Critical Conditions

One

Diane Estevez poked her head into my office at twelve-thirty. “You free for lunch?” she asked.

I try not to schedule appointments on Friday afternoon and had nothing on my calendar until three o’clock, when I had to pick up Lauren at the District Attorney’s office to drive her to DIA for a flight to Washington. Her mother had just been hospitalized with a suspected heart attack, and my wife was heading home to be with her family.

I answered Diane, “Yes, as a matter of fact, lunch sounds great. We haven’t done that for a while.”

“I have one call to make, then I’m ready. How about Jax? Is Jax okay?”

“Jax is good.”

Diane went to make her call, and I locked away a couple of charts that were on my desk. She and I share an old Victorian house that we had renovated to house our clinical psychology practices. At the time we made the financial leap of faith required to invest in the building, we both had thriving fee-for-service practices that paid the bills and rewarded us handsomely for our labor. Over the last few years, though, changes in health care financing had altered the landscape for most health care providers, us included.

Diane and I had adopted different strategies to confront the revolution in the way health care was provided and paid for. She went into the psychological evaluation business with a vengeance, while I retreated into the narrow oasis of doing only fee-for-service psychotherapy. The commonality between us was that neither of us belonged to any managed care rosters of certified or approved providers if that membership required that we either reduce our fee or agree in advance to limit the care we might provide to our patients.

In the managed-care revolution, we were saboteurs. Fortunately, it was a luxury we could each afford. She had a wealthy husband. I had a working wife and a lot of experience living on lean income.

Jax Fish House, where Diane wanted to have lunch, was on the west end of Pearl Street in Boulder, only a couple of blocks away from our offices on Walnut. She arrived first and settled onto the chair I would have chosen if she had offered me the choice, which she never did.

She snapped open her napkin and draped it over her lap. “So, you ready? ’Cause this is what’s going on-I got a call from John Trent today. You know Trent?”

I thought I had heard the name. “He’s a psychologist, right? I think I may have met him at the IDC luncheon you dragged me to. But I don’t really know him.” IDC is the Interdisciplinary Committee on Child Custody, a group of mental health professionals, lawyers, and judges intent on making the process of determining child custody more humane. To me, the committee’s task felt, at best, Sisyphisian, at worst, quixotic. Diane was an officer and a recruiter for the organization. I was one of her recruiting failures.

“Yeah, he’s the one. John’s kind of new in town, what, eight months, a year, something like that? Maybe not that long. He’s from the Midwest somewhere, Kansas maybe, he’s been trying to get established. He does gatekeeping out at Prairie View Hospital, does custody evals, and some forensic work at the jail. Anyway, I’m indirectly involved with a custody case with him, nothing special, really, a run-of-the-mill Boulder divorce.” She watched me fumble with the bread on the table. “You paying attention here? I’m not just talking for exercise, you know. The details are important.”

“Every word, Diane. I’m hearing every word.”

“Okay. This is what it is, then, the custody eval? My psychotherapy patient is the husband-slash-father. He’s a decent guy with some character flaws that I certainly wouldn’t put up with for a weekend, but then I wouldn’t have married him, would I? Still, he has a heart the size of Bill Gates’s wallet and some parental instincts that you just can’t train. Okay?”

I nodded and kept eye contact. I really wanted to open my menu. I didn’t dare.

“The wife-slash-mother isn’t in treatment with anyone, but I suspect she’s a narcissistic personality disorder who sucks Absolut when her kids aren’t around. She’s been investigated twice by Social Services-once for psychological abuse after she threw a tantrum at her daughter’s school, once for neglect after she stranded her kids with a babysitter while she slept off a binge.”

“I’m with you so far.”

“My patient-the father-files for divorce awhile back and asks for custody of the kids. Girl, seven, girl, four. Court assigns the custody eval to John Trent and a social worker named Dani Wu who he’s teamed up with to do evals. I know Dani from IDC. She’s good people. She’s good with kids, I like her work.”

Our waiter dropped by. “Hello,” he said, “welcome to Jax. May I bring you something to drink?”

Before my lips had parted, Diane said, “Iced tea? Alan, that okay with you?” Lifting her eyes to the waiter, she said, “Make it two, no no no, don’t leave. Alan, you like specials?”

“Generally I do, but-” I held up the menu forlornly.

She faced the waiter. “Good. We’ll have two specials. And some bread, please, and thank you.” She sipped at her water and turned back to me. “If that was rude, and I’m relatively certain it was, forgive me, but I have to get back for a two o’clock and sometimes waiters disappear for so long in this town that I start looking for their pictures on milk cartons.”

She wanted me to smile, so I did. When I didn’t get a chance to be with Diane for a while, I really missed her.

“So back to John Trent. From my point of view, custody determination is a no-brainer. Both my patient and his wife are flawed, but if my patient has a common cold, his once-beloved has Ebola. My patient has warned me from the start that it wasn’t going to be easy. His wife’s father, it turns out, is connected big-time, like with gold-plated Monster Cable. He’s some super Republican muckety-muck from La Junta, you know, is friends with George and Barbara, golfs with Gerald in Beaver Creek, advises Newt about PR, is on Colin’s Christmas card list. You get my drift?”

“Yes.” I also got my iced tea. I squeezed a lemon into it and stirred in a packet of sugar. I liked the sweetener that came in either the blue packet or the pink packet but I could never remember which one I liked, so I used sugar unless Lauren was around to remind me whether I preferred the pink or the blue.

“That’s not all my patient is up against. Not only is his wife’s father connected, it turns out her sister is married to some entrepreneur gazillionaire.”

“I’m with you.”

“Good. So the custody eval starts a month ago. John Trent seems like he knows what he’s doing with it. He gets the appropriate releases and does a heads-up interview with my patient. Dani Wu sees the kids. Trent calls me once to ask my opinions and find out how the treatment is going. Between the lines he’s letting me know everything is going to come out like I think it’s going to come out. Kids will live with my patient, with liberal visitation for Mom.”

“But.”

“Yeah. ‘But.’ But earlier this week Trent calls again and says there are some new developments he’s checking out and that I shouldn’t jump to any conclusions about his recommendations, and he implies that now he’s leaning toward Mom.”

“And?”

“And nothing. That’s it. What do you think?”

“About what?”

“About the possibility that Trent’s been compromised by all these power animals that the wife is related to?”

“Sounds far-fetched, Diane. For now I would just take him at his word. See what he has. Maybe the eval revealed some things you don’t know.”

Diane sat back on her chair and lifted her iced tea for the first time. After scoffing at my suggestion that there were things she didn’t know, she said, “Heck, I buy lunch for my favorite conspiracy theorist and this is all I get. I was hoping for a little more Oliver Stone-type intrigue from you.”

“Sorry. Seriously, how much leverage do political types have with people like us, Diane? What can they do? Anyway, you’re talking about interfering with a judicial procedure. The consequences would be devastating if that ever got out. The politicians are much more vulnerable in this situation than John Trent is.”

The specials arrived. Halibut in a chunky tomato broth with capers and chilis. I tasted it. It was delicious. I said, “You’re lucky this is good.”

She felt all around her on the bench and looked on the floor beside her chair. “And you’re lucky I didn’t order any wine. I think I forgot to bring my purse. You’re buying. You’ve heard about Trent’s kid?”

Diane usually forgot her purse. I knew I was buying. I said, “No. What about his kid?”

“Diagnosed with some terrible heart virus. Apparently it’s destroying her heart muscle. She’s real sick. It’s been on the news because of some insurance problems.”

“What kind of insurance problems?”

“One of the usual kinds. The insurers say the treatment the doctors want is experimental and the policy doesn’t cover it.”

I sighed at the familiar refrain. “That’s awful. How old is his kid?”

“Just a baby. Two and a half, I think.”

“Where’s she being treated? Children’s?”

“Yeah.”

“How bad is it?”

“Bad. Apparently, once the heart muscle is infected, the condition is often terminal.”

“God. What about a heart transplant? The insurance will pay for that, won’t they?”

“A cardiologist friend of mine-you know Harriet Lowenstein?-says the problem is the virus. They don’t know how to kill it. If they go ahead and plop in a new heart, it might get infected just like the old one.”

My food was getting cold. I was losing my appetite.

Diane continued eating between sentences. “John Trent is married to that investigative reporter who’s new on Channel 7. You know that at least, don’t you?”

“I don’t watch much television news these days. It stopped being fun last fall. And you know better than anyone that I’m not included in the local gossip circles. If you haven’t told me something interesting, then I probably don’t know anything about it.”

The mention of the events of the previous autumn caused a temporary hush between us. Diane’s husband, Raoul, had been an important part of all that. We didn’t mention it often now.

She dipped a crust of bread in some broth and left it on the lip of her plate. “Well, Trent’s wife-Brenda-is one of those investigative types, specializes in uncovering graft in government and business and industry. Her first big thing had to do with plastic recyclers. She apparently had them shaking in their recycled vinyl boots over kickbacks that were being shoveled to some local politicians.”

“Oh, I did hear about that, maybe from Lauren. One of the district attorneys involved asked Boulder County to supply a special prosecutor, I think. Didn’t some politicians have to resign?”

“Two mayors and a city manager that I know of. One of the mayors, I think from Thornton or Northglenn, even tried to kill himself. His wife walked into their garage, found him hanging from the rafters next to their Buick, and had herself a heart attack on the spot. Turns out the mayor wasn’t actually dead. He was just hanging there asphyxiating watching his wife have a coronary.”

Hearing that story, I should have totally lost my appetite. I did. “Did the guy live?”

“Not exactly the word I would choose to use, but he did survive.”

“What about the wife?”

“Noop.”

I used a sip of iced tea to cover my distaste with the story. “I bet Trent’s wife makes some enemies doing that kind of work.”

Diane shrugged. “Probably no more than a custody evaluator, though.”

“Touché. I guess you get used to it.”

“Have to be thick-skinned, like me. It’s part of the territory. She and John moved here for her career. He gave up a good practice for her. I have to remember that about him, give him some rope. It’s another sign that John Trent must be a progressive thinker.”

My ex-wife had been a producer at one of the Denver TV stations and I was well aware of the musical-chairs nature of local news markets. If John Trent and his wife had really moved to Denver from Kansas, she was moving from a small market to a much larger one. The pressure would be on.

I said, “I don’t know about that, Diane. But he must be a pretty devastated daddy. Are you worried that the situation with his daughter may be interfering with his judgment about the custody eval?”

“I’ve thought about it, but, you know, you and I have both gone through tough times and managed to get our work done. I’ll give John Trent the benefit of the doubt, too.”

“This is worse than anything you or I have gone through, don’t kid yourself. A sick baby? That’s as bad as it gets.”

“You’re probably right, but I’m not just blowing smoke about this political angle. Everybody can be goosed. I don’t trust what I’m seeing with this case. Custody-wise, it’s open-and-shut.”

One of Diane’s few faults was a tendency toward transient clinical myopia. “You always think you know best. You don’t know that it’s open-and-shut; you’re only seeing one side of it. He’s doing the eval, he’s talked to everybody, and you haven’t. Maybe he discovered something. Raoul knows all those people, doesn’t he? The people you’re concerned about, the conservative money crowd? What does he say?”

“He says leave him out of it.”

“Your husband is a wise man, Diane. I think I’ll take his advice. Why don’t you leave me out of it, too?”

“You’re both wimps, you know that?”

“I won’t speak for Raoul, Diane, but I certainly am.”

Her tone didn’t change noticeably as she asked, “How’s Lauren doing?”

Diane’s voice had changed fractionally, just enough to let me know she was asking about my wife’s battle with multiple sclerosis. I said, “Better than last fall, not as good as last summer.”

“Any progress?”

“Slow. Too slow for her taste.”

“How’s the new medicine working?”

“Too soon to tell. But it makes her pretty sick.”

“How are you doing with it?”

“Better than last fall, not as good as last summer.”

Diane looked away. She said, “I can see how hard it is for you.”

I said, “Thanks. Lauren’s off to Washington this afternoon.” I looked at my watch. “Couple of hours. It looks like her mother may have had an MI last night.”

“Oh, my. How is she?”

“Stable, apparently. She’s in coronary care. All the kids are rushing home.”

“Lauren doing okay? She doesn’t need this kind of stress, does she?”

“No, she doesn’t need the stress. What can you do? Things are worse for John Trent, right?”