when I thought about it, it kind of made sense."
I was finding it hard to focus on what she was saying.
"Where do you practice? You have a card?" She waited a few seconds. "Did you hear me?"
I could have told her
my
truth — that the most I could pull off reliably was a ten-minute analysis on the fly, not much more than you'd buy off a decent psychic in a coffee house. I could have told her that she needed someone braver and more honest than I to take her all the way back to whatever fires of hell burned the child in her. I could have told her that I'd probably disappoint, leave her lost and alone somewhere in her past, unable to finish the journey into her pain and back out again. "I don't see patients anymore" was what I managed.
Injured people know one another. Her tone of voice dropped to a croon of empathy. "Don't see patients? But why?"
"Long story." I forced a smile. "You've got your own to think about." I laid the chart on an empty shelf and walked away.
Wednesday, 4:25
P.M.
The sky had gone gray behind a driving rain. I wanted to fly home, to clear my head, but could only lurch from traffic jam to traffic jam. I cursed my wipers, worn nearly to the metal, and leaned to peer through the windshield. Everything looked hopelessly distorted. I rolled down the passenger window to edge my way right, onto Longwood Avenue.
Longwood runs past four Harvard teaching hospitals that have grown around and over one another. I had to lower the window again to squeeze past two construction cranes jutting into the road in front of the Dana-Farber Cancer Institute. The place had swollen to three times the size it was when I worked there as an assistant to Dr. Hyman Weitzman during the summer of my sophomore year at the University of Massachusetts. I was majoring in neuroscience, and Weitzman, an oncologist, had teamed up with neurosurgeons to investigate whether placing radioactive disks directly into glioblastoma brain tumors could slow their growth.
Even back then I had felt like an outsider. The other students working on the project were fascinated by the haphazard shapes of the malignant cells under the electron microscope, the technique of implanting the disks in the brain, the changes in patients' reflexes and vision as the cancer invaded, then retreated. None of that excited me. I stayed late at the institute to ask patients how it
felt
to harbor a deadly intruder, what they fantasized had caused their illnesses, what they believed would heal them.
At the end of the summer at Weitzman, a bespectacled, obsessive man who had survived Auschwitz, called me into his office. He handed me a letter of recommendation highlighting my statistical analysis of our data. "you did a complete and thorough job," he told me. "I appreciate your efforts." He gazed out the window of his Spartan office. "May I share a concern with you?"
I adored Weitzman in the way I adored every older man who showed me any hint of kindness I had missed from my father. I worried he knew I had been playing grab-ass every lunch hour with his research assistant Lisa in her studio apartment down the street. "A concern?" I asked.
"More a piece..."
I cringed.
"... of advice."
"Of course."
He leaned toward me. "I have worked as a researcher many years, Frank. I have known great investigators. Mountcastle, Snyder, DePaulo, Coyle. These men love biochemistry and anatomy and physiology. Structure and function. Cause and effect." His voice rose and fell like German music. "They are perpetually fascinated by the body. They see the whole universe in a single cell." He held his hands in the air like a conductor. "Such a man feels his pulse in the contraction of a single muscle fiber of another man's heart."
I was drawn in by his passion. "Yes!" I said.
He shook his head and leaned back in his chair. "You are not one of these men."
"No?"
"I have been watching you, listening to you. You are interested in philosophy — the meaning of things. Big questions. You are concerned with the soul."
I felt as if I was being disowned. "Well, it isn't that I don't—"
He held up a hand to stop me. "A suggestion."
I waited in silence.
"Have you thought of studying at a seminary, of becoming a minister?"
"A minister?"
"A spiritual guide. A moral leader in the community. Such individuals are sorely needed at this time."
"I've never thought of it." I said.
"Are you a religious man?"
I considered telling him about my contempt for organized religion — organized anything — but I knew he was a devout Jew. "I think I believe in God," I said.
"You think..." He nodded and sighed. "I see."
Longwood ended in a traffic signal near the on-ramp to Storrow Drive. The car in front of me didn't budge when the light turned green. I waited a few seconds, then hit the horn. The car finally started to move, but at a crawl. I stepped on the gas and swerved around it.
Weitzman's advice had seemed bizarre to me, but some of it must have hit home because I went back to U. Mass. That fall as a double major in neuroscience and philosophy. And after four years studying, prodding, dissecting every organ in the body at Tufts Medical School, I picked a specialty concerned with healing the spirit. At least that's what it used to be about before insurance and pharmaceutical companies cut the heart out of it.
Now, with Westmoreland looking more and more like a killer, I wondered whether my choice had been such a good one. Maybe I would have done better to devote myself to the kidneys or the retina, where pathology can be measured in millimeters of urine output or degrees of visual acuity. Because something kept going horribly wrong with me and psychiatry. Emma Hancock liked to dredge up Prescott, but this wasn't the first case I'd botched.
During 1988, while I was in private practice, I had begun treating an adolescent named Billy Fisk. Billy had been abandoned by his biological parents at the age of four and raised by one set of foster parents after another. By age twelve he was drinking steadily; by age fourteen he had stolen his first car. Six grand larceny arrests later he was sent to me for therapy. He had just turned sixteen and was serving time in a Department of Youth Services detention facility.
"You've got to stop stealing," I told him during our first meeting."
He was already as tall as I was and even broader in the shoulders. A scar from a street fight ran from the corner of his mouth across his left cheek. "Cause you say so?" he sneered.
"You think I'm an asshole?" I sneered back. "Why would you give two shits what I say?"
He shrugged but looked me in the eyes for the first time.
"You should stop stealing because you're lousy at it. You get caught every time."
"Not every time," he smirked.
"OK,
pretty
lousy at it."
"How would you know? You never stoled nothin’."
"I haven't?"
He rolled his eyes. "You're a doctor."