Dante's Poison (8 page)

“What do you mean?”

“An attorney can't ethically advance a claim they know to be false. It's why criminal lawyers go to great lengths to avoid asking their clients if they're guilty. Jane understands that better than anybody. If she's not telling me the truth, it's to protect me.”

I was beginning to catch on to the problem. “Hallie, is this your roundabout way of telling me you think Jane might be guilty?”

She sighed. “I never ask that question about a client. Right now, all I have is a suspicion, and I want it to stay that way. But the whole thing worries me, along with how I'm ever going to get her out of jail. My old office decided it was a conflict for anyone there to try Jane, so I'm dealing with the bastards up in Lake County. I offered them five mil plus home detention, but they wouldn't even consider it. Bjorn's already hitting the streets—”

“Bjorn?”

“My new investigator. But it's not likely he'll find anything before the hearing. Right now, the only tangible evidence linking Jane to the crime is the eyewitness. I need to shut down her testimony fast, and I'll never be able to find a better expert in time. Will you do it?”

“If you don't think my credibility will be questioned.”

“I know it's ironic, but just let them try to make something of it. And the one good thing that's happened is that the Assistant State's Attorney they're sending down to the hearing is a total newbie. He'll never know how to deal with you.”

It's sometimes said that there are two types of psychiatrists: those who have experienced a patient's suicide, and those who will someday. Ira Levin had just joined the first and more-populous group, and he was clearly still smarting over it.

“No, I didn't write
Rosemary's Baby
,” he said, giving me a jittery handshake, “and no, I didn't have reason to think Danny Carpenter was a suicide risk.” Explaining the former, he told us that he'd been named after his maternal grandfather, who'd passed shortly before he was born. Under Jewish tradition, this freed up his grandfather's name for future generations and, being a fan of the book, Levin's dad couldn't resist.

“Your father must have had a sense of humor,” Rusty said.

“He had to,” Levin replied. “He was a pathologist for Cook County.”

It was Wednesday noon, and we were gathered at Rusty's offices on Hubbard Street, in a Victorian building that once housed the Chicago Criminal Courts and was studded with history. Leopold and Loeb had been tried there, along with Shoeless Joe Jackson, and its fourth-floor pressroom had been the hangout of such literary lions as Carl Sandburg and Sherwood Anderson. This no doubt explained the building's appeal to Rusty, whose shop occupied the top floor and included, among other amenities, a mock courtroom and a half basketball court. I wondered which one got more use. Our conference room had towering windows and a table that could have accommodated the National Security Council, in addition to a groaning board of sandwiches and soft drinks. After being steered there by Rusty, I randomly picked out one of each and slid into one of the Aeron chairs arranged around the table, stowing my cane on the floor. Rusty followed me, taking the seat to my right.

“So you grew up locally?” Rusty asked Levin, who was still hovering somewhere near the door. “Please, sit down. And have something to eat.”

“On the Northwest Side,” Levin said, selecting some lunch items and sinking into a chair opposite us. “It's where most families like ours ended up.” He launched into a brief history of the sixties and seventies in Chicago, when blockbusting was making realtors rich and the city's white population was fleeing to the suburbs. In an effort to stanch the hemorrhaging, the city council had amended the municipal code to require all of its employees to reside within its boundaries. Even without all the patronage jobs it was a clever idea, and one that had probably saved Chicago from a fate worse than death—namely, Detroit's. “My father worked for the County, so we didn't have to stay in the city, but he had a lot of friends on the police force, so we moved with them. Where we lived in Edison Park every other kid's dad was a fireman or a cop,” Levin explained, “and practically everyone attended Catholic schools. I obviously couldn't, so my parents sent me to Solomon Schechter.”

Rusty used this as a springboard for a series of questions about Levin's education, taking him through college at the University of Illinois and medical school at Wisconsin, where he had also done his residency. A two-year fellowship in child psychiatry at UCSF followed, after which Levin had moved back to the Chicago area. While they were talking, I removed the toothpicks from my sandwich and discovered the mystery meat inside to be turkey—not my favorite but better than one of the vegan offerings everyone now seemed compelled to offer.

“I wanted to stay in the Bay Area, but my parents were ailing, and my wife wanted to be closer to her family in Milwaukee,” Levin was saying. “So we came back and settled in Glencoe. Other than the weather, I have no regrets. It's a good place to raise a family and I can actually talk to some of my patients.”

The small talk seemed to have calmed him down some.

“So you do traditional therapy, then?” I asked, swallowing the last of my sandwich and wiping my face with a napkin. From what I could tell, Levin hadn't yet taken a bite of his.

“Whenever the patient—or more accurately, his or her parents—can afford it, which in that area is quite a few. It takes up eighty percent of my practice.”

I was beginning to like him.

Most people visiting a psychiatrist for the first time have been conditioned to expect a concerned, nonjudgmental professional who will spend long hours ferreting out their childhood traumas while they relax on a couch in a tastefully appointed room. But advances in drug treatments, along with simple economics, have long rendered that picture obsolete. These days, the majority of psychiatrists are psychopharmacologists, doling out whatever cocktail is called for by their patients' symptoms and referring them elsewhere for counseling. A doctor can see four times as many patients an hour in a practice devoted to prescribing and monitoring medications, and while most patients do better with talk therapy, it's expensive and infrequently covered by insurance plans. I'd resisted the trend as much as I could—I hadn't gone to medical school to become a glorified pill pusher—but it was easy to see why many psychiatrists, especially those in private practice, would opt for the more lucrative alternative.

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.”