Regrets Only (4 page)

“No. We’ll handle this ourselves,” Bill had replied.

“Maybe you’d want to come in. We could talk,” he’d persisted. Foster had been his patient for nearly two years. They’d spent fifty minutes together three times a week, plus endless nights on the telephone when Foster, experiencing anxiety, depression, or irrational fears, called without an appointment. He’d met him on Saturdays when he needed an extra session. He’d consulted with Foster’s pediatrician and several different psychopharmacologists as he’d struggled to find the right mix of antidepressants. He’d agonized over ways in which to deal with an adolescent who he recognized early on was in trouble. There wasn’t anything he hadn’t done, and he didn’t appreciate the insinuations to the contrary.

“The police may try to contact you,” Bill had reported, ignoring David’s suggestion. “Faith and I ask that you say nothing. We want our privacy. We want to protect Foster’s memory. This is absolutely painful enough without having his difficulties made public.”

“Would you like me to meet with his sister? This must be exceedingly difficult for her.” Even though he’d never met Foster’s twin, David had heard enough about her and the nature of their relationship to know that the news of his death would be an enormous trauma. Sibling loss was difficult; twin loss could be devastating. At least one study in identical twins showed that, if one committed suicide, there was a 40 percent likelihood that the other would at least attempt it, too.

And from what Foster had said, his sister wasn’t without her share of issues to begin with. He’d spoken numerous times about a particularly troubling incident when his sister had flown into an uncontrolled rage at their father, who had failed to remember and honor Mother’s Day. Her screaming, crying, and carrying on had lasted for more than an hour. She’d even thrown his golf clubs out the window before her tirade ended. Maybe such acting out was typical of any adolescent but, given her genetic connection to Foster, maybe not.

There had been a pause, and then Bill had cleared his throat. “Avery was at school when it happened. She hasn’t been told. Faith and I are driving up there tonight.”

“I’d urge you to at least consider the possibility of professional help. I could—”

“Dr. Ellery,” he’d interrupted. “I don’t want you to speak to anyone in my family ever again, least of all my daughter. Please send any outstanding bill to my office. My secretary will make sure you are paid promptly. Now I have to excuse myself. Good-bye.” The line had gone dead.

David stared at the certificates and diplomas that hung in bird’s-eye maple frames on the walls of his office, then at the comfortable leather couch and club chair where he sat day in and day out, helping people who suffered from all sorts of emotional problems—bipolar I and II, major depression, anxiety, personality and mood disorders, even sexual dysfunction. He’d treated dozens of men and women in his career, many of whom stopped therapy because they felt—and from a clinical point of view were—better. He’d achieved success; his former patients, his honorary degrees, the substantial grant money awarded to him, and the Jaguar parked outside were testaments to that. And yet a suicide meant he’d failed, failed in the most fundamental way.

What had he missed? Although Foster had discussed killing himself, it had never seemed to be a true threat. The references were sporadic; there was no plan.
You should have saved him.

He put his face in his hands. The pressure in his head was intense. He should never ever have taken the referral of this boy who’d been to three different therapists before the Herberts came to him and implored him to get involved. But he’d been lured by the challenge of trying to succeed where no one else had, and by Bill’s offer to pay one and a half times his regular hourly rate. His own arrogance and $225 an hour even if Foster failed to show for his appointment had convinced him.

His thoughts were interrupted by a knock. Looking up, he realized he had no idea of how much time had passed since Faith’s fateful call. Dusk was beginning to fall. Who was still around? His office was part of a suite of three that shared a secretarial station, although the sole support staff—Betty Graham—had called in sick again with a claim of seasonal allergies. He’d heard her excuses and alleged ailments so many times that the lies bored him, but she was too competent when she did show up to dismiss her. Nancy Moore, a psychiatric social worker, had given up her Monday hours to have more time to spend with her family. That meant it had to be Morgan Reese, working late as usual.

“David,” she called through the door, as she knocked again, louder this time. Her concern and apprehension masked the normally melodic quality of her voice. “David, may I come in?”

He quickly pulled a tissue from the box he kept for his patients and blew his nose just as the door opened. He swiveled his chair and saw Morgan standing on the threshold. She had sandy brown hair that she wore pulled back from her face in a thick braid, blue eyes, and smooth, pale skin, except for the dark circles that seemed her trademark. He’d never known anyone who kept the professional schedule that she did—patients, primarily children and adolescents, ten hours a day, often six days a week, a full-time research grant to study some sort of reactive attachment disorder in early childhood, plus full faculty responsibilities at the Medical School of the University of Pennsylvania. Despite what must have been chronic exhaustion, she never seemed to lack either energy or concentration.

“I heard about the Herbert boy. I’m so sorry.”

“I can’t believe it, honestly,” he said. Then he registered the import of her comment. “You heard? How?”

“It was just on the news.”

But she didn’t have a television in her office. And he’d never shared the names of his patients.

His confusion must have shown on his face because she offered, “The radio commentator reported that he’d been under psychiatric care, and . . . and identified you as his therapist.” Then she walked over and laid her hand on his shoulder. “I can only imagine what you’re going through. Do you want to talk?” The physical contact felt odd; they’d been colleagues for nearly ten years and had a professional friendship but nothing more. Even after his marriage ended he’d never asked her out. Although attractive, she’d struck him as unapproachable.

“What else did the reporter say?” He felt an emotion akin to panic and clamminess in his palms. How could his name have been mentioned publicly? How dare some radio station broadcast that information? What if his patients had heard the same program?

“Very little. Neither of his parents would comment on his death.”

“So who disclosed my name, my involvement?”

She shrugged. “You know how it is. Medical records that are supposed to be confidential never are. God only knows what the police had access to.”

“And the media wants someone to blame. Even his parents blame me, and they of all people know how hard I tried to help,” David said, feeling anger creep into his conscience. He needed to get hold of himself.

“I’m sure you did the best you could. There are limits to what any psychiatrist can do. You don’t need me to tell you that.”

He forced a smile. “I appreciate the vote of confidence.”

Morgan took a step closer to him. “We all second-guess our decisions, personal and professional, but you have to compartmentalize. I’m the first to admit I struggle with issues of distance and boundaries, as if going to medical school somehow taught us not to feel. But when the worst happens, you’ve got no choice but to remember your training. Otherwise the boy’s suicide will destroy you, too.”

He closed his eyes, listening to the sound of her voice but ignoring her words. He knew she was trying to comfort him and he also knew his focus should be on Foster, the tragedy of a life interrupted, but he found himself preoccupied with the scarlet letter that was being publicly affixed to his name, his reputation. He needed to formulate a defensive response to the accusations that were sure to be leveled against him. He needed to gather his supporters, who included Morgan, so that his career would not be tarnished by circumstances beyond his control. Short of locking Foster away in an isolation unit and having him disappear into the hidden world of private psychiatric hospitals, nobody could have done more to keep him alive.

“I’m not sure what steps to take next. I offered to help the family. They don’t want to speak to me. Do I notify my malpractice carrier?”

She cocked her head slightly to one side, considering his question. “What do you think happened?”

He thought for a moment, choosing his words carefully. “Foster suffered from recurrent major depressive disorder and had very little coping mechanism. Textbook 296.3x,” he said, referencing the
Diagnostic and Statistical Manual of Mental Disorders
. Clinical shorthand—his professional code—reminded him that he got paid to know best. And he did. He’d dedicated his life to understanding the workings of the mind. “He was noncompliant with his medication. We’d tried a number of combinations, plus we adjusted dosages constantly, but he often refused to take them as prescribed, so short of daily blood tests it was impossible to know whether we’d achieved therapeutic levels.”

“Had he gone off his meds recently?”

“I don’t know. He canceled both appointments last week. His voice sounded good on the telephone, and I didn’t push because his explanation seemed plausible given his history. His twin sister was home for the holiday break, and he said he wanted the time to spend with her. I knew they were very close.”

“A twin?”

“Yes. Based on what was described to me, their connection was more comparable to what the literature says about identical twins: an uncanny attachment, an almost sixth sense about each other. The eerie part was that, according to Foster, they even both had pits under their left ears. He was obsessed with that physical similarity.”

“Really,” she remarked, furrowing her brow.

“I can’t say I know much about a pit, but it did seem odd.”

“Pits are small indentations, common dermatological phenomena in the population at large, but most doctors would tell you they are statistically very improbable in fraternal twins. So your instinct was right. It is very unusual.”

Morgan never ceased to amaze him. Were there any medical minutiae that she didn’t know? No wonder she had virtually the entire psychiatric faculty, as well as a sizable percentage of the regular faculty at the Medical School, thinking she walked on water.

“In any event, when his sister went to boarding school last fall, Foster fell into a downward spiral,” David continued. “He felt abandoned. In my view, his parents simply did not provide the support they should have known he would need when his sister left.”

Morgan sat in a high-back chair opposite his desk. She was smaller than he’d realized, more delicate. She clasped her bony fingers together in her lap. “Are you concerned for the girl?”

“I’ve never met her, so from a professional point of view I suppose I can’t say one way or the other. But if I were her father, I would be. You’re familiar with all the twin studies.”

“I am, but there’s a big difference psychologically between identical and fraternal. As far as I can recall, nobody’s suggested there’s an elevated risk of suicide or attempted suicide in nonidentical twins,” Morgan replied.

Leave it to Morgan to remember the clinical details better than he.

She paused for a moment and then cocked her head to one side. “Why would you be concerned for the sister?”

He shrugged. “The girl just sounded volatile, that’s all. Probably nothing. She’s sixteen, off to boarding school, asserting her independence. No doubt some defiance is part of any healthy detachment process. My concerns—to the extent they’re justified—should be more generalized. It’s a terrible trauma for the whole family.”

“And the parents are undoubtedly lashing out right now,” Morgan interrupted. “Imagine what they are going through. But that doesn’t mean when the smoke clears they are truly going to hold you accountable. Anyone who knows you could vouch for your dedication and commitment to your patients.”

“From your lips to God’s ears,” David said, rising from his chair. He moved to the window, opened the blind, and glanced out at the alley behind his building. An old man bundled in layers of blankets, the same poor sot who showed up virtually every evening making rounds in search of recyclables, pushed his grocery cart filled with empty cans. The rattle of the wheels echoed.

“Were you surprised?” Morgan asked after a moment.

“Absolutely. If I hadn’t been, I would have done something to try to stop it.”

“Do either of the parents have depression?”

“I wasn’t told anything to lead me to think the Herberts do. But the kids were adopted. So as far as biological predisposition, it’s impossible to know.”

When he looked over, Morgan had turned away. She seemed suddenly interested in the collection of books in the shelf to her right. He stared at her for a few minutes before she realized.

“I’ve actually wondered whether the adoption played a role,” he continued. “The parents had just decided to tell him and his sister—after sixteen years, and over the Christmas holiday to boot. Foster took it very badly.”

She stood up abruptly. “Is there anything I can do?” she asked, still distracted.

“No. I appreciate your coming in, though.”

“You and I don’t know each other well, but if you want to talk, or there’s anything you need, please, don’t hesitate. The service can page me—as you well know—but feel free to call me at home.” She nodded and bowed slightly with an almost Oriental formality before turning to leave. “It’s a horrible tragedy, but not your fault,” she mumbled more to herself than to him as she closed the door behind her.

David checked his schedule for Tuesday and then stuffed a pile of paperwork into his briefcase. Foster’s suicide wasn’t his responsibility. He felt more confident of that having spoken to Morgan. If there was blame to be hurled, it should be thrown at the Herberts.

Perhaps he should call the media and make a comment to offset whatever damage might have been done. For a moment, he allowed himself to imagine such a tactic, one that he couldn’t resort to because of ethical restrictions but one that had a certain appeal at the moment. He’d wear a red tie, which resonated credibility, and a dark suit. As he stood before the reporters and television cameras, he’d give his own sound bite. “It’s a sad commentary that the parents of today do not take responsibility for the emotional health of their children. Simply writing a check to a professional isn’t enough. A child deserves support, love, and guidance during the twenty-three hours of each day that he or she is not in the care of a trained therapist. Only a family—only parents—can fulfill that role.”