Guilt (10 page)

He had an endless capacity to be fascinated by the intricacies of the human mind. Annie felt a rush of tenderness. She wanted to reach out and touch his face, outline his jaw and chin with her fingertips.

“While she's given us dreams to help us deal with our feelings, she's also disconnected the motor system during sleep. Otherwise, we might go running around, smashing into walls in our sleep. But sometimes, when you're in the borderland between sleep and wakefulness, your dream factory continues full blast. You're awake, but you feel like you can't move because your motor system is still disconnected, and at the same time you can get these very intense visions. It's not uncommon.”

Another memory came back to Annie. She was young, maybe six years old, and it was right after her grandfather died. She'd be trying to fall asleep and there he'd be, sitting at the foot of her bed. He'd had on his favorite red-and-green plaid flannel shirt, and she could smell his pipe. It wasn't scary at all. He sat there and told her the story of Rumplestiltskin, her favorite fairy tale, and she fell asleep.

“It can happen when you're falling asleep, too,” Peter said when she told him about it. “We've got another twelve-syllable word for that. When you're under stress and your defenses are lowered, like when you're grieving, you can become more susceptible. Did it upset Jackie?”

“She was excited, actually. Do you think she needs to see a shrink?”

Peter gave her a funny look. “A woman married to an abusive husband for seven years, who's still calling him on the phone, and you're asking me if she needs therapy?”

“You know what I mean. To deal with these visions.”

“Probably not. It's pretty normal. Sounds like she's working them through by herself.” There was a pause, and Peter looked away. “Actually, seeing someone you care for who's died can feel like a gift.”

Annie didn't ask, but she was pretty sure Peter was talking from firsthand experience. She knew she'd never have him one hundred percent as she might have if he'd never been married to Kate, and she knew the feeling of loss was something he'd never be without. That was okay. If Kate visited him from time to time, that was okay, too.

11

T
HE NEXT
morning, Peter left home in what should have been plenty of time for morning meeting. He made a stop at a crowded Starbucks, then drove to the Pearce, where he sat waiting his turn in a line of cars backed up at the gate. For the first time in the ten-plus years he'd been working there, a uniformed guard stood outside the gatehouse Peter had mistaken for a telephone booth the first time he'd driven onto the grounds. The guard was checking IDs before letting anyone drive in. Seemed like a ridiculous precaution since the grounds went on for unfenced acres. Anyone with the determination and stamina could wander in on foot, armed with as many Uzis as he could carry.

By the time the guard eyeballed Peter's ID and gave the inside of his car a perfunctory glance, Peter was officially late. Then he had to poke along at the required ten miles an hour over the road that snaked across the rolling grounds, past manicured lawns and geometrically shaped bushes.

Peter wasn't surprised to find the parking lot nearest the Neuropsych Unit full. He had to park in the big lot and hike back.

“It's your fault I'm late,” he told Kwan when he arrived and handed Kwan his chai latté. “You're the one who got me started on yuppie coffee. What a mob at eight in the morning.”

“I've been here since six,” Kwan said, sounding surly. His impeccably tailored suit did look a bit rumpled. “Catch up on your beauty sleep?” He opened the container. “You'll put this on my tab?”

Peter peeled back the lid of his double espresso and took a sip. There was nothing like that first strong, solid hit of caffeine. He checked the whiteboard. There were the names of eighteen patients. That meant the unit was full. Full was good. It kept hospital bean counters off their backs.

Sunlight was trying to make its way in through the conference room windows, which, like the windows of most psychiatric hospitals, were covered with mesh screening. With its massive fireplace and ornate mantel, the narrow room seemed lopsided. It was half of what had once been an elegant sitting room in the good old days when the rich and famous spent months at the Pearce getting their beaks clipped and their feathers soothed.

Peter took Gloria's latté out of the bag just as she arrived, breathless.

“Sorry. Trying to get a few things sorted out,” she said, digging into her pocket for money. Peter waved her off.

Gloria had been in early, too, but the collar of her white oxford shirt was stiff, and the crease was still in her khaki trousers. It was her short hair that was going in all directions, the comb lines long gone.

She removed the lid and took a sniff. She sat and drank, then sat back and sighed, a look of contentment on her face. How on earth could decaf be that satisfying? It was like drinking nonalcoholic beer. Why bother?

When the rest of the staff arrived—social worker, occupational therapist, a couple of interns, the new psych fellow, and two mental health workers—Peter started the meeting. They did a quick once-around of what was up. Everyone agreed there was an extra level of agitation on the unit. The bombings remained the
topic du jour
in the common room and it was coming up in every group.

“No matter how I try to steer them to individual work, the focus keeps shifting back to these bombings,” said the social worker.

Even the demented patients were affected, Gloria told them. Take Mr. Sanchez, for example. He had no idea what year it was, where he was, or whether he'd eaten breakfast. Now all of a sudden he was talking nonstop about the time he and his brother had been attacked by a machete-wielding robber in Colombia fifty years ago.

“If you ask him specifically about the bombing, he hasn't a clue. But it's as if he's channeling everyone else's anxiety.”

Peter wasn't surprised. The emotional component survived long after dementia destroyed short-term memory. Mr. Sanchez had probably forgotten whatever he may have heard people say about the bombings, or even that there had been bombings; what stuck was the aroma of fear, which in turn hooked itself onto scary events in the past that he could recall.

They settled down to work, starting with the new admission. Peter pulled the file from the rack and read out the salient points. “Rudy Ravitch. Male. Thirty-five years old. Security guard at the Cambridge Courthouse. He was on duty day before yesterday.” Around the table there was a collective murmur of sympathy. “Struck in the head by debris. Unconscious for a brief period. Ten at the scene on the Glasgow Coma Scale.” Mild head injury. That hardly rated a trip to the Pearce. There had to be more.

“He was taking a break when the bomb went off,” Kwan explained. “A chunk of debris came down on his head. EMTs treated him at the scene. Took him to the ER. Kept him overnight, then released him. Yesterday he shows up at the ER at the Faulkner. Dizziness. Shortness of breath. Severe chest pain.”

He went on. “They worked him up. CT scan. EKG. Blood tests. Nothing. Now they've got him attached to a Holter monitor. No doubt about it, there's something going on, but it doesn't look like a heart attack. They release him. On his way out, he collapses again. This morning they ship him to us to rule out PTSD.”

Ruling
out
post-traumatic stress disorder involved ruling
in
an insult to the brain that could account for the symptoms. “No history of seizure?” Peter asked.

Kwan shook his head.

“Not on any meds? No drugs in his system?”

“Nothing to write home about. He'd taken a couple of Advil, but that was—” Kwan broke off and sat forward, alert. There was a commotion in the hall.

Gloria and Kwan exchanged a look, and everyone headed for the door. A heavyset man Peter hadn't met before was in the corridor, bent nearly double and groaning. One of the nurses was propping him up, helping him in through the doorway from the screen porch.

A well-practiced team, they sprang into action. Peter and Kwan rushed over to assist the patient, while Gloria went for a wheelchair. The man had his hand clutched to his chest and his face was glazed with sweat. A three-inch gash in his head, lined with stitches, was purple against his pale skin. This had to be their new patient, Rudy Ravitch.

His face twisted in agony as they eased his rigid body into the wheelchair. “Oh, god, it hurts. I can't breathe. My back—” he said, gasping. “I'm dying.”

Kwan listened to Ravitch's chest while Peter crouched in front of him.

“Just keep breathing and try to relax,” Peter said. He could smell cigarette smoke. The nurse had probably taken Ravitch outside for a smoke. “You're going to be all right.”

After examining Ravitch, Kwan called a technician to administer an EKG. Later that morning Kwan called Peter in his office. As they'd both suspected, test results ruled out heart attack. That left the default diagnosis: panic attack. The symptoms were nearly identical to a heart attack, just as painful and terrifying to experience but not life-threatening. After what Ravitch had witnessed, panic attack seemed an entirely appropriate aftermath.

The standard treatment for panic attacks would have been an anxiolytic such as Xanax and a few weeks of behavioral therapy, but Ravitch's head injury complicated things. Kwan ordered an MRI. They needed a closer look at Ravitch's brain before deciding what to do next.

*   *   *

“I heard this place was a country club. So where's the first tee?” Ravitch asked with a nervous chuckle. He and Peter were sitting opposite one another in the examining room. Peter had asked him if he'd be willing to talk to MacRae, and he'd agreed.

“So, you play golf?” Peter asked. Ravitch nodded. “Unfortunately, you're fifty years too late. There used to be a golf course right on the grounds.”

Ravitch looked around the room, taking in the floral watercolor on the wall. His look said: How the hell did I end up here?

“You a shrink?” he asked, addressing a blue-and-white Chinese vase lamp base.

“A neuropsychologist. That's someone who studies the relationship between behavior and what goes on in the brain.”

Ravitch's jaw tightened. “I'm not crazy.”

“Yes, well, that's our working assumption as well.”

He seemed startled, and for the first time he looked right at Peter.

“And since your problem doesn't seem to be heart disease, either, the likeliest scenario is that you're having panic attacks.”

Peter told him he wanted to hear more about what had happened to him, and then he was going to administer some psychological tests to help determine the best treatment.

“I smoke,” Ravitch said. It sounded like a non sequitur, but it wasn't. “That's what I was doing when it happened. I was out in front of the building, lighting up. My buddy, Leon, he's an ex-smoker, so he's sympathetic. The other guys, they're all a bunch of stiffs.

“So Leon tells me it's okay, he'll cover for me.” He grimaced and shook his head. “You know what happened to Leon?” His voice broke and his shoulders heaved. Tears flowed down his cheeks. For a few moments, he couldn't say anything. “Pieces. He got blown into pieces. His wife won't even get a whole body to bury. Jesus Christ, what a shitty thing to happen.”

There was a box of tissues on the counter. Peter got it and put it between them. Ravitch took one and wiped his eyes, then blew his nose. Peter waited before going on.

“And what happened to you?”

Ravitch held the tissue tight in his fist. “Me?” He blew his nose again. “I'm outside, and the next thing I know I'm on the ground. I can't see. I'm sitting there, trying to figure out what the hell just happened. It's really quiet and I realize I can't hear anything. I clap my hands and I can't hear them. Even after I wipe the blood out of my eyes I still can't see straight. But I can see enough to know that there must have been a bomb, and I can tell it was in the lobby. I try to stand up and the place starts spinning and I'm back on my ass again.” His voice shook with emotion. “All I know is I've got to find Leon and I can't fuckin' see, I can't fuckin' hear, and I can't fuckin' stand.” His face contorted and his eyes screwed up. Tears started again. He bent double and put his face in his hands.

Peter sat back and waited. Ravitch would need to return many times to the moment of the explosion, to the minutes before and after, and to all the surrounding events before he'd be able to talk or think about them without breaking down.

Finally Ravitch sat back. He stared into his lap, the tissues clutched in his fist.

“Sounds like a pretty harrowing experience. How long before your hearing came back?”

“I'm in the ambulance, on the way to the hospital, when I realize, thank god, I can hear the siren. I ask the guys in there with me about Leon but they don't know anything. They take me to the emergency room and stitch me. My head's hurting like hell. They keep me overnight.

“Next morning, I get Leon's number from information. Call his wife. That's when I find out, Leon passed away.” His body went slack and he stared out in front of him with vacant eyes.

Ravitch roused himself. He gestured. “I went over to Leon's house. Christ almighty, there's a
FOR SALE
sign on the lawn. Leon was retiring and they were moving to Florida.” He kneaded his hands together. “I'm sitting outside on the porch, taking a smoke. You can't smoke anywhere anymore. For chrissakes, gotta go to New Hampshire to have a beer and a smoke.”

“So you're outside?”

“Right. I need a smoke, but I'm trying to make it quick. I light up. Inhale. And that makes my head hurt, so I'm taking little puffs, and all of a sudden I can't breathe. My heart is pounding and chest feels real tight. And my back—it's like someone's driving a knife in between my shoulder blades, driving it and banging it in there. I'm sure I'm having a heart attack.”