Blues in the Night (15 page)

twenty-five

Monday, July 21. 1:38
P.M.
6600 block of Yucca Street. A man was thrown from a fourth-floor apartment balcony by a suspect who approached the victim, asked if he was OK, then offered to provide the victim with protection. When the victim declined, the suspect demanded money, then threw the victim from the balcony. (Hollywood)

The Korwin Clinic was housed in a two-story, beige-pink stucco building in Reseda in the San Fernando Valley. The offices, examining rooms, and common areas (game room, dining area, exercise room, visitors’ room) were on the first floor; the bedrooms for residential patients, on the second. In its prior life the structure had been an assisted-living facility.

I learned all this from Eileen, the pleasant, matronly brown-haired receptionist, while I waited in a small anteroom to see Lawrence Korwin, with whom I’d scheduled an appointment before leaving my apartment this morning to do my rounds at the various police stations, gathering data for the
Crime Sheet
. I had visited Northwest, Culver City, and Wilshire. I still had West Hollywood and Hollywood to cover (the
Crime Sheet
hopes to expand coverage to include the Valley soon), but I wanted to do the latter when Connors was there. I’d phoned the station several times, but he was out in the field.

There were handsome, full-color brochures on a wood coffee table in the reception area. I picked one up and learned that the clinic was staffed by a team of psychiatrists, psychologists, and other experts with vast experience in the field of women’s mental health, including but not limited to mood disorders and premenstrual, natal, postpartum, and perimenopausal depression.

“We’ve been open only two years, and we’re really doing well,” Eileen informed me proudly. “Many of the women are outpatient, but we’re getting so many new residential patients that we’ll have to start turning people away. Six months ago I didn’t know if we were going to make it.”

“Have you been with the clinic long?”

“From the start. This is a dream come true for Dr. Korwin. He was nervous about doing something on such a large scale, even with backing. But the book’s prepublicity helped, and now that it’s out, we’re getting calls from women all over the country. It just came out last week. Have you read it?”

Lenore had the book, so Korwin had probably given her an advance copy. “Not yet. But I plan to.”

I’d looked up Korwin online on the Google search engine and had read about the thirty-eight-year-old psychiatrist’s background and accomplishments. Pages and pages of dissertations, and several reviews of his new book. I hadn’t heard of it until I’d seen the copy in Lenore’s apartment, but plenty of others had: He’d made the L.A.
Times
and
New York Times
nonfiction bestseller lists, and his Amazon ranking as of this morning was forty-three. That was in Stephen King and Grisham territory. My best Amazon ranking for
Out of the Ashes
was 987, and that was only for an hour. The next hour the book plummeted to 5,081, where it hovered for a day before settling into the twenty thousands. This morning it had been at 76,892, which isn’t bad, considering the book has been out for a year. (Have I mentioned that I’m compulsive?)

“It’s absolutely wonderful.” Eileen handed me the glossy hardcover sitting on her desk. “Dr. Korwin publishes medical monographs all the time, but he wanted to reach women who didn’t have easy access to a mental health practitioner or didn’t realize they needed help.”

I looked at the cover.
Rock-a-bye Baby: When Baby Blues Won’t Go Away.
Below the title was a drawing of an empty cradle rocked by the hand of a shadowy figure of a mother. Underneath that was Korwin’s name. Below that,
What every woman needs to know.
The back cover was crowded with testimonials from medical practitioners to Korwin, whose friendly, bearded face smiled at me from the back inside flap, above an impressive alphabet of degrees.

“He’s doing
Good Morning America
and
The Today Show
, “ Eileen said. “He’s been asked to chair a symposium in the Netherlands next year. It’s been amazing and overwhelming. You’re lucky he had a cancellation, or he wouldn’t have been able to see you until next week.”

I wondered if he still had time for his patients. “Is Dr. Korwin married?”

“To his work.” Eileen smiled. “He’s the most caring person I’ve ever met and takes great interest in every patient. They all adore him.”

What Nina had said. “Does he see every patient personally?”

“Absolutely.” She seemed offended by my question. “Dr. Korwin does the initial evaluation, and consults with the doctors on staff to create a therapy program. And he follows up regularly. You said you’re a reporter. Is this for a newspaper or magazine article?”

“I’m not sure yet.” I glanced at my watch.

“He’s running a little late.” She picked up the phone receiver and pressed a button. “Dr. Kor— I’m sorry. I just wanted to remind you that Miss Blume is here.” She put down the receiver, her face flushed. “He’ll see you now. We’ve had a stressful few days because of a crisis, and he hasn’t been himself.”

“You mean Lenore Saunders’s death. I saw on the news last night that she was Dr. Korwin’s patient.”

Eileen sighed. “What a horrible tragedy. I don’t think I’ve ever seen Dr. Korwin so shaken. Her mother phoned on Friday, and I didn’t know what to say. And of course, patients have been calling nonstop, needing reassurance.”

Korwin met me at the door and escorted me to one of the black leather chairs in front of an oversized mahogany desk cluttered with books and papers. My kind of guy. He was wearing suspenders over a light blue shirt that strained across his gut. His handshake was firm, and his eyes were a warm brown.

“Sorry I kept you waiting,” he said when he was seated. “It’s been a little hectic the past few days.”

If he was tense, he was covering up well. “Congratulations on your book. Your receptionist filled me in.
Good Morning America. The Today Show.
” I smiled. “You’ll be a household name right up there with Tom Cruise.”

“Eileen’s my biggest fan.” Korwin’s grin was ingenuous. “It’s a real kick at first, and my parents are thrilled. Now they can tell all the neighbors that their weird kid made it big. But you wanna know the truth? I hate flying, and I hate hotel rooms, and I hate the whole media circus. I’d rather be here at the clinic. This is where it comes alive for me.” He waved his hand.

I like to think that I’m a good judge of people, and I have to say he sounded sincere. “So why do it?”

“It sells books, so it makes my publisher happy, and they’ll publish my next book. Listen, I’m grateful the shows
want
me. Despite what you said, Tom Cruise I’m not.” He pointed to his paunch. “Without the media exposure, I’d reach a handful of women. My goal is to reach thousands, tens of thousands. The more, the better.”

“Women suffering from postpartum depression.” I took out my notepad.

“Women who are pregnant or contemplating becoming pregnant or have just given birth. Ten to twenty percent of new moms suffer from postpartum depression, maybe more. One to two in a thousand suffers from postpartum psychosis—again, maybe more. I want to help them and protect them from themselves, and protect their babies. And if elected . . .” He smiled again. “Sorry for the speech. I get carried away.”

“Good speech.” I smiled back. “So what’s the difference between depression and psychosis?”

“You know about baby blues, right? Happens to most moms right after birth and lasts a couple of days. Postpartum depression is more intense and doesn’t go away after a week or two.”

“Describe ‘intense.’ ”

“A woman with postpartum depression feels uncontrollably miserable and has some, but not necessarily all, of the following symptoms. She’s crying daily, has trouble sleeping, and not just ’cause the baby’s keeping her up all night. She loses interest in doing anything, can’t concentrate or make decisions. She feels listless, worthless, guilty, inadequate as a mother. She worries excessively over her child’s health. She loses her appetite, and feels an overall sense of helplessness. She thinks about death and suicide.”

A catalog of gloom and despair. Was that what Lenore and other mothers like her felt all day, every day? I scribbled madly to keep up, engulfed with a wave of sadness. “What about psychosis?” I asked, wondering how anything could be worse than what Korwin had just described.

“It’s far more severe and usually strikes in the first two weeks to one month after delivery, although it
can
start later. In extreme cases, it can lead mothers to harm themselves or their babies. By the way, we’re the only Western country that puts postpartum psychotic mothers in jail. Other Western countries, like England and Italy, recognize that new moms are particularly vulnerable to mental illness that could, in some cases, lead to infanticide.”

I shuddered. It was a horrible word. “What are the symptoms?”

“Obvious mood swings, extreme insomnia. Excessive concern about the infant. Hallucinations—seeing or hearing things that aren’t there, like hearing voices when no one’s around. Or delusions—having thoughts that aren’t based on reality. A mother may be convinced that someone is trying to harm her, or that her baby is the devil.”

What had Lenore seen in her baby’s eyes? What had she heard in his cry that had caused her to shake him to death? I tried to picture a mother gazing at the face of a newborn and seeing the devil, but it was beyond me. It was a place I didn’t want to go.

“The risk of psychosis after childbirth is twenty times higher than the risk before pregnancy,” Korwin added. “Did you know that?”

I shook my head.

He grunted. “I’m not surprised. We doctors know all about gestational diabetes, preeclampsia, and preterm delivery, but even though postpartum depression is more common, it hasn’t received equal attention in contemporary medical literature, training, and clinical practice.”

“Until Andrea Yates.”

“That’s postpartum
psychosis
, not depression,” Korwin corrected, his voice stern.

“Sorry.” I’d obviously pushed a button.

“It’s upsetting when the media carelessly label Yates and other women like her who killed their children ‘depressed.’ Postpartum depression and psychosis are two completely different entities. PPD doesn’t lead to psychosis. It’s not like a flu that can become pneumonia.”

“Okay.”

“It’s not just a question of semantics, Miss Blume. Say you’re a mother with PPD and you heard a news broadcast about Andrea Yates or someone like her, and the reporter said she’d killed her child because she’d been suffering from PPD. Can you imagine how stigmatized you’d feel, how terrified that you might end up killing your own child? And what if that stigma prevented you from seeking help?” He stopped, his point made, but he was still frowning.

“I can see what you mean. So postpartum depression is a relatively new diagnosis?” I asked, seeking safer ground.

“Actually, in 460
B
.
C
. Hippocrates talked about puerperal fever and theorized that suppressed lochial discharge traveled to the brain, where it produced agitation, delirium, and attacks of mania.”

“Lovely theory.” I had no idea what lochial meant, but it didn’t sound pleasant. And “discharge” has never been one of my favorite words.

“You like that?” Korwin smiled. “Here’s another. An eleventh-century gynecologist thought that if the uterus was too moist, the brain would fill with water, and the excess moisture would spill into the eyes, causing the woman to involuntarily cry. I know,” he said, seeing the expression on my face. He leaned forward, his hands clasped. “My point is that postpartum depression has been around a long time. Left undiagnosed and untreated, it can have devastating consequences. In New York State, by the way, the law says new moms have to be advised that one in ten women will have a depressive episode, and that one or two in a thousand will suffer postpartum psychosis. I’d like to see that happen nationally.”

I could see why Nina and Lenore admired him. He was passionate about his field, caring, charismatic. “Won’t that make moms with baby blues more nervous?”

“Better nervous than unaware. And remember, baby blues go away after a few days. The goal is to have women who need help
get
that help.”

“Why wouldn’t a woman who’s feeling all those symptoms want to get help?”

“Good question.” He nodded his approval. “Maybe she can’t distinguish between feeling miserable and feeling exhausted and overwhelmed. Maybe she’s embarrassed to admit she’s depressed. She’s getting congratulatory phone calls and visits, the baby’s being showered with gifts. She’s supposed to be thrilled. Or maybe she thinks she’s a failure if she admits she needs help. So she tells herself things will get better if she hangs in there.”

Korwin was echoing what Lenore had told Robbie. “So what
is
the cause of postpartum depression?”

He leaned back against his chair. “There are several factors. First, there’s the patient’s medical history. Did she suffer from depression before becoming pregnant? Depression in women, by the way, is twice as common as in men. Is there a history of depression in the family? If we’re dealing with psychosis, is there a previous history of postpartum psychosis, or of a bipolar mood disorder or schizophrenia? Second, what about the home situation? Was she unhappy to learn she was pregnant? Was her partner unhappy to learn she was pregnant? Is she having marital problems? Did she recently have a stressful incident in her life? By the way, adolescent moms have a much higher rate of postpartum depression.”

According to Jillian, Robbie had wanted a divorce even before the baby was born. And Nina had said that the marriage had problems, that Lenore was unhappy because Robbie was away so much, that she’d suspected him of cheating on her. Had Lenore worried that Robbie would leave her and go back to Jillian, just as her father had left her mother?

“And then there’s the biochemical component,” Korwin said. “Estrogen has been shown to inhibit depression. Immediately after childbirth, there’s a dramatic drop in progesterone and estrogen, which causes changes in the chemicals in the brain. We think that in some women, those changes can trigger postpartum depression or psychosis.”