Any reticence I had about treating Kol wasn't because he seemed normal. He was definitely peculiar. His name, for example. He'd explained that his given name was actually Cole but that he'd decided that it should be written K-O-L after having gone all the way through high school near San Diego insisting to his teachers that it be spelled C-O-A-L. "That's me. Anthracite, man—I'm the black panther" had been his explanation for the adoption of the juvenile sobriquet.
I had long before developed a bias that "peculiar" didn't qualify as a clinical problem. Maturity and experience had convinced me that trying to eliminate peculiarity in the guise of seeking normalcy was not only outside my therapeutic pur view, but also a light-year beyond my skill set. I suspected, too, that trying to eliminate peculiarity was an endeavor of dubious value—although that was a philosophical debate more than a psychological one.
Peculiar or not, I remained unconvinced that Kol met my criteria for psychotherapeutic intervention. Over my years in practice the should-this-person-be-in-treatment checklist had evolved to a point that the decision tree was a relatively simple three-step process. First, a patient must have at least one identifiable problem of the mental-health variety. Second, the problem must have a solution that I had the skills to assist in shaping. And third, the patient must demonstrate an interest, however dim, in marrying the solution with the problem and engaging with me in the intervening process.
My assessment with Kol was that numbers two and three on my list were problematic, and number one was no slam dunk—I had reached a tentative conclusion that he might have a workable problem, just not the one he suspected.
During his intake visit a few weeks before he had been one of those thoughtful patients who had announced his DSM-IV diagnosis for my benefit. He'd walked in the door to my office, plopped his narrow frame down on the chair across from me, and—before I'd said a word, let alone asked a single question—spared me the trouble of having to conjure up a clinical tag for him. Kol reported that he and his parents thought he was an "adult autistic with ADHD"—attention-deficit hyperactivity disorder.
"An adult autistic?" I'd asked. The closest I could come to a recognizable label would have been someone with "residual autism," a nonspecific diagnostic tag for an autistic child who had grown into adulthood hobbled by the echoes of the earlier developmental disorder. As I listened for Kol's additional diagnostic thoughts I made a tentative decision to proceed as though that was what he'd meant.
"I was a mildly autistic kid. Now I'm an adult." Kol was twenty-six. "Okay, maybe moderately autistic. Ergo, I'm an adult autistic." He said it with more pride than ennui. For him it was a badge of honor of some kind, not a limiting label. I was cool with that, though residual autism raised a problem with number two on my need-to-be-in-therapy checklist. I had no ready intervention for that disorder in my clinical toolbox.
That first day I wasn't prepared to commit to anything diagnostically but my impression of the man sitting across from me would not have placed residual autism high on the short list of disorders I was ruling out. I cautioned myself that children with a history of autism rarely present as adults as simple grown-up versions of the child who had suffered from the early affliction, and that the aging diagnostic formulations reflected little of the rapidly accumulating wisdom about autism.
"Can you tell me a little bit about the autism? When you were younger?"
"I was an animal, man. An animal." He shot a quick look in my direction, then away. "Skittish. Scared. Didn't like to be touched. Got fascinated by weird things. Motion. I could go off on something moving for, like, ever. A second hand on a clock? Whoa. A merry-go-round? That'd be a day."
I sensed he wasn't done. I waited.
"Did I mention loud noises? They freaked me out. And I was, like, persnickety."
"Persnickety?" I was pretty sure it was the first time I'd spoken that word in my office.
"Everything had to be just so. I don't like stuff out of place." He stuck a slender fingertip into a slit on the edge of the cushion on the chair on which he was sitting. I hadn't previously been aware that the cushion had any damage. "Like this. I don't like stuff like this. It's not right. You should fix it."
I think he was waiting for me to hop up and pull out a nee dle and thread and do the job right then and there. I waited for him to continue. When he didn't I asked, "And the ADHD?"
"Textbook," he assured me. "I have the attention span of a puppy. I was a little-yellow-bus kid. Only thing was music. Repetitive, techno. You know Moby? Do you?"
He wanted an answer. I said I knew Moby. I didn't say I wasn't particularly fond of Moby.
"Moby's cool," he said. "In school? Music, yeah. Theater, okay. Some. Classes? No way, no . . . way. I lived on Ritalin. Lived on it. Bingo."
It was impossible for me to know it during the initial moments of that first session with him, but punctuating the end of sentences with the word "bingo" was one of Kol's peculiarities.
His description of his early experiences rang reasonably consistent with someone with mild autistic impairment. I was allowing for the possibility that Kol had indeed suffered some degree of childhood autism and that he continued to struggle with the aftermath. While I pondered the range of possible diagnostic sequelae—all the way from residual autism, through Asperger's, past some personality and mood disorders, to the territory most of us called normal—I gave him a full minute to resume the discussion of his symptoms on his own. He wasn't inclined to continue. He had withdrawn into an intense focus on the way the upper joint of the index finger of his left hand worked. It was interesting: he could bend his fingertip while keeping the rest of the joints aligned.
Clinically I was more than a little lost. I retraced my steps and decided to go all the way back to start.
"So how can I be of help?" It was usually my first line as I sat down with a new patient, but Kol's premature diagnostic pronouncement had interrupted the natural rhythm of the beginning of that first session.
At least I recognized that I had some catching up to do.
EIGHT
WHILE I waited for Sam and Lauren to arrive at our house I put some of the takeout in the refrigerator, some of it in the oven, fed the dogs, and set the table for dinner.
I was still thinking about Kol's explanation for all the blood.
I was thinking, too, about what he'd said: W
as it "I mean
it's not like what happened with—Your dad?" Or had it been:
"I mean it's not like what happened with . . . your dad."
My
dad? Or a generic "your dad."
Which?
No. It wasn't
possible. How could he?
A sudden nosebleed, Kol had said. "I get them sometimes. It's not a big deal. Weak blood vessel or something. Get 'em when I'm on 737's coming out of the sky. Bingo. Got one on Pirates of the Caribbean at Disneyland. Did I freak the mice-men out? Double bingo."
I didn't believe the nosebleed story, at least not a hundred percent. The rest of the patter? It felt like noise. I wondered why he'd needed it.
Diane and I shared a concern about security in our office. We kept a locked door between the unmonitored waiting room—like many psychotherapists we didn't employ a receptionist—and our clinical offices. Because of the hundred-yearsago architecture of our old building, the locked door had a secondary, unintended impact: it didn't allow our patients access to the first floor's only bathroom.
That simple fact could have explained why Kol hadn't chosen to wash up in our building's restroom. But it didn't explain why Kol hadn't just gone home. He lived only a couple of blocks away in one of the recently built, multiuse condo/loft buildings south of the Pearl Street Mall near Broadway. If he was having such a vicious nosebleed, why didn't he rush home, pack his nostrils until the bleeding stopped, clean himself up, and change his clothes before coming to our session? Wouldn't being a few minutes late for the appointment have been preferable to fouling Diane's prized fountain with his blood and then showing up for therapy looking like he'd just wandered down Elm Street and done ten rounds with Freddie?
I couldn't figure it. I tried to write it off as merely a fresh indication of Kol's peculiarity. But that didn't feel right, either.
"It's not like what happened with . . . your dad."
My intestines cramped like a clenched fist as I replayed those words in my head.
Does Kol know? Of course not.
No one knew.
Grace and the dogs all beat me to the front door to greet Sam. He arrived before Lauren; I'd been expecting them to show up together.
"Hey, Alan. Long day. Gracie! How's my favorite little girl?" He threw a heavy shoulder bag on the floor and lifted my daughter into his arms while simultaneously trying to greet both dogs. His comment about the length of the day wasn't an inquiry about how mine had gone. It was a declaration about his.
I probably wouldn't have told him about my patient who had shown up covered in blood. Some things are best not dangled in front of a police detective's eyes.
"Sorry," I said. "Lauren said you guys misplaced a witness. That's true?"
"We didn't lose her, if that's what you're asking. The witness might have misplaced herself. More likely, somebody else might have helped misplace her."
"That would complicate things?"
I didn't really expect him to respond. Finally he mumbled, "Yeah, you could say that."
"She's important?"
"You could say that, too." He looked at me as though he were trying to weigh how much I knew about the grand jury case. I kept my face impassive. "Tonight your wife and I are supposed to come up with a viable plan B."
"Okay then," I said.
He followed me from the entryway to the kitchen, dodging the dancing dogs. Grace was already bored with the adult conversation. She squirmed from his arms, said, "Hi,
Sam
. Bye,
Sam,
" and ran back toward the bedrooms where she'd been playing.
Our kitchen is at the back of a great room that has a wall of western windows that frame a stunning view of Boulder, and beyond. The "beyond" was a hundred-mile-plus section of the central Colorado Rocky Mountains from the hogbacks to the fourteeners of the Continental Divide, and from Pikes Peak to Longs Peak and then some. Sam took a seat at a stool at the counter of the kitchen island. He was facing the remnants of a sunset that was dissolving in the distance, which left me with a view of the back of his abnormally large head.
I pulled a couple of beers from the refrigerator and handed Sam a Smithwicks. He popped it open and took a long pull before he glanced at the label on the bottle, which I knew he couldn't read without fumbling to find reading glasses to stick onto his nose. He apparently didn't recognize the color pattern of the label. "So what is this?" he asked. "Should I be impressed?"
"You like it?"
"It's all right. What is it?"
"Irish ale. Smithwicks." I pronounced it "Smith-icks," with no
w,
the way a gracious publican did in Kerry after I'd mispronounced it when I'd asked for one after I began to tire of the Irish diet of stout. How many years before was that? I'd lost count. Before Lauren. All the way back to Merideth. Wife uno.
Sam elevated an eyebrow and said, "I thought they all drank Guinness."
"Misconception," I said. He didn't really care. Although he was a fan of some local Colorado craft beers, he would have been just as content with a Pabst or a Bud. For me, tasting Smithwicks was like eating fresh soda bread, or seeing thirty shades of green in the same vista. It was a little bit of Ireland, bottled.
I changed the subject. "How's Simon?"
He looked back over his shoulder toward me for a second before he returned his attention to the post-sunset colors over the Divide. "Good. Better than good." He paused. "Sherry's started a campaign to convince me that he should be going to private school in Denver. Better fit academically, she says. Better hockey team too. That's for my benefit. She doesn't really give a shit about Simon and hockey. If she had her way he would take up swimming, or ballroom dancing, or something. She thinks he's going to get hurt."
Sherry was Sam's ex. She'd been living in one of Denver's booming northern suburbs since their split. Sam had stayed in their modest house in Boulder after the divorce. He had Simon during the school year and on weekends during the summer. He liked the arrangement just fine, considering. Although he and Sherry had their share of disagreements I'd always gotten the impression that the divorce was civil.
"Sounds expensive," I said, picking the least controversial of what I imagined would be Sam's myriad objections to Sherry's plan.
"Only about a third of my salary. But Sherry's new boy friend is going to pay the tuition, or so she says." He belched—a short, vibratory thing—after the boyfriend/tuition pronouncement. "The boyfriend's generosity is supposed to make me feel better."
"Does it?"
He belched again. I gave him points for a failed effort at trying to suppress the second eruption. "Let's say we put him in private school. Number one, that means he lives with his mom during the week, not with me. That sucks. The boyfriend pays the tuition for a few months. Then Sherry dumps him like she dumped her last three boyfriends, or he dumps her like he probably dumped his last ten girlfriends. Then what? Eh?" He drank some beer. "The new boyfriend? He's an endodontist. Name's Kevin. Know what that means? Kevin does root canals all day. Then he does them all day the next day. And then he takes a day off. But the one after that? More root canals. Can you imagine? Kevin may have enough extra money to send my kid to private school, and to have a ski condo in Avon, and to buy himself some big old German car, but every one of my bad days is better than his best day. You asked me what works to make me feel better when I've had a crappy day? Well, that's what's working right now. That works just fine. Sherry's Kevin doing root canals."