Critical Conditions

Twenty-six

I stopped at Abo’s for a slice of pizza after leaving Dead Ed’s house and barely had time to eat it and squeeze in a return phone call from Sam Purdy before my one o’clock patient.

“Hi, Sam, you made it back down from the ranch?”

“Got back around five this morning. Lucy just woke me up. The Summit County cops haven’t located Haldeman yet. And the prints on the pop cans in the barn belong to the two kids. You were right.”

Having my suspicions confirmed disappointed me. I was hoping Madison and Brad were simple runaways well on their way to someplace like Sacramento or Billings. “So how do you have it? How are they mixed up in this?”

“Great question. And how the hell did they know about Ed’s cabin and his damned RV? I don’t know any of it. Lucy’s presenting everything to Malloy and the brass at a meeting right now. Maybe they’ve developed something that will help make sense of it.”

“Someone should call the girl’s mom, Sam. She’s worried sick.”

“Yeah, don’t worry. I’ll get someone to call her. Lucy’s good at that.”

I was trying to finesse a way to let Sam know about John Trent’s visit to Ed Robilio a couple of days before his death. But I couldn’t find a detour around the confidentiality issues. Cozy figured that the cops already knew, and if Lucy knew, then Sam knew, so I decided to let it rest.

“I was just at the Robilio house with Cozy Maitlin. He talked Mitchell Crest into giving him a little tour of the crime scene. Cozy’s suspicious that there’s some evidence that your colleagues haven’t explained, some physical evidence or some fingerprints or something, and that’s why Merritt hasn’t been charged. You know anything?”

He was silent.

“Okay, let me rephrase my question. You know anything you can tell me? Anything I can use with Merritt to goose her to talk? I have to get her to start talking, Sam. She’s not helping Cozy at all. And I can’t judge how suicidal she might still be.”

When he spoke, his voice had slowed and softened. The change in tenor grabbed my attention. He asked, “You saw her the first day in the hospital, right, after her overdose?”

“Yes, I did. Not in the ER, but upstairs in the ICU. She wasn’t conscious, though.”

“When you were there-think back-did you notice her hands, her fingernails?”

Oh, God. “Yes, they were painted red. A bright cherry red.”

He was silent again. Waiting for me to join him somewhere. Guiding me someplace significant with his formidable will.

I said, “One nail was broken. Badly. The kind of break that would really hurt. Let me think. It would have been her left hand. I was sitting on the left side of the bed. The ring finger. The ring finger of her left hand.”

“Okay. Anything else?”

“The next day when I saw her upstairs, after she regained consciousness, the nail polish had been removed and the break had been filed down.” I paused, trying to remember. “I think that’s it.”

“Remind me, what was your question before?”

What? “I asked if there was anything that you could tell me-”

“Yeah, I remember, that was it. Listen, I have to go. Brenda’s agreed to have lunch with me, if you can believe it. I don’t think I should be late. Good luck with Merritt later on, say hi for me. Tell her I love her.”

As was becoming our routine, I greeted Merritt in the dayroom and walked beside her as we made our way across the locked unit to the walk-in-closet-size interview room. Other than the night she visited her sister, she had not been allowed off the unit.

On the aggravating drive into Denver I continued to question my therapeutic strategy with her. From the start, I had been treating her as though she were any other patient, any other talking patient, and would schedule and start a daily psychotherapy session, as though such a thing could exist solely in silence. And as though time were on my side and the corrosive quality of familiarity and routine would eventually sway her enough so she would trust me sufficiently to begin talking.

So far, though, my strategy hadn’t worked; no words but mine had fractured the silence in the interview room.

I’d decided that today would need to be different. The eroding quality of time wasn’t working well as a strategy. Two kids were in significant danger. And the police were going to be questioning John Trent about his actions soon enough.

I turned the knob and pushed the door inward. Merritt preceded me inside, as she had each time. This time, though, she walked across the room and curled herself casually in the chair that I had used the previous three days.

The room was furnished with a total of six chairs so that small groups and families could meet. I chose one of the chairs about five feet from her and sat down. I had spent much of the hour on the drive from Boulder to Denver pondering how long I would permit this session to go on in silence before I exposed my new strategy. Was ten minutes long enough? Twenty minutes too long? Or should I go right after her from the first bell. What?

Joel Franks and the treatment planning team had felt from day two of the admission that I should be putting some increased pressure on Merritt to start talking. As was common in this milieu, they were tempted to use privileges on the unit as bait. She could do this if she talked; she could do that if she talked. Or we could threaten her with a transfer to the state hospital at Fort Logan and use that as an incentive.

With another kid, I might have signed on. With Merritt, I wasn’t sold.

Merritt’s silence had never felt like a behavioral issue to me. In fact, other than the consideration that she hadn’t spoken a word since her arrival, she was a model of decorum on the unit; this wasn’t some kid zipping it up in order to be defiant. And as paradoxical as it sounded, her silence had never really felt like a control issue to me, either.

I had already decided by then that her silence was tactical. I hadn’t concluded exactly what the battle was, or what the tactic was supposed to accomplish. But there was a method to the silence. And the method, I had been assuming, had to do with Dead Ed, the gun, and the bloody clothes that Merritt had stuffed under her bed. Now I was adding two additional motivations and complications: Merritt’s stepfather, John Trent, and her best friend, Madison Monroe.

If I was being totally honest with myself, I would have admitted, however, that even before this day, I had grown frustrated with the lack of progress and with the fact that Merritt was more patient about our standoff than I was. I consoled myself with the reality that at least I was being more patient than just about everyone else who was involved in the case: the treatment team, Joel Franks, Cozy Maitlin, Merritt’s parents, MedExcel, and the Boulder Police Department.

I said, “You chose a different chair today?”

If she wasn’t going to talk, she couldn’t much object to my little confrontation, and I supposed I could be as trivial as I wanted to be. So far, I’d done serious soliloquies on Madison’s reaction to our meeting at Starbucks, reasoned explanations of Merritt’s incredible legal troubles, poignant presentations on the sorrow surrounding her sister’s illness, and provocative commentary on the state of women’s basketball in America.

A petulant diatribe about what chair she sat in didn’t seem too far out of line.

Her eyes were warm. Her lips formed the words, “Thank you.”

It struck me that she was entirely too comfortable sitting with me in silence, day in, day out.

I said, “You’re welcome. I assume you’re talking about my breaking every rule in the book to allow you to go visit your sister?”

She nodded.

“It appeared that it made a remarkable difference for Chaney, your being there.”

She tightened her jaw and widened her eyes. I thought she was trying not to cry.

On another day, in another mood, with another agenda, I might have exploited her vulnerability in an effort to weaken her resistance. But not this day. I was planning a more direct approach.

I said, “You’re in a tough battle, aren’t you?”

Instantly, her expression turned as bland as oatmeal. But I thought I detected a flash of curiosity in her eyes.

“This fight you’re in, it’s tough. You’re alone and you don’t have many weapons on your side. Silence feels like all you have going for you. But from where I sit, it doesn’t look like much leverage anymore. The other side has all the big guns. You have silence. That’s nothing.”

Finally, after examining my words from every possible direction, looking for subtext, she nodded suspiciously.

“The other side? Your opponent? They’re not playing fair anymore. Do you know that?”

She shook her head.

“They’ve started taking prisoners and they’re spying on the good guys.”

She shrugged, too quickly. I was sure her pulse was quickening. I was circling close to something.

“I don’t know what you think. Maybe you think you have them outfoxed. You don’t. They know about your stepfather’s visit. The police know he was there.”

Merritt looked away and pulled her long legs up to her chest and rested her heels on the lip of the chair. Her torso was almost totally screened from my view. Finally she peeked at me from around her right knee.

“And Madison? Your friend? She has a boyfriend named Brad somebody? A frat boy? They screwed up big time. Broke into Dr. Robilio’s mountain home and stole his RV. Half the cops in the state are looking for them right now. They’re armed and the cops know they’re armed.”

Merritt looked enraged. She stood and spun toward the door. The act was cat quick, and startled me.

In a tone that I knew was too parental the moment the words escaped my lips, I said, “We’re not done here. You’re not going back to the unit just because I’ve succeeded in making you uncomfortable. This isn’t about retreating from me anymore. Though I admit you’re good at that.”

She stopped. Her back puffed out and I could see the definition of her musculature as she inhaled.

I adjusted my voice. “This isn’t about retreating, Merritt. It’s about surrendering.”

She faced me.

“Please have a seat. It’s time for you to hold up the white flag. It’s time for you to surrender. Let me help you do that. Let me help you surrender.”

I thought she looked like a caged animal. Not like Emily in her dog run. Emily always wanted the gate to open. Merritt preferred the cage. She was a fearful animal. She was fearful that the cage would be opened. And that she would no longer be safe.

She sat. Folded her arms across her chest. I noticed that she was wearing her CHURCH GIRL T-shirt again.

“Merritt?” I said. “Look at me, please.”

Petulantly, she did. In that instant, with that expression, I was reminded that there was still plenty of adolescent residing in this remarkable girl.

“One more thing you should know. The police have your fingernail. The red one. The one you broke when you were at his house.”

This time she couldn’t stop the tears.

A good five minutes later, her eyes were dry and she was staring at me with a mixture of indignation and surprise. I imagined it was the look she would flash at a referee who had just fouled her out of a game on a questionable call. My ambush, I was afraid, had failed. She wasn’t going to talk.

Her shoulders dropped. She swallowed. Before my eyes, her resolve crumbled into pieces, and she said, “Okay, I think I’m ready to talk.”

The sound of Merritt’s voice should have shocked me, but it didn’t. I’d imagined her voice before, of course, but I’d imagined it wrong. I’d anticipated an edge to it, a snarliness, but her voice was soft and tentative and was graced with the soft curves of a young girl’s melody. I’d imagined, too, the poignancy of her first words to me, and I’d imagined that wrong as well. She was matter-of-fact about beginning to speak, almost as though talking was something she had been doing her entire life.

I said, “Great.”

She said, “I guess.”

“Hi,” I said. It was probably clinically ill advised to smile, but I couldn’t help myself.

She smiled back. My indiscretion, I decided, had been worth it.

The times I don’t know what to say in psychotherapy are easily as numerous as the times I think I do. Most of the time, I think, my patient and I are better off when I admit that I’m at a loss for words. I said, “I’ve already talked too much, Merritt. I don’t know what to say now. I think now that you’ve decided to speak that it’s up to you to decide what happens next.”

She smiled again, the rueful smile I’d already witnessed where the corners of her mouth actually turned down a little. She held up her left hand and spread her fingers. She said, “The police know I broke my nail?”

“I don’t know what they suspect. I know that they recovered the broken part.”

“And they know about my-about Trent?”

Brenda called her husband by his surname. Merritt had apparently adopted the name, too.

“Again, I don’t know what they suspect. They know that he was there.”

She retreated for almost a minute, and I feared that she had decided to once again be dumb. Finally she said, “I have some other questions.”

“Okay,” I said. I almost said, “Shoot.” Sometimes I’m really stupid.

“Trent’s a psychologist, you know that, right?”

“Yes.”

“And I know all about the rules that you keep reminding me about that says he, or you, can’t say anything about what happens with somebody that they’re talking to. But he does, you know? Not seriously, but he’ll tell my mom that my patient, George, or whoever, said this or that, or did this or that, or whatever. You know?”

“Yes, I know. Unfortunately, it happens. Are you concerned I will do that, too?”

“Can you wait before you ask your questions?”

Chastised, I said, “Of course, please continue.”

“My roommate told me something last night that I didn’t know. She said I have rights, even though I’m a kid, that I can talk to you and tell you things and that you can’t tell anybody, even my parents, what I said. Is that true?”

Colorado law grants fifteen-year-olds many of the psychotherapy privileges and protections that are enjoyed by adults.

“Yes,” I said, “that’s true. With some exceptions.”

She seemed surprised and troubled by my reply. “What are the exceptions?”

“Child abuse is one. Or if I think you’re going to kill yourself, or if you threaten to hurt someone else. That’s about it.”

“That’s about it? Or that’s it?”

“That’s it.”

“Can I even keep you from telling Mr. Maitlin what I said?”

“Technically, yes, you can.”

“Even though I’m a kid?”

“Even though you’re a kid.”

“I am fifteen, you know.”

“I know.”

“Good.” She looked at her feet. “I’m including your wife. You have a wife, right?” She moved her gaze to my left hand searching for a ring.

“Yes, I’m married.”

“Not her, either. You can’t tell her.”

“Not her, either. That’s no problem.”

“That’s it?”

“That’s it. Except for the trusting me part.”

She rubbed the place on her arm where the IV catheter had been pulled. “I already trust you. I was beginning to trust you before Chaney got so bad the other night. That night aced it for me.”

“I’m glad you trust me, Merritt. Consider yourself warned, though, I’m not convinced that keeping everything secret is what’s best for you, especially not from your attorney and your parents.”

“Well…maybe that’s because you don’t know what I have to say.”

“Maybe.”

“You remind me of Trent.”

Dangerous ground. I didn’t comment.

Merritt read my reticence and said, “Don’t worry, that’s a compliment.”

“What about me reminds you of your stepdad?”

“You don’t get caught up in stuff. Things go nuts all around you and you act like it’s going to be fine. And like I said, I think I can trust you.”

“Thanks. You trust him? Trent?”

“Yeah, I do. Maybe more than my mom. What do you want to know first? Why I’ve been silent?”

“Sure.”

“Wait, what about the people here at the hospital? The nurses, and Dr. Franks? Can you tell them what I say without my permission?”

In all my years of inpatient work, I’d rarely had a patient ask for confidentiality from the treatment team. “Again, technically, you can keep me from telling anyone what you tell me. Including the treatment team. I doubt if I have to tell you that I think that’s a bad idea. But it’s your right to prohibit me from telling anyone.”

She straightened in her chair. “Okay, let me list the rules. If you want me to tell you what’s been going on, then you’re going to have to consider yourself prohibited. From telling anybody anything. My parents, my lawyer, anybody here, anybody.”

I thought about her offer and said, warmly, “Fine. I understand what you’re asking. And with that restriction in place, our session is over.”

“What? I’ve just started talking.” She couldn’t believe I would walk away from the opportunity to hear her story.

“Merritt, you have rights, and because of those rights you can set the rules. Clinically, I’ll accept that you may have valid reasons for wanting confidentiality from your parents and even your lawyer. I’m not saying I agree, but I’ll abide by those rules. But I disagree with your exclusion of the treatment team here at the hospital. And I do have a choice about that. I won’t be manipulated by your rules. I won’t conspire with you around them, and I won’t let them dictate my treatment of you. If you insist that I keep our conversations secret from the treatment team, then I have to do that. What I don’t have to do is be your collaborator. As long as you insist I keep secrets from the hospital staff, I won’t listen to your secrets. We won’t have conversations until you change your mind.”

She pulled her legs back up onto the chair, again resting her heels on the lip of the seat. She lowered her head to her hands and gazed at me through the space between her knees. She eyed me, unblinking, lips parted, for what felt like an eternity of seconds.

“The reason I’ve decided not to talk is that I think that if I start talking, I’m afraid that I’ll screw up and say something that will…hurt other people.”

“Have you changed your mind about the treatment team?”

“No.”

“Then I can’t let you go on, Merritt. I’m sorry. I owe you confidentiality. So, as much as I would like to hear what you have to say, I’m forced to decline to listen.”

“I’m trying to talk to you here. God, I thought that’s what you wanted.”

“More than you know. I just can’t accept your limitations. And it appears you can’t accept mine. So we’re back at stalemate, I guess. We can both think about our positions and go over it again tomorrow.”

“I didn’t do it.”

“We need to stop, Merritt. I’m sorry.”

“I didn’t do it.”

I felt an incredible compassion for her struggle right then. I was sorely tempted to grant her anything she wanted just to keep her talking. But what I said was, “Give up, please, Merritt. Let me help you surrender. I won’t leave you alone.”

I stood to escort her out the door.

She stopped to look at me. I thought, for the first time in this treatment, that patient and therapist were equally exasperated.

I hoped I had made the right decision.