Missing Persons

39

After getting all of four hours’ sleep I got all of four hours’ warning before the next shoe dropped. I spent most of those four hours wondering whether having any warning at all was a good thing or a bad thing.

I never quite decided.

Patients, when they call my office number, are given a voice-mail instruction to call my pager directly in the case of an emergency. How often do my patients take advantage of the opportunity to reach me on my beeper? Once or twice in a bad month, infrequently enough that the mere sight of an unfamiliar phone number on my pager makes me anxious. So, on Thursday morning, while I was idling at the intersection of Broadway and Baseline on the way to work and my beeper vibrated and displayed an unfamiliar (303) 443- number, I was wary.

The 443 prefix meant the call came from a Boulder address. That’s all I knew.

I returned the page as soon as I stepped into my office.

“This is Alan Gregory,” I said. “I’m returning a page to this number.” I don’t use the “Doctor” appellation in those circumstances because I don’t know if the person who called me will answer the phone or if someone else will. If it’s someone else, discretion might dictate that my profession remain secret.

“Thanks for calling back so soon,” the man on the line said. “This is Bill Miller.” And then, as if I might not know, he added, “I’m Mallory’s dad.”

What a sad thing, I mused, that he could use his daughter’s unfortunate notoriety as a quick social identifier. And an even sadder thing that he would.

“Mr. Miller,” I said, buying some time while I hurriedly chewed and swallowed the ramifications of the simple fact that he had called me. “What can I do for you?”

“Can you squeeze me in for an appointment? It’s… important.”

“Umm,” I managed. My eloquence, given the circumstances, was profound.

“Today, if possible,” Bill Miller said.

I wondered whether he was asking me to get my tongue untied sometime “today,” or whether he was asking for an appointment with me sometime “today.”

If you asked me to write an ethics problem for a psychologists’ licensing exam, or to dream up a delicious ethical conundrum for clinical psychology graduate students’ comprehensive exams, I don’t think I could have come up with something as devious as the dilemma I was facing at that moment.

“Do you have some time available?” he said, kindly pretending not to notice how flummoxed I was. “I’ll be as flexible as I need to be.”

The problem freezing my communication skills wasn’t my schedule. My practice calendar that day was no more or less constricted than usual. On most days, if I was willing to give up a meal or stay late at the office, I could squeeze in an emergency.

The problem I was struggling with was that I didn’t know if I could see Bill Miller professionally at all. The issue that was complicating what should have been a simple matter of logistics was a problem of professional ethics.

My initial impulse about the ethical maze? I didn’t think that I could see Bill Miller as a clinician. But I wasn’t at all sure I was correct in that snap assessment. The circumstances were complex. I quickly decided that I’d never confronted another set of facts quite as complex in my entire career.

The arguments for agreeing to see Bill Miller for therapy? They were easy. He had once, albeit briefly, been my patient. His present circumstances-or at least the ones I knew about-were so public and so tragic that they might cause someone to seek professional help. Empathy and compassion both argued for me to make myself available to him.

The arguments for refusing to see Bill Miller for therapy? This is where things got messy. Psychologists are under an ethical obligation to avoid what the profession calls “dual relationships.” At its heart, this is a conflict-of-interest clause, intended to ensure that a clinician is free to act in the best interest of his or her patient, uncomplicated by competing forces. In practice, the dictum requires that a clinician not wear two different hats in a patient’s life.

In simple English, it means I shouldn’t do psychotherapy with the woman who cuts my hair. I shouldn’t join a book group run by one of my therapy patients.

Simple, right?

Usually, yes. But try to apply those simple guidelines to my relationship with Bill Miller. That’s what I had been trying to do for the hours between his morning phone call and the midday appointment time I’d eventually offered him.

I hadn’t gotten very far.

Did the fact that I was a good friend of a Boulder cop who was involved with the investigation of Bill Miller’s daughter’s Christmas Day disappearance qualify as a dual relationship?

I wasn’t sure, but the degrees of separation seemed to be sufficient insulation.

Did the fact that my practice partner was covering the clinical work of a therapist who had died, and possibly been murdered, weeks after seeing Bill Miller’s daughter for a single therapy session qualify as a dual relationship?

Once again, blank spaces seemed to separate Bill Miller’s place on the board from the space that I was occupying.

Did the fact that I was seeing a patient who parked his car in the garage of the house of the man who lived right next door to the Millers qualify as a dual relationship?

Maybe, maybe not. In isolation, I would lean in the direction of “not.” My patient had spoken with Bill Miller’s daughter, considered her a friend. That was all I knew about Bob’s relationship to the Millers. It wasn’t much of a tie.

Did the fact that my partner and good friend had disappeared while on a trip to Las Vegas to try to arrange a meeting with Bill’s estranged wife constitute a dual relationship?

I knew of absolutely nothing that tied Bill Miller to any of those events.

Did the fact that my friend and partner’s husband, someone else whom I enthusiastically considered a friend, was busy looking for Bill Miller’s estranged wife qualify as a dual relationship?

Probably not, for all of the same reasons.

But I wasn’t totally sure. I didn’t know if I should be contemplating additive effects. If a wasn’t greater than z, and b wasn’t greater than z, and c wasn’t greater than z, did I have to be concerned whether a + b + c was greater than z?

Ethical algebra hadn’t been covered in graduate school.

I interrupted my obsessing over the Bill Miller conundrum to address a practical problem: Diane was still missing, and Thursday was the day she was supposed to be back in her office seeing patients. Although Diane and I shared space, our practices were separate businesses: I didn’t know how many patients she was scheduled to see, nor did I know any of their names.

My problem was that I had to figure out some innocuous yet compassionate way to notify Diane’s patients that their doctor would not be in the office that day. My solution was to post a note on the front door, the patient entrance to our little building. It read:

To Anyone With An Appointment With Dr. Diane Estevez:

Dr. Estevez is unexpectedly away from the office to deal with an urgent situation.

She is unable to cancel her appointments personally, but will not be in today.

She will contact each of you individually upon her return,

and she appreciates your understanding, and your patience.

Dr. Alan Gregory

At the bottom of the note, I belatedly scrawled a handwritten offer that anyone with a clinical emergency should call me, and I left my pager number.

When I’d returned Bill Miller’s call, the offer for an appointment that I eventually made to him wasn’t any more straightforward than was the prevaricating note I had left for Diane’s patients. “I’m not sure I can see you, Bill. I may have an ethical conflict.”

“How?” he said. “We haven’t spoken in, well, years.”

“It’s complicated,” I said, lamely. “It’s not even clear to me that I actually have a conflict. I’m just concerned that I might.”

“Well, how about this,” he said. “Let’s schedule a time. In the interval between now and then you can think about your ethical problem. We’ll talk, I’ll run my concerns past you, and you can decide if you’re able to help.”

He sounded eminently reasonable. I was reminded that even during the session with his wife so many years before, Bill Miller had always seemed levelheaded and reasonable. Almost, I also reminded myself, to a fault.

“How about eleven forty-five?” I asked.

Bill Miller was close to ten minutes late for his appointment. Since I was meeting with him over the brief window in my day that would have constituted my lunch hour, I’d greedily used the free time to devour an energy bar from the emergency stash in my desk.

“Déjà vu, huh?” he said as he settled onto the chair across from me. “It feels odd to be here without Rachel. That was one day that I will never ever forget.”

My natural human instinct was to offer condolences to Bill, to be sympathetic about whatever had happened with Mallory, to reflect on the sad outcome of the situation with Rachel. But I didn’t. Instead I contemplated the fact that after so many years between visits with me his first association in my presence was to his long-estranged wife, and not to the tragedy of his recently absent daughter.

Ironically, one of the most difficult things about the psychotherapeutic relationship is the necessity for the therapist to, at times, put brakes on reflexive human kindness. Were I to presuppose to start this interaction with Bill Miller with expressions of compassion, or even overt sorrow, at his plight-or by giving him a big hug, a pat on the back, and a hearty “hey, big guy”-I might unwittingly interfere with whatever motivation he’d had for picking up the phone.

So I waited. The truth was that most of the time, when I reached over my shoulder into my therapeutic quiver I ended up drawing out the dullest arrow, the one that was marked SHUT UP AND WAIT.

“I bet you’d like to know why I’m here,” Bill said.

“Yes,” I said evenly. “I would. That’s a good place to start.”

Bill was dressed in wool flannel trousers, good leather loafers, and a crisp blue dress shirt that was the color of his eyes. His sport-coat wasn’t new, but it looked like cashmere, and hung on him with the drape of good tailoring. He wore no tie; few men in Boulder did.

“What’s your ethical problem?” he asked. The question was neighborly. He could have been inquiring about a problem I said I’d been having with my gutters.

“Explaining the circumstances would lead to a whole different ethical dilemma for me. It’s something I’m going to have to deal with on my own. When I reach a determination, I’ll let you know.”

“But you’ve obviously dealt with it enough to have this meeting?”

“I’m hoping to get a better understanding about why you’ve come to see me. That might make my concerns moot, or it might clarify things so I’ll have a clearer sense of what I should do.” That was the plan, anyway.

Bill closed his eyes for a moment, a long moment that grew into seconds. Five, then ten. Finally he opened his eyes, looked right at me, and with pain etched in his brow, he said, “You’ve been at my house twice over the past two days. Why?”