Therapy

“Yes… I found that worrisome. Then again, the human brain- especially the young human brain- can be wonderfully plastic. I was hopeful.”

“For full recovery?”

She shrugged.

“Plasticity,” I said. “You do neuropsych.”

She studied me for half a second. “I keep up with the journals. There was no need for neuropsych because the organic end was being handled by a neurologist. He and I agreed there was nothing further to be gained by subjecting Gavin to yet more tests. What the patient needed was emotional support, and my job was to provide it.”

I pulled out my notepad. “Dr. Singh.”

“Very good man.”

“Did he refer Gavin?”

She nodded.

“When?”

“Gavin’s been in treatment for about three months.”

“Seven months after the accident.”

“It took a while for things to settle.”

I pretended to read the pad. “He was referred to your group, not to you directly.”

“Pardon?”

“I’ve been told that Gavin began with one of your partners but switched to you.”

She crossed her legs. The black marble pedestal blocked most of the movement, but I could see the tip of one red shoe. “Now that you jog my memory, that’s exactly what happened. Singh referred Gavin to the group and Franco- Dr. Gull- was on call. Franco saw Gavin a couple of times, then I took over.”

“Problems between Gavin and Dr. Gull?”

“I wouldn’t term them problems,” she said. “Back then- immediately after the accident- Gavin was extremely irritable. Once again, par for the course. You know how it can be with therapists and patients. Sometimes you mesh, sometimes you don’t. And Franco’s patient load was already heavy.”

The black eyes found mine. “Like with you and Teresa Wetmore. I’m sure most of your patients adore you and trust you. But others… are you with the police full-time or do you still see patients?”

“I do short-term private consults.”

“No therapy?”

“Not usually.”

“Private practice can be tough,” she said. “The HMOs with their nonsense, the thin referral stream when money gets tight. I suppose working for the police can be helpful providing a nice steady income.”

“I’m not employed by the police. I do short-term consults for them, too.”

“Ah…” She smiled. “Anyway, Gavin did become my patient, and I felt we were making progress.” Her legs uncrossed, and she shifted forward in her chair. “Alex, I can’t think of anything I could tell you that would help a police investigation.”

“What about Gavin’s obsessiveness?” I said.

“I wouldn’t call it that. Nothing on the level of a full-blown OCD. Gavin could be a bit persistent, that’s all.”

“Getting an idea in his head and not letting go?”

She smiled. “You’re making it sound more pathological than it was. He could be a bit… enthusiastic.”

“His parents said he’d switched career goals. From business to journalism.”

That seemed to surprise her, and I wondered how well she’d known her patient.

“People change their minds,” she said. “Young people especially. Sometimes tragedies get people to focus on what they really want to do.”

“Is that what happened to Gavin?”

Noncommittal nod.

“Did he have any plans to return to college?”

“It was hard for him to stay motivated, Alex. One of my goals was helping restore a sense of meaning to his life. But it had to be gradual. Gavin was still wrestling with the changes.”

“So he’d slowed down cognitively.”

“Yes, but it was subtle. And, I believe, exacerbated by emotional stress. I’m curious, Alex. Why are you so interested in his personality?”

“I’m interested in his obsessiveness because the police are wondering if it could’ve gotten him into trouble.”

“How so?”

“Angering the wrong person.”

“The wrong person.”

“Anyone who’d react violently.”

She touched a finger to her lip. “I’d be surprised at that- Gavin consorting with violent people. He was a nice boy, a conventional boy. He certainly never mentioned anything like that to me.”

“Was he pretty communicative?”

The black eyes rose to the ceiling. “How shall I put this… like many young men, Gavin wasn’t much for introspection.”

“What did he talk about?”

“I was working on getting him to open up about his feelings. Anger at feeling different. Guilt, about surviving the accident. Two of his friends were killed, you know.”

I nodded.

She said, “My sense was that Gavin knew he’d lost something- an edge, a sharpness- but he had trouble expressing himself about it. I suppose that could’ve been aphasic. Or just a postadolescent male’s lack of verbal skills. Either way, I knew he was wrestling with his feelings. I couldn’t push him too hard, Alex. One time, though, he did express himself in a way that I thought was extremely eloquent. This was just a few weeks ago. He came to session looking downcast. I waited him out, and finally he punched the arm of the sofa- that sofa- and shouted, ‘This is fucked, Dr. K! To everyone else I look okay, everyone keeps telling me I’m okay, but I know I’m not okay.’ Then he stopped, his chest was heaving and he was flushed, and the next time he spoke it was so soft I could barely hear him. What he said was, ‘It’s like one of those android movies. I’m not me, anymore, I’m still the box I came in, but someone’s fucking with the wiring.’ Then he said, ‘I really miss being me.’ And, finally, he cried. I thought it was a breakthrough, but the following week, he canceled his appointment, and the one after that. I’ve only seen him once, since then, and during that session it was as if nothing had happened. All he wanted to talk about was cars and sports. It was as if we were starting from square one. But that’s how it goes with young men.”

I said, “Did he talk about his social life?”

“Social as in dating?”

“Yes.”

“There’d been a girlfriend, some girl he knew in high school. But that was over.”

“Because of the accident?”

“That would be my assumption. Once again, I needed to step around personal topics.”

“Gavin was guarded about his outside life.”

“Very.”

“Did he mention any other girls?”

She shook her head.

“Would you mind looking at a picture of the girl who was killed with him? It is a morgue shot.”

She shuddered. “I don’t see the point.”

“No problem.”

“No, you might as well show it to me,” she said. “I need to integrate all this misfortune.”

I placed the death shot on the glass tabletop. She didn’t attempt to touch it, just stared at it. Her mouth lost determination. A vein pulsed at her temple. Rapid pulse.

“You know her?” I said.

“I’ve never seen her in my life. I’m just imagining. The way it was for the two of them.”

CHAPTER 7

Mary Lou Koppel walked me out of her waiting room and watched me descend the stairs. When I paused to look back, she smiled and waved her fingers.

Back home, I checked my messages. Three nuisance calls and Allison letting me know she’d had a cancellation, it had been a long time since we’d seen a movie, did I have time tonight? I phoned her exchange, said how about di

Next, I booted up the computer, logged on to my faculty MEDLINE account, and reviewed articles on closed-head prefrontal injuries. With serious brain trauma, bleeding and lesions showed up on X-rays or CAT scans. But in less dramatic instances, the damage was subtle and invisible, the result of something called axonal shearing- a microscopic shredding of nerve fibers. Those cases resisted neurological tests and could be best diagnosed by neuropsychological evaluation. Instruments like the Wisconsin Card Sort or the Rey-Osterreith Complex Figure test pulling up problems in attention and thought and information processing.