Therapy

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 dinner first, I could be there by seven.

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.

Patients with prefrontal injuries sometimes had temper-control problems. And they could grow impulsive and obsessive.

I printed a few articles, changed into shorts and a T-shirt and sneakers, and took a long, hard run, not wanting to think about the short sad life of Gavin Quick. I thought about it, anyway, and focused on appreciating my own life. After showering and getting back into street clothes, I tried Milo at the station. By the time I’d reached his car phone, I’d put the interview with Mary Lou Koppel in context.

She’d cooperated but really hadn’t told me much. Maybe she didn’t know much. Gavin had been in therapy for three months, and my guess was there’d been plenty of missed appointments. Combine that with his resistance and Koppel’s avoidance of his cognitive problems, and treatment didn’t amount to much.

Mary Lou Koppel’s approach boiled down to what’s known in the trade as “supportive therapy.” Not necessarily a bad thing; sometimes all a patient needs is a yeah-saying or a shoulder to cry on. But sometimes being “supportive” is an excuse for not doing more.

“You’re saying she was phoning it in?” said Milo.

“Maybe she did her best. She sat in that office with Gavin, I didn’t.”

“Chivalrous. But you still don’t like her.”

“I have nothing against her,” I said.

“I must’ve heard wrong. You get into why she stonewalled you the first time?”

“She brought it up right away. Said the patient hated and distrusted me and forbade her to tell me anything.”

“Taking a dig at you, pal?”

“The patient did file an ethical complaint against me.”

“Ouch,” he said.

“The charge was dismissed.”

“Course it was,” he said. “What, a disgruntled weirdo?”

“Something like that.”

“Assholes.”

Supportive therapy.

I said, “Anyway, that’s about it on Gavin’s emotional state.”

“Not as smart as he used to be and obsessive.”

“We knew that before.”