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For Sandy, with love and thanks
Unexpressed emotions will never die.
They are buried alive and will come forth later in uglier ways.
—Sigmund Freud
Chapter One
I’m a sociopath. I look normal, but I’m not. I’m smarter, better, and freer, because I’m not bound by rules, law, emotion, or regard for you.
I can read you almost immediately, get your number right away, and push your buttons to make you do whatever I want. I don’t really like you, but I’m so good at acting as if I do that it’s basically the same thing. To you.
I fool you.
I fool everybody.
I’ve read that one out of twenty-four people is a sociopath, and if you ask me, the other twenty-three of you should be worried. One out of twenty-four people is 4 percent of the population, and that’s a lot of sociopaths. Anorexics are 3 percent, and everybody talks about them. Schizophrenics are only 1 percent, but they get all the press. No one’s paying any attention to sociopaths, or they think we’re all killers, which is a misconception.
It’s not being paranoid to worry about us. You should be more paranoid than you are. Your typical suburban mom worries all the time, but she worries about the wrong things.
Because she doesn’t worry about me.
People think evil exists in the form of terrorists, murderers, and ruthless dictators, but not in “normal” people like me. They don’t realize that evil lives on their street. Works in the cubicle next to them. Chats with them in the checkout line at CVS. Reads a paperback on the train next to them. Runs on a treadmill at their gym.
Or marries their daughter.
We’re here, and we prey on you.
We target you.
We groom you.
I took a sociopath test, not officially, of course. Only trained professionals can administer the real test, called the Hare test, but I found a version of it online. The first two questions went like this:
1. I am superior to others.
Circle one: Doesn’t apply to me. Partially applies to me. Fully applies to me.
And:
2. I would not feel sorry if someone were blamed for something I did.
Circle one: Doesn’t apply to me. Partially applies to me. Fully applies to me.
There were twenty questions, and forty was the top score. I scored a thirty-eight, which means I would be graduating with honors if I majored in being a sociopath.
I didn’t need the test to tell me who I was, anyway.
I already knew.
I have always known.
I don’t have any feelings, neither love nor hate, no like or dislike, not even a thumbs-up or thumbs-down like on Facebook.
I do have a Facebook account, however, and I have a respectable number of friends.
Ask me if I care.
Actually, I think it’s funny they’re my friends, because they have no idea who I am. My face is a mask. I hide my thoughts. My words are calculated to please, charm, or undermine. I can sound smarter or dumber, depending on what you expect to hear. My actions further my self-interest.
I’m neither your friend nor your frenemy, unless you have what I want.
In that case, I’m not only your enemy, I’m your nightmare.
I get bored easily.
I hate to wait for anything.
Waiting makes me so restless, and I’ve been in this room for hours, even this video game is boring. God knows what idiots are playing online right now, forming their pimple-faced teams, exploring dungeons, going on quests, killing dragons, hookers, and Nazis, all of them playing a role.
I wonder if whoever invented World of Warcraft realizes it’s practice for sociopaths.
The gamers I play online name themselves KillerCobra, SwordofDeath, and Slice&Dice, but I bet they’re in middle school.
Or law school.
If one out of twenty-four people is a sociopath, I’m not the only gamer who tried to burn the house down.
My character name is WorthyAdversary.
I role-play every day in real life, so I’m very good at gaming.
I’m always a step ahead, maybe two.
I plan everything. I set everyone in motion, and when the moment comes, I strike.
I always win in the end.
They never see me coming.
Know why?
Because I’m already there.
Chapter Two
Dr. Eric Parrish was on his way out when he was paged to the emergency department. His gut tensed as he approached, though he’d been Chief of the Psychiatric Unit at Havemeyer General Hospital for five years. There was always the possibility of violence on an emergency consult, and last year in nearby Delaware County, a hospital psychiatrist on an ED consult was shot and his caseworker killed by a psychotic patient. The tragedy ended when the psychiatrist, who carried a concealed gun, returned fire, killing the patient.
Eric hustled down the hospital corridor, followed by two medical students on their psych rotation, a female and a male talking among themselves. He felt confident that he could protect them, and himself, without a gun. His employer, the PhilaHealth Partnership, had become hyperaware of security after the Delaware County shooting and had trained him in defensive strategies and escape procedures. Eric would never carry a gun in a hospital. He was a healer at heart and, he suspected, a bad shot.
Abruptly the loudspeaker system switched on, and a recorded lullaby wafted through the speakers. The hospital played the lullaby each time a baby was born in its labor and delivery service, but Eric cringed at the sound, knowing it would cause misery on his psych unit, upstairs. One of his patients was a young mother depressed after the stillbirth of her child, and the intermittent lullaby always sent her into an emotional tailspin. Eric had asked administration not to pipe the music into his unit, but they said it would cost too much to alter the speaker system. He told them to take it out of his budget, but they said no.
The chimes of the lullaby reverberated in his ears, and it bugged him that he couldn’t get the hospital bureaucracy to listen to him. He knew it was part of the larger problem, that mental illness wasn’t taken as seriously as physical illness, and Eric was on a one-man campaign to change that. He was living proof that there was hope, even happiness. Back in med school he’d developed an anxiety disorder, but he’d gotten his symptoms under complete control during his training. Since then, he’d ended talk therapy and weaned himself off his meds. He’d been symptom-free. Cured.
He pushed open the double doors leading to the ED, which bustled on a Friday night. Nurses in patterned scrubs hurried in and out of full examining rooms, a physician’s assistant pushed a rolling computer desk, and a group of black-uniformed EMTs talked near an empty stretcher with orange head-immobilizing blocks, resting on a hospital gurney.
Eric approached the octagonal nurses’ station, and a blonde nurse looked up from her computer m
onitor, smiled, and pointed to examining room D. Everybody recognized the hospital shrinks from the bright red W on their lanyard IDs. The W stood for Wright, the wing that contained the locked psych unit, but the staff teased that W stood for Wackos. He’d heard all the jokes—How do you tell the psychiatrists from the patients in the hospital? The patients get better and leave. Eric told the best psychiatrist jokes, though he never told the ones about psychiatrist’s kids. He didn’t think those were funny. He lived those.
The medical students quieted as he beelined toward the examining room, walked to the open curtain, and stood in the threshold, relieved to see that his patient was a sweet-faced older woman with cropped silvery white hair, resting comfortably in bed in a hospital gown. Next to her sat a young man, looking concerned as he held her hand. Standing behind him was Dr. Laurie Fortunato, a short, curvy figure in a crisp white lab coat, the black rubber stems of her stethoscope decorated with flower stickers for her pediatric patients. She and Eric had been friends since medical school and were running buddies, even though she was faster, which sucked.
“Hi, Laurie, good to see you.” Eric entered the room followed by the medical students, whom he introduced briefly before they stood at the back wall, observing discreetly, per procedure.
“Eric, same, thanks for coming down.” Laurie grinned. She had a bright and lively aspect, owing to her warm brown eyes, longish Roman nose, chubby cheeks, and a generous mouth that never stopped moving, whether she was yakking away, cracking wise, or making faces. She was appealing without makeup, which almost none of the female professionals bothered with in the hospital, but Laurie’s earthy lack of vanity was her defining characteristic; she always twisted up her curly brown hair in a knot, held in place at the nape of her neck by whatever she could grab—pencil, pen, or tongue depressor.
“Happy to do it. How can I help?”
Laurie gestured to the patient. “This is Virginia Teichner and her grandson Max Jakubowski.”
“I’m Eric Parrish. Good to meet you both.” Eric took a step closer to the bed, and the elderly patient looked up at him with a sly smile, her hooded brown eyes making direct contact, a good sign. She had no evident injury, but she was on a saline IV drip and her vital signs were being monitored by a finger clip. Eric checked the glowing screen; her numbers were normal, if not great.
“Ooh, look at you, you’re so handsome,” Mrs. Teichner said, her voice raspy. She eyed him over in a mock-stagey way. “You can call me Virginia. Or honeybun.”
“Now we’re talking.” Eric reached for the rolling stool, pulled it over, and sat down next to her bed. He enjoyed working with geriatric patients, and his first task was to establish a rapport with her. Humor usually worked. He smiled at her. “If you think I’m handsome, there’s obviously nothing wrong with your vision.”
“Not true, I got macular degeneration.” Mrs. Teichner winked. “Or maybe I’m just a degenerate!”
Eric laughed.
Mrs. Teichner gestured at Laurie. “Dr. Parrish, how come you don’t wear a white coat like her?”
“It makes me look fat.” Eric didn’t add that many hospital psychiatrists didn’t wear white coats, to be more relatable to the patients, and he had on a blue oxford shirt and no tie, with khakis and loafers. The look he was going for was Friendly Suburban Dad, because that’s what he was, but he suspected he’d achieved only Cialis Guy.
“Ha!” Mrs. Teichner laughed. “You’re funny!”
Laurie rolled her eyes. “Mrs. Teichner, please don’t encourage him. Dr. Parrish doesn’t need any more female fans in this hospital.”
Mrs. Teichner’s hooded eyes twinkled. “You’re just jealous.”
“I agree.” Eric smiled at Laurie. “Jealous.”
“Hardly.” Laurie snorted.
Mrs. Teichner cackled. “Now she’s embarrassed.”
“Bingo.” Eric mentally ran through the elements of the MSE, the Mental Status Examination, whenever he met a patient, and he assessed their level of consciousness, appearance and behavior, speech and motor activity, mood and affect, thought and perception, attitude and insight, as well as his reaction to the patient and the patient’s own cognitive abilities. Mrs. Teichner was already scoring well on most of the factors. Eric’s gestalt reaction to her was that her mood was euthymic, or completely normal. “So, how can I help you, Virginia?”
“Eric,” Laurie interjected, answering, and her expression changed, falling into professional lines. “Unfortunately, Mrs. Teichner has been dealing with congestive heart failure and advanced-stage lung cancer. Two months ago, she was admitted upstairs, spent three days in cardiology, and was just about to begin palliative care at home.”
Eric listened, hiding his emotions. It was the worst possible prognosis, and he couldn’t help but feel sympathy for Mrs. Teichner, as Laurie continued.
“She came in tonight because of a choking incident at dinner. I ordered new X-rays, and we found another mass growing in her throat, impacting her ability to swallow.”
“I’m sorry to hear that,” Eric said, meaning it, but he felt surprised by Mrs. Teichner’s calm demeanor, given the dire state of her health. She didn’t seem distraught or even depressed, nor did she present with the vagueness of aspect or speech that characterized any memory or other issue he’d expect in a geriatric patient, though he’d test her later to confirm.
“Thanks, Doc, but I know I have cancer, it’s not new news.” Mrs. Teichner’s tone turned matter-of-fact. “My grandson, Max here, wanted us to call you. He’s seventeen years old, so he knows everything. He keeps telling me I’m crazy and—”
Max interrupted, “Not crazy, Gum. Depressed. I think you’re depressed, and the doctor can help with that. He can give you some antidepressants or something.”
Eric shifted his gaze to Max, who was short and slight, maybe five two and 130 pounds, which made him look younger than his age. His face was round, and he had a small straight nose, eyes of a pale, washed-out blue, and a shy smile with a single dimple. His longish hair was light brown in a shaggy cut, and he had on baggy jeans and a black T-shirt that showed an undeveloped skinniness to his upper arms, as if he never lifted anything heavier than an iPhone.
Mrs. Teichner waved him off with a hand gnarled by arthritis. “He calls me Gum, Gummy, Gumbo, all kinds of names like that, because he couldn’t say grandma when he was little. He likes to play with words. He’s smart as a whip, he’s a National Merit scholar, got perfect SAT scores, tops in his class, and that’s why he’s such a know-it-all—”
“Gummy, please,” Max interrupted her again, gently. “We need to talk about you, not me, and about why you’re not eating.” Max turned to Eric, looking at him with a direct blue-eyed gaze that echoed his grandmother’s. “Dr. Parrish, the cardiologist told us that if she eats, she can keep her strength up. He said he could give her a feeding tube if she doesn’t eat, but she doesn’t want the feeding tube and she doesn’t want to eat either. I know that’s the depression talking. I think she should get the feeding tube. She has to.”
Eric realized why Laurie had called him. End-of-life care presented an array of emotional issues for patients and their families, and Eric knew he could do some good. “Max, thank you for that information, that’s helpful. If you would step outside for a moment, I’d like to examine your grandmother.”
“Sure, great.” Max stood up, letting go of his grandmother’s hand, and smiled at her. “You behave yourself, Gummy.”
“Don’t tell me what to do,” Mrs. Teichner shot back, cackling, and Eric could see the love that flowed easily between them. Max shuffled out of the room, and Eric glanced at Laurie.
“Let’s talk after I’ve evaluated Mrs. Teichner.”
“Good. Come find me when you’re finished.” Laurie patted Mrs. Teichner on the shoulder. “My dear, you’re in excellent hands.”
“No kidding. Now get out so we can be alone.” Mrs. Teichner cackled again, then gestured at the medical students, standing at the wall. “Can?
??t they leave too, Doc? I need a peanut gallery like I need a hole in the head.”
“They have to stay,” Eric answered, amused. “Try to ignore them.”
“How’m I gonna do that? They’re looking at me.”
“I do it all day, it’s easy. Now, seriously, tell me how you are. Are you feeling depressed? Blue? No energy?”
“No, I’m right as rain.” Mrs. Teichner shook her head of short white hair, which swiveled on her neck like a baby snow owl.
“You sure about that? It would be natural, given your illness.”
“I tell you, I’m fine.” Mrs. Teichner snorted. “I don’t need my head examined, but where were you when I married my second husband? Sheesh!”
Eric smiled. “Okay, let me ask you a few questions. What is today’s date?”
“What difference does it make?”
“I’m doing an assessment and I need you to answer a few questions. Who’s the president of the United States?”
“Who cares? All politicians are crooks.”
Eric smiled again, persisting only because he had to for legal reasons. “Listen carefully, I’m going to say three words.”
“I love you?”
Eric chuckled. “The three words are banana, strawberry, milkshake. Can you repeat those words?”
“Of course! Banana, strawberry, milkshake! Dr. Parrish, there’s nothing wrong with my brain.” Mrs. Teichner’s smile vanished into her deep laugh lines, evidence of a life well-lived. “I’m not depressed, I’m worried.”
“What about?”
“My grandson Max. He lives with me, I raised him. He’s the one who’s depressed, and I don’t know what’s going to happen to him after I die.” Mrs. Teichner’s forehead buckled. “He’s different, Max is. He’s got no friends, he’s always alone.”
“I understand, but you’re my patient tonight.” Eric didn’t want to neglect her, even if she was inclined to neglect herself. “You’re here seeking treatment, and I’d like to evaluate and, if necessary, treat you.”