Eric tried to imagine the weight of responsibility on the boy. “So is no one helping you? Who’s home with your grandmother now?”
“Hospice sent a day nurse, and she’s there today. Her name is Monique and she’s Jamaican. She has such a thick accent, neither of us understand what she’s saying, but we like her.” Max brightened. “Gummy likes to sing, and Monique sings with her, old songs like from Judy Garland and people like that. They were singing ‘You Made Me Love You’ when I left today, and Monique is going to bring some Red Stripe tomorrow.”
Eric smiled. “Good for her. Whatever she wants.”
“That’s what I say.” Max chuckled, but it stopped abruptly. “I wish I could be there, but she wanted me to come see you, then go to work, to try to keep everything normal.”
“I understand that, don’t you?”
“Yeah, but I told my boss I’d only be in in the mornings because that’s when she’s asleep anyway. In the afternoon, her TV shows are on, and we watch them together.” Max smiled, in a bittersweet way. “She’s a Golden Girls junkie.”
Eric smiled, touched by the boy’s kindness, though he couldn’t help but wonder if Renée Bevilacqua came to her SAT tutoring in the morning. “You work on Sunday?”
“Yeah, a lot of our students have summer jobs, so they’re only free on the weekend.”
Eric made a note, Renée in morning? “This is a very difficult thing for you to go through, and still work.”
“I know, I guess.” Max paused, seeming to lose his train of thought. “It’s weird, like, thinking that this is the … end of her life. I keep thinking, how much time does she have left? Like, how long can you live, if you can’t eat or drink anything? I keep asking Monique, but she says it depends on the person. What do you think?”
“I think the hospice nurse has more experience than I do.”
“I just want to know, since you are a doctor, what you thought? How long does she have? Online it says if you can’t eat or drink, you live three to five days.”
“I can help you to deal with it, whenever it comes, and I’d like you to talk about it. Take your time, think about your feelings. Our treatment goal is to help you express your emotions, so we can examine them, and you’ll inevitably feel better and happier.”
“If I had medication, I just wouldn’t feel the feelings, so I’d automatically feel better and happier.”
“But this is talk therapy—”
“Dr. Parrish, I bet I could buy whatever I needed from kids at school. I know of a kid who sells his mom’s Valium, and you can get Ritalin or Adderall, easy.”
“Don’t do anything like that. Take nothing from anyone else, and nobody else should either.” Eric let it go, not to engage him in a downward spiral of argument, which would do nothing to open him up. “Give me some background. Where is your mother? You said she works. Where does she work?”
“In Center City at an insurance company, RMA. She’s in the billing department.”
Eric made a note. “What time does she come home?”
“She doesn’t, not every day anyway. She stays in town with her boyfriend. Sometimes she calls.” Max checked his watch and Eric knew he was counting the moments until eight fifteen.
“Does she understand what hospice care is?”
“Of course.”
“And yet she still doesn’t come home?”
“Nope.” Max’s lips contorted in disgust.
“When she calls, does she ask about her mother?”
“No, but I tell her.”
“Does she ask about you?”
“No, but I tell her that anyway, too.”
“Why does she call then?”
“Why do you think?” Max burst into derisive laughter. “She calls for money! Like, she needed two new tires, and she didn’t have the money, so she has to make sure money got put in her account for that.”
“How do you do that?”
“I do it online. My grandmother gave me her password and I pay all her bills online. Gummy puts money into my mom’s account every week. I mean, I do, for her.” Max snorted again. “My mom wants me to put it on automatic pay, but if I do, I’ll never hear from her.”
Eric suppressed a sympathetic pang. “This must be hard to deal with on your own.”
“Not really, I’m used to it. I do it all the time. I like taking care of Gummy. She needs me.”
Eric heard warmth in his tone, for the first time. “It’s a good feeling to be needed, isn’t it?”
Max nodded. “It is, yes.”
“Does it ever feel like a burden? That it’s too much for you to handle, on your own?”
“No, not really.” Max shrugged his shoulders.
“Explain that to me, because I think a lot of people your age would find this a very difficult burden.”
“She can’t help that she got sick, and you saw her, she’s fun. I think I just like her so much, really, that it doesn’t feel like a bad thing. It feels like a really good thing.”
Eric felt his throat constrict, and it was almost as if he could see the bond between grandson and grandmother become visible. “I think that’s called love, Max.”
Max’s eyes filmed suddenly, but he wiped them roughly. “Are you trying to make me cry?”
“Absolutely.” Eric smiled, because he knew Max needed one. “That’s my job.”
“Ha!” Max wiped his eyes again, then his gaze fell on the Kleenex, but he didn’t get one out of the box.
Eric made a note, no Kleenex. It was his tell. He had noticed that many patients stopped themselves from taking Kleenex, as if it were a sign of weakness, and in his experience, he had noticed the outcomes were the best for those patients who took the Kleenex. So he worried about Max.
“I feel so dumb, it’s embarrassing.” Max shook his head, exhaling loudly. “Like, if anybody in school found out I was sitting here crying over my grandmother, they’d think I was the biggest idiot on the planet, which they already think anyway.”
“The emotions you’re feeling are very natural and they show that you make connections to other people. That’s actually a sign of good mental health.”
“What?” Max’s weary eyes widened in disbelief. “How can you say that somebody with OCD is mentally healthy?”
“Think of it as a mental ailment, like any physical ailment. Just because you have diabetes doesn’t make you a sick person. It makes you a healthy person, with diabetes. If we can fix the diabetes, you’re good to go.” Eric thought about it, though he hadn’t before. He still learned new things every day, from his patients and from the process of talk therapy itself. “Max, we’ll get you through this. You’ll become healthier and happier quicker because you are mentally healthy. Now, tell me, are you having intrusive thoughts about Renée?”
Max checked his watch. “I think about her all the time, I have to tap and go through all the other rituals.”
“Did you see her yesterday?”
“Yes … uh, I did,” Max answered, hesitating.
“Why are you hesitating?”
“Well, I didn’t only see her at tutoring.”
Eric felt Max was being evasive. “Where else did you see her then?”
“I sort of saw her in town, like, where she works.”
“Where does she work?”
“The frozen yogurt shop, Swirled Peace, in that strip mall?”
“How did that come about, that you saw her?”
“I just was around town, and I saw her, like, driving to work. She was on the phone again.” Max’s expression tightened, his lips forming a firm line, and his hands found each other, clinging together. “Like I told you, it’s dangerous and she doesn’t even use a wire or hands-free, and she texts a lot too.”
Eric made a note. “So did you see her driving or in the yogurt shop?”
“Um, kind of, I saw her at both, if you really want to know”—Max began to knit his fingers, and anxiety crept into his voice—“I mean, I was home gaming on my laptop, and
my grandmother was asleep and I know Renée works on Saturdays, so I went over to get some fro-yo but then I didn’t go in.”
“Why not?” Eric made another note.
“I don’t know, I thought I would have a hard time explaining it and she would know I was crushing on her, so I didn’t go in.”
“What did you do?”
“I waited in the car, and when it was the end of her shift, I left then too, to make sure that she didn’t get into any trouble or have an accident on the way home, you know. I mean, like, I just wanted to make sure she was okay and she got home okay.”
“So you followed her home?” Eric kept the judgment from his tone, and the concern, not only for Max, but for Renée. He wrote, waited for her after work, stalking? Tarasoff?
“No, not really, well, I guess you could say that.” Max shifted forward on the chair, leaning over urgently. “But it wasn’t in a creepy way, I swear to you, it’s not like I’m stalking her or anything.”
Eric met his eye. “How is it different from stalking her?”
“Stalkers follow you to hurt you or upset you, but I would never hurt her. I’m watching over her. It’s, like, I know she does all these things that cute girls do, like how they’re on the phone all the time and always texting each other, I see it in school, in the cafeteria, and in the library, everywhere she is, she’s always on the phone.”
“Renée, in particular, is always on the phone?”
“Renée has a lot of friends, she’s cute and popular. That’s how girls are, the cute ones anyway, they’re always on the phone and if she keeps talking on the phone when she’s driving, she’ll hurt herself.” Max knit his hands. “I’m not trying to hurt her, I’m trying to protect her.”
“So paint me a picture. You’re driving behind her, a car length or two?”
“Yes, that’s all, I just keep an eye on her to make sure she’s okay.”
“How does that protect her?”
“What do you mean?”
“I mean, what would you do, if she gets on the phone and you’re behind her?”
“I’d just watch her. I watch her to make sure she’s okay.”
“Have you done this before?”
“Yes.” Max grew suddenly still.
“How many times?”
“Twice, I followed her twice.”
“Do you drive by her house?” Eric made some notes.
“Yes.”
“How many times?”
“A lot.” Max checked his watch.
“Would you harm her?”
“No. Never.” Max’s eyes rounded again, horrified. “It’s weird, I go to make sure I didn’t harm her, and nobody else did.”
“Max, in your past, did you ever hit anybody, or get physical with anybody?” Eric wasn’t taking any chances with the girl’s safety.
“No.”
“Ever get into fights at school?”
“Are you kidding?” Max asked, incredulous. “No way. I’d get my ass kicked!”
“Did you ever throw something in anger?”
“No.”
“Have you ever been violent at all?”
“No, no!”
“What about toward animals? Cats or any pets like that?”
“Is this for real? You’re kinda freaking me out right now.” Max recoiled, bewildered, and Eric scrutinized him. He thought Max’s taking the girl’s phone and following her home were beyond the pale, but it didn’t involve any physical threat to her. Eric understood Max’s logic, acting as a protector, not a threat. Also Max’s tone sounded genuine, which didn’t mean the behavior wasn’t concerning, but it fell short of the level of dangerousness required for being admitted to the hospital or triggering the Tarasoff duty to warn.
“I was asking out of concern for Renée.”
“I’m not following her for a bad reason, I want to make sure she’s okay. I’m not, like, a creeper or anything. It’s just the opposite. I’m, like, her guardian angel. I’m looking out for her, and she needs me to look out for her.”
“So you believe she needs you.” Eric caught Max’s eye and held his gaze for a moment.
“She does need me.”
“And does that ring a bell, in terms of what we were just talking about?”
“No, what do you mean?” Max checked his watch.
“With your grandmother.”
Max recoiled, rolling his eyes. “Dr. Parrish, I know the difference between Renée and my grandmother. That’s gross.”
“I understand that, but is your feeling about them the same, and is it related? Consider what I’m saying. Is your worrying about your grandmother tied to your worrying about Renée? So that now you’re worrying more about your grandmother, you’re worrying more about Renée?”
Max blinked. “Do you think?”
“You tell me.”
“Maybe, kind of, I guess that could be true.”
“Do you think you tap to prevent harm from coming to others, like Renée or your grandmother?”
“I have to think about it, but whatever the reason is, it’s not helping to know it, like, it doesn’t change anything, I still want to tap, I have to tap. I need to right now, I know it’s almost time.” Max checked his watch, his hair falling into his face. “Fifteen minutes exactly. Time to tap and say the colors.” Max tapped his temple with his right index finger, then his lips moved silently. “There.”
“Did that help?”
“Not really, it’s not like doing it makes me feel better. It’s not working the way it used to. That’s why I say it’s getting worse, why I came to you. Now I have to do it not to freak out.”
“How about other intrusive thoughts of Renée, the ones you mentioned to me last time, in which you were afraid you would harm her?”
“I had them last night, I just worry about, like, that I’ll hurt her.”
“How specifically?”
“Like all kinds of ways, like I told you last time, and just this morning, it makes me nervous, and I worry that, like, I would go over there and somehow hurt her”—Max’s words ran into each other as his anxiety gathered momentum—“or I would see her face and neck, and the necklace with the little gold plaque, and then my hands are on her neck, squeezing. It’s upsetting me so much, that these ideas keep coming into my head and I just can’t stop them, it’s like if you have a nightmare only you’re awake and you have it ten times a day, or twenty, and there’s nothing you can do to stop it, nothing at all, no tapping or colors or anything relieves the pressure in your head.” Max took a breath, ragged with emotion. “I can’t take it anymore, Dr. Parrish, I really can’t. I just want it to stop. It has to stop.”
“I understand.” Eric reached for the Kleenex, tugged one from the box, and handed it to Max. “Here, use this, please.”
“Thanks.” Max wiped his eyes, leaving pinkish streaks on his fair cheeks. “Sorry, I mean, this is ridiculous to sit here and cry like a baby.”
“It’s not ridiculous, it’s human. You’re doing excellent work here, and I know it isn’t easy.”
“It isn’t, it sucks, it just … sucks.”
Eric felt confident in his differential of OCD and knew how to treat it, going forward. “Max, I am going to give you a script for some medication. It won’t work right away, but be patient. You’ll have to get some bloodwork done, too. I want to see you Wednesday night, at eight, here. It’s my next available opening.”
“Great.” Max looked relieved, his forehead relaxing. “What meds are you putting me on?”
“Fluoxetine, or Prozac.” Eric had good results with it, but he had to watch for short-term side effects. “Call me right away if you feel unusual restlessness. Understood?”
“Yes, thanks,” Max said, wiping his eyes.
Chapter Thirteen
Monday morning, Eric got off the elevator in Wright and walked down the glistening hallway, taking his keys from his pocket, preoccupied. He’d spent most of the night worried about Max, his grandmother, and Renée, t
hen about whether to file for primary custody of Hannah. He’d finally come to a decision and he’d call his lawyer after the morning staff meeting. He reached the door to the psychiatric unit, swiped the ID card on the lanyard around his neck, and inserted his key in the lock, then unlocked the door, closing it behind him, per safety procedure. Inside was a small anteroom and another locked door that served as a security airlock. His unit hadn’t had an elopement, or a patient leaving unauthorized, since Eric had started here and he intended to keep it that way.
He opened the door and entered the unit, which was laid out like a rectangle, so that after the locked entrance was a small nurses’ station in front of a large TV lounge containing an overstuffed sofa, matching chairs, and a wall of donated books and old computers with restricted Internet. To the left was the north hall of patients’ rooms and to the right was the south hall of conference rooms, offices, a kitchen, and a few patients’ rooms, reserved for patients whose dangerousness required they be segregated; all twenty patient rooms were singles for security reasons. Patients ranged in age from eighteen to ninety, suffering from depression, bipolar disease, schizophrenia, and other major mental disorders. One of the patients was currently on suicide watch, and two were on alert for self-harming behaviors like cutting. These numbers were low because of the summer months, but would double during the winter holidays.
Between the north and south halls at the center of the unit was the dining room, and behind the dining room was the main nurses’ station, enclosed in thick Plexiglas for security reasons. The nurses had a good view of the outdoor patio beyond them, which was mandated by law for all mental health units in the state. Evidently, the Pennsylvania legislature believed that fresh air was beneficial for mental patients, so Eric wouldn’t tell them that his patients used the patio to smoke. The hospital was smoke-free, but he didn’t have the heart to deny a psychotic his cigarettes.
Eric took a left down the south hallway toward his office, dropped his messenger bag inside, hustled to the small conference room, and opened the door. His staff milled around, sipping their first coffee of the day and finishing their how-was-your-weekend chatter. Eric greeted everybody and made small talk, and the staff eventually made its way around an oblong conference table, too big for the room, of the same modern black fake-wood with black knock-off Aerons used throughout the hospital.