Obsession

“Euthanasia?”

“I told you it was creative.”

“If Patty had a tendency to play God, wouldn’t Rick know?”

“The E.R. is one thing, Alex. People come in to be saved. But watching some feeble old guy waste away? That could tug at the heartstrings-even a good person’s heartstrings. Nothing premeditated, she wasn’t a criminal. Something impulsive that she came to regret. Then she got sick, deja-vued, and blurted it to Tanya. Maybe thinking about her own death got her obsessing on how she’d hastened the process for someone else. Or this whole deathbed confession thing is crap and you should concentrate on helping Tanya deal with being alone and I should spend my two weeks off watching TV.”

“Deaf detectives?”

“Jesus,” he said. “No, my concept of nirvana is TiVoing a month of Judge Judy, cooking up some microwave chili, and zoning out.”

“Truth and justice,” I said.

“Stupid people getting yelled at. If I were straight, I’d try to date that woman.”

I laughed. Gazed out the car window. None of the children had returned to the fountain. “First Patty’s a dope dealer, now she’s a mercy killer.”

“She said she killed a guy, Alex.”

“That she did.”

“I’ll tell you one thing,” he said. “No sense pursuing Colonel Bedard’s death. Whatever happened, the certificate’s going to say natural.”

He tilted his head toward the bungalow court. “In terms of this Eden, there was bound to be plenty of street crime back then, let’s see if Isaac pulls anything up. Not that I’m any more convinced something happened than I was yesterday. But if there was no euthanasia, my next bet would be something to do with the Cherokee drug market. Especially after meeting Lester Jordan. Let me sniff around some more, pay Jordan another social call.”

He yawned, stretched, closed his eyes. “Enough for one day. Drive.”

“TiVo time?” I said.

The eyes opened. “Not so fast, bucko. Expensive lunch on you.”

“Sure,” I said. “Afterward, we can revisit Jordan.”

“Nope, too soon. I’ll go it alone tomorrow.”

“What do you need me to do?”

He lowered the window and breathed in smog. “Play it by ear. Which is a nice way of saying I don’t have a damn idea.”

I got home at three, belly full of Thai food, took Blanche for a puppy trot around the garden, freshened her water, heard about her day, toted her and her food bowl into my office.

She ate as I had another go at Tanya’s file.

Starting at the beginning.

The tape-loop soundtrack of obsessive-compulsiveness is powered by anxiety. The noise can be switched off by SSRIs-drugs that increase the flow of serotonin to the brain. But not much is known about how psychoactive meds affect kids long-term, and when the patient stops taking the pills, the soundtrack cranks up again.

Cognitive behavior therapy takes longer and requires active participation by the patient, but it has no side effects and teaches self-help skills that can endure. By the time Tanya first came to see me, I’d successfully treated scores of kids with OCD, sampling from a grab bag of CBT methodologies.

I try to view every patient with a fresh eye, but after you’ve been in practice for a few years, preconceptions are inevitable, and when she arrived I had a plan in mind.

1. Build trust.

2. Find the anxious core.

3. When the time’s right, use thought-stopping, guided exposure, desensitization, or some combination, to replace tension with relaxation.

By the fourth session, rapport seemed set and I was ready to work. Tanya marched into the office and sat at the play table and said, “They’re gone.”

“Who is?”

“My habits.”

“Gone,” I said.

“I don’t do them anymore.”

“That’s great, Tanya.”

Shrug.

“How’d you do that?”

“You said I was being nervous so when I got nervous I chased the habit feelings away.”

“Chased them?”

“I said, ‘Stop, that’s stupid,’ and put other feelings inside.” Tapping her temple.

Would you like your clinical license to go, or will you eat it here?

“What other feelings did you put into your head?”

“Taking a walk with Mommy. Going to Disneyland.”

“Disneyland’s a favorite place?”

“Small World’s boring,” she said. “I like the Spinning Teacups.” Rotating one hand. “I like the pink cup.”

“Spinning Teacups is something you’ve done before with Mommy.”

“No,” she said, looking vexed. “We don’t really do it, Mommy gets sick when she spins. We watch.”

“You’d like to do it.”

“I pretend to do it.” Rotating both hands, now. Fast and choppy, like an agitated bus driver.

“You pretend to spin.”

“Fast,” she said.

“That makes the nervous feelings go away.”

Doubt sharpened the pale green eyes. “You said the habits were being nervous.”

“You’re absolutely right, Tanya. You did a great job.”

“I didn’t do it all,” she said.

“Someone helped you?”

Emphatic head shake. “I didn’t do it all the first time.”

“You did some of it.”

She turned away from me. “I looked under the bed. A little. I washed my hands a bunch of times. The second time I didn’t look under the bed and I only washed my hands once. I had to wash. To be clean, Mommy says to use soap and water before I go to sleep, and brush my teeth.”

“Sounds like a good idea.”

“Washing only once is a good idea,” she said. “More is stupid.”

“Mommy said it was stupid?”

“No! I say it to myself.” She picked up a pencil, twirled, poked the playhouse.

“I’m really impressed, Tanya.”

No response.

“You must be proud of yourself.”

“Having habits made me tired,” she said, airily.

“And now you can handle them.”

“When I get nervous, I say ‘You’re being nervous, you don’t need those habits.’”

I said, “Perfect. You could be a doctor.”