Psychopath (5 page)

A young woman near the back of the room raised her hand.

Jonah nodded toward her.

"How did you figure this out?" she asked.

"By listening to Benjamin," Jonah said.

"He didn’t say a word," the young woman said.

"Exactly," Jonah said.

"Exactly, what?" another man in the middle of the audience asked.

"Benjamin’s complete silence was my first clue to what was wrong with him," Jonah said.  "If he had uttered a single word, I would have been tempted to wonder what it meant psychologically.  If he had cried, I may have taken time trying to get him to tell me about his sadness, or what other symptoms of depression he might be experiencing."  He paused.  "Benjamin helped me to focus.  The key was to sit with him in silence and observe what I could without words or feelings getting in the way."

Paul Plotnik cleared his throat as he raised his hand.

Jonah nodded to him.

"Before we call in a neurosurgeon, shouldn’t we get that MRI?" he asked.  "Can you be certain it won’t be normal?"

"I can’t be certain," Jonah said, "but I would be shocked if it were."

Plotnik looked away.  His shoulders slumped even more.

Jonah wanted to rehabilitate him.  "Dr. Plotnik’s psychological theory," he said to the audience, "strikes me as very plausible, by the way.  Benjamin’s illness could indeed have been caused by his father’s abrupt departure from the family."

Plotnik looked back at him.  "Didn’t you just say he has a brain tumor?"

"Glioblastomas incubate as long as six years before spreading," Jonah told him.  "That takes us back to the time Mr. Herlihey walked out on his family.  Let’s not forget:  the limbic system is the brain’s emotional control center.  No one can know for sure that losing one’s father couldn’t spark a malignancy there.  Why should that be less likely than stress damaging the heart?"

Plotnik stared back at Jonah.

"And who’s to say," Jonah continued, shifting his gaze back to the entire audience, "if Mr. Herlihey had told the whole truth about the months he went missing whether that could have somehow bolstered Benjamin’s immune system, raised his level of antibodies, maybe even made his tumor remit?  Truth has the power to heal."

Jonah saw that Craig Ellison was watching him with a kind of reverence.  He decided to go the extra mile and bring out the whole truth about why Paul Plotnik had missed the boat with Benjamin.  He looked back at him.  "What’s equally interesting, Paul, from a psychological standpoint, is that you know from your own experience something about what Benjamin has suffered neurologically."

Plotnik looked at Jonah quizzically.  "Are you talking about my stroke?"

"Yes," Jonah said.  "Would you mind terribly if I use your experience to make a teaching point?"

"Not at all," Plotnik said, no resentment left in his voice.

"Your stroke," Jonah said, "was minor.  But judging from the particular facial muscles affected and the overcompensation of muscles on the right side of your body — that strong handshake of yours — the brain injury was probably in an area of motor cortex adjoining those that control mood and language."

"Exactly," Plotnik said, incredulous.

"So that right after your stroke you would have not only felt physically weak, but would have had trouble with word finding — and with depression."

"A bit."

"And both largely resolved as the affected brain tissue healed."

"Resolved completely," Plotnik said.

Jonah didn’t feel the need to point out that Plotnik’s speech and appearance had not completely returned to normal — and never would.  But Plotnik’s refusal to accept the continuing impact of the stroke reinforced Jonah’s suspicion.  "It’s possible that your not wanting to think about your brain injury would make it that much harder to recognize Benjamin’s.  Your first impulse might be to try not to think of it."

Plotnik squinted at Jonah.

"I think that’s going out on a limb," Craig Ellison said.  "As you’ve said, none of us would have been likely to get an MRI in a case like—"

"No, Craig," Plotnik interrupted.  "I think he’s right."  He turned to Ellison.  "Diagnosing Benjamin’s pathology would have meant revisiting my own — thinking about my stroke again.  That’s something I haven’t been willing to do."

"So you presented the case here," Jonah said.  "You knew there was something about Benjamin you might not be seeing."

Plotnik nodded.  "A clinical blind spot."

"And you dealt with it by bringing him before other eyes.  Ours.  You got him the help he needed."

"If I did," Plotnik said, "it’s thanks to you."

Jonah winked at him.  "Assuming the MRI doesn’t come back normal," he said.

*            *            *

Jonah planned to spend the rest of the day and night on the locked unit, reviewing the medical charts of six patients being transferred to his care from Dr. Jenkins and Dr. Plotnik.  Craig Ellison had offered to let Jonah get his feet wet with just a few patients, but Jonah had jumped at the chance to immerse himself in a half dozen young lives.

He sat in his borrowed office on Seven West, poring through what amounted to chronicles of soul murder.  Naomi McMorris, six years old, raped at age three by her mother’s live-in boyfriend; Tommy Magellan, eleven years old, born addicted to cocaine and now addicted to both cocaine and heroin; Mike Pansky, fifteen years old, hearing voices telling him to kill himself, fully ten years after his psychotic mother had tried to kill him.

With every page he read, Jonah felt further and further from Route 90 East and Anna Beckwith’s frozen corpse.  He had another chance to redeem himself, another chance to be a healer, and he was intoxicated enough by the river of psychopathology flowing at his feet to believe he could make that commitment — and keep it.  He would do no more harm.  Like an addict with a needle in his vein, he could not see past the high.  He could not see that drugging himself with other people’s demons would never purge him of his own.

He sat back, closed his eyes, and imagined living through parts of a day or night as Naomi McMorris or Tommy Magellan or Mike Pansky.  He felt the ceaseless tug-of-war they fought hour by hour between instincts to love and to hate, to trust and to fear, to hope and to despair.  He understood — not only with his mind, but with his heart — how an ego stretching to bridge such extremes could collapse, leaving a boy like Mike in a free fall from reality, his inner feelings of worthlessness boomeranging back to him as disembodied voices demanding he kill himself.  He imagined waking from a deep sleep as little Naomi might, not simply embarrassed to have wet the bed, but utterly undone by it, shrieking, clawing, inconsolable, her shame and terror at losing control of her bladder rooted in a rape that had robbed her of all control.  He shuddered with the unquenchable desperation of Tommy as a newborn, wrenched not only from the peace of the womb, but from a constant infusion of cocaine, every cell in his body already craving a chemical he would always and forever unconsciously connect with comfort and safety.

As Jonah absorbed these children, he felt the raging tides in his own soul ebb, with an easing of his skeletal muscles, a watering of his eyes, the familiar stiffening in his groin.  He felt as though he could shed his own skin and slip inside any other life.  He felt free.

He opened his eyes and started to reach for a fourth chart, but stopped at a knock on the office door.  He took a long, dreamy breath, stood, walked to the door, and opened it.

Michelle Jenkins smiled at him.  "Settling in?" she asked.

Jonah turned and looked back at the office.  It was a barren space, with a pressed wood desk, a black leather desk chair, a single upholstered chair for a patient, an empty bookcase, and a beige metal filing cabinet.  The walls were off-white and freshly painted, decorated with two framed mountain scenes like those in the auditorium.  "It needs something," he said.

"Jim Wyatt had every inch of this place stacked with books and journals.  The walls were covered with photographs he’d taken and landscapes he’d painted.  He’d been here almost twenty years."

"I don’t think I’ll do it justice in six weeks," Jonah said.  He walked to the desk, sat on the edge.

Jenkins stepped into the room.  She nodded at Jonah’s briefcase sitting beside the desk — an oversized, well-worn brown leather satchel with a combination lock.  "You never know," she said.  "There’s a touch of character already."

"I’ve had it since residency," Jonah said.

"Where did you train?" she asked.

"New York," he said.

"Don’t make me work so hard.  Which hospital?"

"Columbia Presbyterian."

"Impressive."

"And you?"

"Mass General, in Boston."

"Very impressive," Jonah said.

"Not really," Jenkins said.  "I was all the diversity they needed, in one tidy package.  I’m sure I was the only half-Latino, half-Asian woman who applied for a residency there.  Being from Colorado couldn’t have hurt, either."

"You’re a long way from home," Jonah said.

"I followed a ski instructor," Jenkins said.  "He turned into my husband.  It was all downhill from there."

Jonah laughed.  "Still together?"

"Divorced," she said. "Eleven months ago."

"May I ask how long you were married?"

"You can ask me anything," Jenkins said.  Her amber eyes held Jonah’s as she sat down in the chair opposite his desk.  "Five years.  Somewhere between twenty-five and thirty mistresses.  I lost track.  Women still call looking for him."

"I see," Jonah said.  Jenkins was a woman scorned.  He glanced at the diamond on her middle finger.  Nothing she had said explained it.

"Not from him," Jenkins said, still looking at Jonah as she ran her thumb over the stone.  "My mother’s.  She died when I was a teenager."

Death.  Again.  The one constant.  The funereal melody playing in back of all life’s happy-go-lucky scores.  "I’m sorry to hear that," Jonah said.

Jenkins shrugged.  "We didn’t get along," she said.  "I went through real growing pains as an adolescent.  We were constantly at each other’s throats.  As it turned out, we didn’t have time to work through it."

Jonah tilted his head and studied Jenkins.  Even for a psychiatrist, she seemed especially open, ready to divulge a great deal about herself.

"So what’s with the pickup line in front of my boss?" she asked.  " ’Rescue me if you see me going down in flames.’  Not very subtle."

"I didn’t mean it as a pickup line," Jonah told her.

"Then you must
really
want to pick me up," Jenkins said, "if that message came directly from your unconscious."

It
had
come directly from Jonah’s unconscious.  He did feel something for Jenkins.  "You’re a good psychiatrist," he said.

"Sometimes I think so," she said.  "Then I see someone do something like I saw you do today with Benjamin at the case conference.  And I realize I have a lot to learn."

"Beginner’s luck," Jonah said.

"Sure."  Jenkins stood up, caught her lower lip between her teeth.  "So here goes.  If you don’t have plans this weekend, I could give you the grand tour of Canaan."

Jonah said nothing.

"We won’t need more than a night," Jenkins said.  "There’s one decent restaurant and one discount movie theater."

Jonah felt a pang of regret.  Jenkins was beautiful and kind and perceptive, and he might have liked listening more to her, even touching her.  She had the lithe, dancer’s build he preferred in women.  Small breasts, slender waist, narrow hips, long legs.  But ever since taking his first life he had resolved to keep to himself, until he could keep himself in control.  He didn’t need anyone getting close enough to see the darkness inside him.  To penetrate a woman was to become penetrable to that woman.  "Another time," he said.  "I look forward to exploring new places myself — at least at first.  It’s part of what I like about locum tenens work."

"Being alone," Jenkins said, with no ill will.

"Maybe so," Jonah said.

She shrugged, took two steps back toward the door.  "You’re an interesting case," she said.  She started to walk out, but turned back to Jonah.  "You might like to know," she said, "Paul did get that MRI on Benjamin."

"Oh?" Jonah said.

"Glioblastoma, like you said — right where you said it would be."

"Early enough?" he asked.

"Maybe," Jenkins said.  "Paul has a neurosurgeon and oncologist consulting on the case."

"A neuroradiologist would be best," Jonah said.  "Gamma knife radiosurgery is the best route to go with a glioblastoma in that location.  It’s a fairly vascular part of the brain.  They’ll need to get Benjamin to an academic medical center.  Johns Hopkins would be ideal.  Baylor in Houston would be my second choice."

Jenkins nodded.  "I’ll mention it to Paul."  She paused.  "What happened at case conference wasn’t beginner’s luck, Jonah.  You’re extraordinary.  You have a gift."  She turned and walked out.

Jonah watched the door close behind Jenkins.  He stood up, stepped to the side of his desk, and reached down for his briefcase.  Then he carried it to the small closet in the office and gently placed it behind his coat.

f o u r

Afternoon, February 20, 2003

Chelsea, Massachusetts

Frank Clevenger’s feet were on his desk, his gaze directed out the window of his Chelsea waterfront office at three Coast Guard cutters as they zipped around a fleet of tugboats pushing and pulling an oil tanker to its docking station on the Mystic River.  Chelsea was all about oil and grime, a tiny, fierce port city in the shadow of the Tobin Bridge, its steel skeleton arching into Boston, its giant concrete feet set deep into the Chelsea jumble of triple deckers, greasy spoons, keno joints, and meat factories.  Oil floated on the river and seeped into the ground.  You could smell it in the air.  It literally made the streets flammable, and twice, in 1908 and 1973, dozens of blocks burned.

Clevenger loved the place.  It was a city without pretense, two crazily overbuilt hills kissing a chaotic valley where people were struggling simply to live, not obsessing over how to live well.