I

To all the people who had ever insulted or belittled him he could now claim (if he ever met them) that he was an expert in his field. This on face value would mean nothing to them, being the kind of people who insulted and belittled, but at some point in their small lives they’d find themselves in some vulnerable position where he held all the power, and they’d be kicking themselves for having ignored him at a party or punched him in the stomach or implied once that his mother (who had done her very best every day to keep him and his sister fed and clothed and cared for, who had come to America to give them a better life) had sex with anyone who wanted her. And even more humiliating for them would be the fact that he wouldn’t be vengeful: he would show them compassion and forgiveness and leave them no opportunity to smart at his totally justifiable opprobrium. They would come away from their brief, formal interaction with him feeling that the world was bigger than them and their petty psychodramas, bigger and more complex than what they thought it to be when they tried to lord their strength or knowledge over him, and they would learn far too late something he had always known, which was that you had to make peace with your insignificance in order to become someone of significance.

He sat in a chair in the visitation room at Cook County Jail, the Plexiglas reflecting his diminutive form by virtue of the fluorescent lights and dark opposing wall. When he wore short sleeves it was easy to see his muscle tone and conclude that he was strong, but when he wore a suit, as he did now, it could only be concluded that he was small and athletic – in truth his body had been heavily disciplined by half-marathons and morning strength training. At his side was a briefcase, and from that briefcase he withdrew a neat stack of papers across which he’d written notes in medical shorthand.

On the other side of the Plexiglas, Archer Armour took his seat. In his regulation jumpsuit he looked like another nameless victim of the state. The news had barely mentioned that he owned a Zagat-rated restaurant in Greektown. The eyes in his greyish-tawny face seemed to be taking in his surroundings, but his features did not suggest he was registering any visual input. He picked up the receiver to his left.

‘You Dr Lihn?’

He nodded. ‘It’s nice to finally meet you, Archer. Do you want to call me Leo?’

Archer looked down and then back up. He shook his head. Behind him, a guard shifted his belt beneath his paunch.

‘That’s fine,’ Leo said. ‘So I think you’ve been told by your lawyer that I requested this interview. I’d like to get to know you a little better before I give you what’s called a “Structured Clinical Interview”. This is like a pre-interview interview, just to get the jitters out.’

‘It’s fucked up,’ Archer said, his voice almost a keening. ‘It’s fucked up what happened and what’s going to happen.’

Leo could tell this was not how Archer normally spoke, but maybe it was how he used to speak at moments of peak frustration during his adolescence. It was the kind of desperate, emotional speech that somehow required a freshly-minted baritone.

‘We’ll see about what’s going to happen. What I want to do right now is get more information from you, OK?’

Archer sighed and nodded.

Leo flipped over the first few pages of the stack, preliminary notes to himself, landing on a page with Archer’s mugshot and the words armour, archer, 41 printed underneath. The rest of the page was blank. ‘Do you ever see things other people can’t see?’

Archer’s nostrils briefly flared. His pupils might have constricted, or that could have been a trick of the light. ‘No,’ he said.

‘Do you hear things other people can’t hear?’

‘No.’

‘Do you ever experience periods of heightened energy: grandiose moods, racing thoughts, decreased need for sleep?’

‘No.’

‘What about periods of decreased energy: isolation, lethargy, suicidal ideation?’

Archer blinked and laughed curtly. ‘I’ve got a family and a business. I own my house. Why would I want to kill myself?’

‘What about desires to harm others?’

It took a moment for the question to land, then Archer blanched. His fingers tightened around the receiver. ‘What are you trying to do here?’

Leo allowed a five-second silence and watched Archer move back in his chair and sit up straight. In that moment he resembled a classmate of Leo’s from grade school, a boy named Max whom bigger boys tortured but who was big enough to torture Leo. Max had an excess of norepinephrine such that his eyes were always wide and panicked during class time. Unlike the other unintelligent kids, who did what they could to ignore their surroundings, Max would jerk his head in the direction of whomever the teacher called on for an answer, nervously awaiting the moment when his own ignorance would be exposed. When he was called on and inevitably didn’t know the answer, he’d emit a low whine and pound his thighs with his fists, inspiring laughter from the bigger boys. Girls ignored Max, which Max didn’t like. Sometimes he would find Leo on his way home from school, trip him, and kneel across his back, pressing Leo’s face into the grass and dirt as he called him a fag.

Leo made a note: Plans to harm others: fear, disbelief, dissociation. Highly lucid.

‘Are you trying to set me up?’ Archer asked. ‘Whose side are you on? I don’t have to talk to you about anything.’

‘I’m not trying to set you up,’ Leo said, and smiled tensely. ‘Your lawyer has asked me to testify about your case in court. I’m sure she told you that.’

‘She told me a psychiatrist was coming to talk to me. That was it.’

‘Archer, you believed that man was Donald Trump, right?’

‘I don’t know what I fucking believed, man.’

‘You believed a man was Donald Trump who was not Donald Trump. You know that.’

Archer’s shoulders slumped and he exhaled loudly into the receiver. Some over-extended band of resistance had finally snapped in him. Leo made a point of not holding his receiver away from his ear.

‘I’ve never taken drugs in my life,’ Archer said, his speech pressured. ‘I know you people probably think I have after what happened, but I never have. Not even marijuana. I was a straight-A student in college. I’m a good husband and a good father. I swear to God, nothing unusual happened that day except I woke up with this voice, high-pitched like a demon girl’s, telling me I was going to die. It was all I could hear. And I thought I saw Donald Trump with a gun in my front yard and I thought that was the demon girl’s prophecy, that he was the one coming to kill me.’

Leo wrote: Hallucinations, possible psychosis, schizotypy. Insight to a moderate degree.

‘It sounds crazy, but I swear to God that’s what happened. That’s all that happened! I didn’t want to hurt anyone except if they were going to hurt me!’

‘I know. I can tell from talking to you that you were acting in self-defense.’

The storm behind Archer’s eyes cleared. He nodded, his mouth open in a grateful half-smile. ‘Yes, thank you, doctor. Thank you.’

They spoke until the guard sauntered up behind Archer and told him his time was up. Archer held the receiver with both hands when he said goodbye.

On the way to the train, Leo turned his phone on to find that his sister Grace had sent him a picture of her husband sitting on their ratty sofa in a pair of cutoffs, cradling their two massive cats in either arm. He wore a T-shirt that read kill me, kill you, under which the decapitated head of Shaggy from Scooby Doo appeared to be in mid-spin. They turn two today! Grace had written.

What’s his shirt mean? Leo wrote back. He could remember sitting on that couch last week, dialing Grace’s husband over and over again while she sat in the adjacent armchair with her knees to her chin, crying.

It’s a band. He used to roadie for them.

Leo struggled with what to send next. He settled on How are you?

The text bubble appeared promptly and he watched it for a full seven seconds. Then it disappeared. He spent another minute staring at the screen, waiting for a response. Then he put the phone back in his pocket.

 

II

Because Richard freelanced from home, Leo was accustomed to him sleeping in on weekdays. On this morning, however, Richard woke up and leaned over the side of the bed to watch Leo do pushups.

‘You’re a morning addict,’ he said. ‘You’re addicted to mornings.’

Though it compromised his form, Leo raised his head to watch Richard walk stiffly from the bedroom through the living room to the kitchen and then disappear behind a wall. There was running water. The French doors between the living room and the bedroom bobbed up and down in Leo’s vision. In the mornings, Richard moved with the shuffling circumspection of a man twenty years his senior. He spoke differently in the mornings, too, as if he were practicing lines of dialogue without a scene partner.

‘Shall I try the new beans?’ he asked, and before Leo could answer there came the chaotic whir of the coffee grinder.

He decided to skip his morning run and stood, shook his arms out, and went through the living room to his office, where he opened his laptop. There were three emails from clients, all about recent changes he’d made to their medication regimens. He answered them all quickly but thoroughly: Hi Renata, The prior authorization for the Vraylar went through, so you can check with your pharmacy now; Hi Jeremy, You should be fine if you stay the course with the Paxil; Hi Lou, If the agitation persists, you can go up to 2mgs of Rexulti, but no more. His email signature read:

Dr Leo J. Lihn

Professor of Professional Practice, Feinberg School of Medicine

The Lihn Group, 750 N. Dearborn St., Chicago IL, 60654

He checked his phone. A text from Ellen, the other Lihn Group clinician, who was wondering if he would be willing to assess a 27-year-old patient who had been referred by a well-regarded therapist. She totally understood if Leo didn’t have time for this, and would normally do it herself, but her son was home sick with what appeared to be chicken pox and she would have to leave by noon.

Leo wrote back: OK.

In the kitchen, Richard was pouring the coffee into a mug that read rush university and another that had a silhouette of a cardinal on it. He gave Leo the cardinal mug and then brought his hand to the small of Leo’s back and pulled him in.

‘How do you feel this morning?’ he asked, his lips to Leo’s ear.

‘Fine.’

Richard kissed his ear, then his cheek. The kisses made him shiver.

‘Just fine?’

‘Good! I feel good.’

Richard made a scoffing noise. He went to the kitchen table, where Leo had left his Archer Armour file after studying it for two hours the night before. He made a show of carefully leafing through it. Leo felt a flood of warmth in his face, the way he remembered feeling whenever his mother brought him along to a parent-teacher conference and she and the teacher spent an hour discussing how exceptional he was. He laughed and made a halfhearted effort to snatch the file out of Richard’s hands. Richard jumped away.

‘Archer Armour c’est moi,’ he said.

‘Archer Armour? I think he has schizoaffective disorder, probably bipolar type. You’re nothing like him.’

‘Well, I want to kill Donald Trump,’ Richard said, and spun around to open the refrigerator. ‘And I’m not a to-the-manor-born white man.’

Leo finally grabbed the file back. He opened it to make sure all the papers were in order. ‘But you wouldn’t do it. Not even if the opportunity presented itself.’

Richard unscrewed and sniffed a jar of sauerkraut, wrinkled his nose, and set the jar down. ‘How do you know? You’ve only known me two years – you didn’t see me on election day. You don’t know what I’m capable of. I don’t even know what I’m capable of.’

‘What did you do on election day?’

‘That’s my secret,’ Richard said, smiling a pointed, impish smile. His eyes darted to the left, then the right. ‘I might very well have spit at a cop.’

‘Sure you did.’ Leo pecked him on the cheek. ‘And we’re all very proud of you.’

In the train on the way to the office he checked his phone for texts from his sister. None. He composed one: You probably know what I’m going to say about going to group, so preempt me by actually going to group. It was harsh. Grace had once told him he acted like a Bond villain when he got angry. He deleted the message and wrote instead: Call me after 4 today?

His least favorite of the three secretaries was working on her own that day, by some wretched scheduling logic known only to the three of them. She wore a turtleneck sweater despite the 73-degree heat and gave him a wide smirk as he unlocked the door. When she stood – and he hated when she stood – she had at least three inches on him.

‘Hi Dr Lihn,’ she said.

‘Hi Marsha,’ he said. ‘That’s a nice sweater.’

She took the edge of the left sleeve in her hand and nodded.

He passed Ellen’s office in the hallway and she rushed to her door. She too wore a sweater, but it was cable-knit and the sleeves gaped at her wrists like loose skin. Her concealer flaked in the wrinkles at the corners of her eyes. Leo remembered without wanting to that, when he was a teenager, his mother had worn concealer to hide a sudden-onset case of rosacea. She was working in a restaurant then and told him very solemnly that if the server’s face was dirty, then the customers thought the food was dirty, too.

‘Thank you so, so much for covering for me today! I told the patient she’d be seeing you, at least for the intake, and she seemed fine.’ She held his hand in both of hers. He felt suddenly grateful to Ellen: for her goofy expressiveness, for all the times she told him not to be so hard on himself in that stale-smelling break room during their residency at Rush, for that fourth of July when she let Grace read tarot for her.

‘It’s really no problem,’ he said, regretting his simple OK. ‘Matthew needs his mom.’

Ellen rolled her eyes. ‘What Matthew really needs is his dad. If I could get Matthew senior to take off work like I do, maybe we’d be in business.’

Leo nodded, not wanting to even begin to imagine that family dynamic, and excused himself with the promise that they would get lunch later in the week. For the rest of the morning, he updated charts and listened to Ellen’s patients – most of them the well-dressed women he often saw in the waiting room picking at the stacks of old magazines – sobbing in the next room. At 2:30, Marsha buzzed him to let him know the 27-year-old patient had arrived.

She was tall, much taller than him, and wore a striped tank top and owlish glasses. Her hair was Annie Lennox short. Her jeans buttoned high at her waist and were nearly bleached white – ‘mom jeans’. She shook his hand limply and took small steps as she walked to the couch, her shoulders hunched. She moved with the attitude, long familiar to Leo, of a young woman who has spent years of her life loathing her body. She said her name was Dillon Halliday, spelled D-I-L-L-O-N.

‘Is that a southern name?’ he asked.

She shrugged. ‘My mom’s from Texas.’

He asked Dillon to tell him a little bit about what had brought her in today. She said her therapist had recommended the Lihn Group because they were supposed to be the best in the business, and she had problems with sleeping and remembering things and often wanted to kill herself and couldn’t stop thinking that she might be straight even though she knew she was gay. He recorded all this on his laptop and then looked up at her.

‘Any other symptoms of OCD?’ he asked. ‘Repetitive behaviors? Intrusive thoughts about taboo subjects?’

Her eyes widened. ‘How did you know?’

‘How did I know what?’

‘Did my therapist tell you? That she thinks I have OCD?’

‘No, you would have to sign a release of information form for me to talk to her. It was just clear from what you were saying that you’re presenting with something we call pure OCD, possibly coupled with depression and anxiety.’

‘But I didn’t even tell you about any of the big-ticket items,’ she said. ‘Like the cutting and the picking, or the thoughts that I might be a pedophile.’

‘All OCD,’ he said, and tried to maintain the lilt in his voice that would keep her from feeling like just another chart on his laptop. ‘And fortunately, it’s highly treatable.’

Her mouth hung open in the same way Archer Armour’s had. She scooted forward on the sofa. At this point in his career – he was 43 and had been practicing for thirteen years – he could feel when transference was occurring: it happened the quickest with young millennials, impressed with his speed and accuracy and willingness to listen to them as they spoke about themselves. Kids whose futures had been mortgaged by the generations ahead of them, who were working in corporate chains like Whole Foods with horrible pay and strangely decent health benefits (the ones without insurance never saw him, of course), saddled with student debt, with scars on their forearms and bad dye jobs, accustomed to bingeing Netflix shows about serial killers or female friendship, mumbling about how rising sea levels and melting ice floes were ‘good news for my depressed ass’. Kids who identified so strongly with their diagnoses that Leo was like a monarch knighting them, inducting them into the realm of the Mentally Troubled, where they could find relief in an explanation for their abnormal psychologies, where they could indulge in the comforting language of destigmatization and self-care.

‘Why don’t you tell me in a little more detail about the other symptoms you mentioned?’

Dillon sat forward in her seat. She was looking at him in the way she probably should have looked at her parents as a child, her face aglow with wonder, admiration and unconditional trust. She began telling him about a day at the beach during which she’d abandoned her friends to cut the soles of her feet with a shard of glass she’d found. While she spoke, he imagined the apartment she probably shared with three roommates: the common area a hodgepodge of roughly assembled Ikea furniture, her room barely big enough to fit her bed, a flimsy bookcase full of radical literature from the women’s and gender studies courses she’d taken in college. He imagined that she went home to that room every night and picked furiously at the skin on her arms and hands (he could see the scars from seven feet away), trying to stave off thoughts about her insignificance. Maybe she held a lighter under her thumb like Grace had when their mother went out grocery shopping and left her to watch Leo. She’d hold the lighter close until the pad of her thumb grew coarse and ashy from exposure to the flame. Then she’d move on to her index finger, then her middle finger. She’d keep her hands out of reach of Leo and keep burning her fingers while he mewled Stop it! Stop it! and jumped up and down, trying to grab the lighter.

He let Dillon talk for the rest of the session and then told her he would prescribe 100 milligrams of Luvox to be taken daily in the morning. He said, ‘Do you have any questions for me?’ and reread her chart instead of looking at her.

From Dillon’s direction came a throaty growl: ‘Fucking faggot loves killers.’

He looked up. Dillon wore the same grateful smile she’d worn moments ago.

‘What did you say?’ he asked.

She looked confused. ‘Sorry – I didn’t say anything?’ She shifted around on the couch and looked down at the cushions, as if between them lay a viable explanation for his question.

‘You didn’t say anything?’

‘No, I didn’t. I’m still thinking of questions. Did you hear something? Sorry, I’m really hard of hearing. I think it’s from going to shows?’

He looked right at her and heard the growl again, this time with no words.

‘It must be the building,’ he said, trying to keep an even tempo to his speech. ‘It’s an old building.’ He wanted her out of his office.

She stood up and lingered by the couch, then the door. He told her that next time she would be seeing Dr Ellen Mirsky and not him – he would make sure Dr Mirsky got her chart.

‘Oh but I want to see you, if that’s OK?’ she asked. ‘You’re probably the best psychiatrist I’ve ever seen.’

He thanked her and told her he would be able to see her again in two weeks.

It was 4:03. Ellen was gone. He was alone in the office with Marsha, who was probably moving glacially around the little alcove where she sat behind the sliding glass window, gathering her phone and crossword puzzles and stress ball made to look like an alien’s head before she left. He sat still, waiting for the growling to begin again. It had been atavistic, a feral dog’s growl. He went to the window and looked down into the street. No dogs, and he was too high up to hear them even if there had been any. It could be an auditory hallucination, for which he typically prescribed risperidone, aripiprazole, olanzapine, ziprasidone or quetiapine. When those drugs failed, clozapine or haloperidol.

The colors in the room went suddenly bright and electric and then desaturated again. He blinked. He couldn’t tell if he was hearing the growl or an echo of the growl.

‘What do you mean I’m a faggot who loves killers?’ he asked the room. He received no response.

His phone buzzed and he had the thought that maybe whatever had been growling was now calling him. His tongue cottoned. Whenever they watched a horror movie and Richard noticed him lingering on a particularly gruesome scene, he would tell Leo not to let himself be scared for a second longer than he needed to be, or else he’d be scared forever. Heart flapping in his chest, he reached for the phone and saw that it was Grace.

‘Hey,’ she said. ‘You told me to call you.’

He held the phone in his right hand and worried a shirt button with his left. He asked her how her husband was doing after his bender last week.

‘Fuck,’ she breathed. ‘This is what you wanted to talk to me about?’

He told her it wasn’t what he wanted to talk to her about, he was just worried.

‘No, you’re not worried, Leo. You’re all superior and trying to parent me from your little office downtown. You’re trying to run my life.’

He wasn’t trying to run her life. Also, she sounded drunk.

‘Fuck you, Leo,’ she said, and hung up.

 

III

He had a light teaching load that semester at Feinberg, just a lecture course called Special Topics in Medical Literature: Psychotic Disorders. He assigned two tests and the department assistants graded them both for him. That afternoon he had to deliver a lecture called ‘DAOA/G72 Polymorphisms and Heritable Psychosis.’

He checked his phone on the train. Archer Armour’s attorney had written with the information that the warden would allow him to conduct a psychological evaluation in the medical examination room, if that was of any use to him. The attorney wanted a report from him in two weeks at the latest – she hoped that didn’t inconvenience him. Richard had texted him about possibly getting a guest membership at the gym. Ellen had texted him thanking him again for yesterday, including a picture of her red-pocked son giving the camera a thumbs up. Leo wrote back to her: No problem, although I think the client wants to stick with me.

There were no texts or emails from Grace.

He looked up and his heart began to flap again. Dillon was sitting across from him. Today she wore a jean dress with ruffled sleeves, loose even on her frame, and a pair of clogs.

‘Hi Dr Lihn!’ she said.

‘Hi Dillon,’ he said, and looked back down at his phone.

In the upper periphery of his vision, he watched her shift uneasily on the train seat as she had on the couch the day before. She had the proportions of a Marfan sufferer.

‘I just wanted to say that you really helped me out yesterday,’ she said. ‘I really, really feel a lot better because of what you said.’

The rule was you did not engage a client about their case outside of your practice unless they engaged you first.

‘I’m glad,’ he said.

She smiled. A feeling of urgency swelled in his chest, as though he had just realized he was about to get mugged. He wanted to turn to the woman sitting next to him – middle-aged, wearing a papery raincoat and playing Candy Crush – and tell her that he was in grave danger.

‘So are you from here?’ Dillon asked.

‘No, um, not exactly,’ he said.

‘I’m not either.’

‘This is my stop.’

He waved a curt goodbye and got off the train. He was twelve blocks from Feinberg. As he walked he heard an officious baritone not unlike Alex Trebek’s say ‘People die because of you.’

He shook his head and checked his watch. 7:46. No one dies because of me.

‘But they do,’ Alex Trebek responded.

Time moved faster than he was accustomed to. His students’ faces were blank, featureless, their questions inane or possibly nonexistent. He wondered on the train back home whether something unfavorable might be happening with the dopamine receptors in his brain. What were his symptoms? He thought of being six or eight and having to jump over the small oval rug in the bathroom an even number of times or his mother would die. He thought of when his mother actually did die, how he overworked himself in his residency and didn’t take any of Grace’s calls. His boyfriend at the time, a fellow psychiatry resident with an attractively crooked nose, had given him a copy of Modern Man in Search of a Soul, which Leo had read in twenty-four hours. When the boyfriend gave it to him, he’d said, ‘Leo, don’t hide your grief.’ He had one patient ten years ago, a particularly neurotic teenaged boy, who had not cried when his sister died of bone cancer and was consumed by the thought that his grief had instead manifested as a tumor in his brain. He was prescribed Paxil and Xanax. That had been a clinical error, Leo realized later, because the boy ended up becoming addicted to the Xanax and overdosing.

When he got home, he found a bean casserole in the fridge with a note taped to it: Dig in, dearest. He cut himself a big square and brought it into his office, where the Archer Armour file was sitting on his desk. He opened it and flipped past the police report, his own cursory notes, and a news clipping (‘Mailman Slain by Suburban Restauranteur’), to a scanned page of a teenaged diary Archer’s mother had given the attorney. The entry was dated 8 March, 1994:

There are two voices, a little one and a big one, and they’re both telling me to kill myself. I’m not going to because I love my parents and I can’t put them through that, but that doesn’t mean I don’t want to. It would be worth it just to get the voices to go away.

If anyone ends up reading this, don’t worry – I turned out OK. Everything went fine for me. 

Leo didn’t read the rest. He stood and listed to the couch in the living room. There he checked his phone again, registering only the few lines of his silhouette visible against a wallpaper photo of him and Richard skiing in Colorado. He was needed. He had a place in the world, unlike so many of the people who relied on him. Plus he had been through enough humiliation in this life, taken enough gut punches for himself and his mother and Grace and sometimes even Richard, that this, whatever it was, was entirely unnecessary. That is to say, if there was some kind of codified karmic justice at work, it would be a huge error to strike him now.

He recalled unbidden that the worst part about getting his face rammed into the ground by dumb Max back in grade school was that he’d actually liked it. The humiliation, the dirt smeared across his cheekbones and lips, Max’s bony knees in his back. Back then he had, in fact, departed from his body and viewed the scene from above and stiffened a little with pleasure. Of course he would never tell anyone that. Not even Richard.

‘Filthy slut,’ Alex Trebek said. ‘Kill yourself.’

He sprang from the sofa and began a text to Ellen: I’m having symptoms of . . .

He deleted the message and tried again: I was wondering if you could give me an evaluation?

He deleted that too, and sat back down, biting his lower lip. The walls of the room were expanding and contracting as though he were in a lung. When Richard met with his editor, he was usually back by 6:15 and it was 5:46. Twenty-nine minutes to go. Leo had probably seen hundreds of clients like Dillon, hundreds of broke twenty-somethings dogged by thoughts of suicide. What power could she possibly have over him?

Suddenly it was morning and he was lying down somewhere and there was a loud beeping coming from behind him. Richard was standing over him, and when they made eye contact he smiled and said, ‘You’re awake, my love!’ And then, ‘Grace, c’mere!’

Grace’s sallow, bone-thin face appeared over him. She wore a small smile.

‘The idiot’s awake,’ she said, and shook him softly by the shoulder.

Richard’s face was gone and then back again. He proffered a cup of water, which Leo found himself wanting desperately. He drank and then sat up. He was in a hospital bed. There was a pulse oximeter on his right finger. He took it off.

‘Don’t take that off!’ Richard said, waving his hands. Leo ignored him.

‘Did you ever come home?’ he asked. ‘Why are we here?’

Grace and Richard looked at one another. Leo could feel his pulse in his right forearm, and noticed that the entire thing was wrapped tightly in gauze and tape. ‘What’s this?’

Grace turned to him, her face taut. He recognized her expression – it was the same dour expression he himself wore whenever he had to tell a client bad news. Richard put one hand on Leo’s thigh, the other on his shoulder.

‘What do you remember?’ Richard asked.

Leo shook his head. ‘What do you mean what do I remember? I was at home eating the casserole you made and waiting for you and now we’re here.’

‘On what day were you home?’ Grace asked.

So now Grace was asking the clinical questions. ‘Thursday,’ he said. ‘June 6th.’

‘It’s June 8th,’ said Grace.

Leo shook his head. Grace pulled her phone out of the pocket of her tiny tight jeans and showed him the lock screen: Saturday 8 June, 3:12 p.m.

‘Let me see my chart,’ Leo said.

‘I – I don’t know how to do that,’ Richard said. ‘What I know is I saw you walking down Clark with a massive gash in your arm on Thursday night as I was coming home. People were scared. I got you in the car and you passed out on the way to the hospital. You’ve been in and out of consciousness since then.’

‘People were scared?’

‘You weren’t yourself,’ Richard said gently.

‘Can you go find someone who will let me see my chart? Is this Rush?’

Grace and Richard both nodded.

‘OK, see if Dr Reddy is still attending,’ Leo said. ‘She taught me in med school. Can you do that?’

Richard sighed. ‘I’ll try, love, but I can’t promise you anything.’

He stumbled out of the room and Grace took a seat. Leo made to swing his legs over the side of the bed but she stood to block him.

‘You’re in the hospital,’ she said. ‘You’re here for a reason.’

‘I feel fine.’

‘You always “feel fine”.’ She rolled the sleeves of her sweatshirt up: he saw now that it had been screen-printed with the same spinning Shaggy head as her husband’s T-shirt.

‘That shirt is grotesque,’ he said.

She narrowed her eyes at him. ‘You’re grotesque.’

Her face was pitted with acne and a tangled clump of hair rose asymmetrically from the back of her head. She seemed to feel his gaze on her, because she raised a hand to smooth the hair back down. She was unsuccessful.

‘You went crazy,’ she said. ‘You carved like a four-inch gash into your arm. Richard found the knife in the kitchen.’

His forearm pulsed again. He felt his cheeks redden and his mind speed up.

‘How’s the restaurant?’ he asked.

‘You just woke up in the hospital and you want to talk about the Hard Rock Cafe?’

‘Getting any big tips?’

She put her arms on her hips and exhaled, a gesture she used to do as a teenager to communicate that whomever she was speaking to had completely exhausted her reserves of patience. ‘Come on, Leo.’

‘Your young husband disappears for four days and comes back missing a tooth, I talk to you on the phone and you sound drunk, you expect me to just ignore all that?’

‘I’m staying sober,’ she hissed. ‘My life is my life. How can you manage to make a crisis about you into a crisis about me?’

‘There is no crisis about me,’ he said. ‘I’m fine.’

‘You were raving in the street!’ She threw her hands up in the air as if to solicit a witness to his unreasonableness.

‘I’m under a lot of stress,’ he said slowly. ‘People under a lot of stress are prone to breakthrough moments . . .’

‘Breakdown moments.’

‘. . . where the fabric of reality twists and bends for them. It’s completely normal. If this were a legitimate clinical issue, I’d still be exhibiting symptoms.’ He was lying to her, he knew, but he wasn’t sure to what extent. ‘Really, whose opinion are you going to trust? Mine or Richard’s, who writes magazine copy for a living?’

‘Richard’s, because he wasn’t the one who dug into his arm with a knife.’

Every time she mentioned the arm, it felt worse. He tried to raise it and it was log-like, heavy.

Richard came back into the room, a look of benign confusion on his face. ‘I don’t think Dr Reddy’s here anymore,’ he said. ‘I asked everyone. They thought I was a madman.’ At the pronunciation of this last word he inhaled quickly and looked cautiously at Leo as if he’d said something unforgivable. ‘You know, Leo, Grace and I had a little bit of a conversation. About where we’d go from here?’

Leo scowled and picked at the gauze. His arm was beginning to throb. Whatever they’d given him was wearing off. Was he not worth a morphine drip?

‘Since you were a bit erratic on Thursday, we’d, um, like to do something for you. And I know you, I know you definitely don’t want to do inpatient. They didn’t have any beds. And in any case, no one – not me, not Grace, not any of the staff here – is going to make you do it.’

‘Doing inpatient’ was a term Richard had learned from Leo. He hated it being weaponized against him. ‘Why would I need to do inpatient? I was momentarily stressed, that’s all. I’ve had clients go through a lot worse and come out fine.’

‘You did carve up your arm,’ Grace said. Richard made a little waving gesture to quiet her.

‘We were thinking that Grace would try and rearrange her schedule this coming week to be with you after work, during that time after you get home from the office and before I get home from my meetings.’

‘Just this coming week. I’ll be gone after.’

Leo could feel something hot and bilious rising in his stomach. ‘No, I don’t want you gone, Grace, remember? Right before she died mom told me I had to keep an eye on you. I don’t want to be derelict in my duties.’

Grace huffed and looked up at the ceiling. He knew she didn’t believe him because she hadn’t been there. She had been off in Tucson getting married to her first husband while Leo was twenty-two and headed to medical school. The car was packed full of his belongings – in the morning he and his mother planned to drive from the south suburbs to his dormitory at Rush – and they were sitting at the kitchen table eating spaghetti dusted with parmesan. Leo’s mother had placed her hand on Leo’s wrist and said, ‘Your sister is wild. I need you to watch after her.’ He had looked up from his spaghetti to see that his mother’s eyes were watering and her lips were screwed up in a diagonal line. ‘Of course,’ he’d said, and grabbed her searching hand in his own.

‘I think this will be good for everyone,’ Richard said, his eyes darting between Leo and Grace. ‘I think we all stand to benefit from this.’

 

IV

Even when he wore his suit jacket with the slightly long sleeves, the gauze was still visible. He had been lazy about re-dressing it, partly because he didn’t believe he was the one who’d injured himself, partly because he didn’t want to believe it was even there. It was possible – distinctly possible – that someone had attacked him and Richard and Grace were protecting him from this knowledge. The stitches hurt.

‘I want you dead,’ the growling voice said. Alex Trebek said something inaudible that sounded like it had been distorted by wind. He flicked at his ear as if to brush the sounds away. He had written himself a prescription for 100 milligrams of tiapride, which he had picked up at Walgreens with Richard, who had made him promise to ‘do something’. In the Lyft on the way to Cook County Jail, he shook out a pill from the bottle and took it with a gulp of coffee from the thermos Richard had prepared for him. The coffee burned the back of his throat.

As he was given his visitor’s badge and taken past the security barrier, he had the feeling that his brain had been sliced diagonally and a magnet of an opposing pole placed in each half, so that trying to get the halves to cohere in his skull was extremely painful. He wondered if he was developing an aneurysm just by trying to keep both halves of his brain in his head. Everything around him – the walls, the floor, the swaying shoulders of the prison guard walking ahead of him – seemed bright and unreal, as if his faculties were set to peel off into insanity, and he wondered if there would ever come a time again when he was just sitting at home with Richard watching a dumb TV show and feeling bored. The idea that he might have permanently lost boredom and all its beige normalcy, its safe uneventfulness, struck him as profoundly sad and a little scary.

Archer Armour was already waiting for him in the medical examination room, flanked by two guards: a stocky one with a shaved head and another who very conspicuously wore a gun on his right hip. Archer had gotten a haircut since Leo’s last visit. The grey showed more obviously at his temples. Leo felt Archer’s eyes travel to his gauze.

‘What happened, doctor?’

Leo shrugged, the halves of his disintegrating brain banging around in his head. ‘Nothing, just an accident in the kitchen.’

‘It’s at a weird angle to be an accident in the kitchen,’ Archer said. ‘Usually those happen on the hand, not the wrist.’

‘Quiet,’ one of the guards said.

‘No, it’s fine.’ Leo opened his briefcase and withdrew a binder containing the Structured Clinical Interview for DSM-5. ‘I don’t care if he asks me about it.’

‘Were you good at math and science in school?’ Archer seemed determined to pursue some line of questioning.

‘What’s your problem?’ one of the guards asked him. ‘Let the doctor do his job.’

‘Really, it’s fine,’ Leo said. ‘Yes, I was good at math and science.’ And philosophy and English and art history. ‘I liked science so much that I went to med school.’

‘A lot of you are good at math and science,’ Archer said. ‘You, um, people who become doctors. I myself couldn’t do anything in school except English, and I wasn’t about to become some goddamn English teacher. I was born to make money.’ He laughed, and one of the guards sighed and looked at his watch.

Why was Archer in such high spirits? It occurred to Leo that he might be manic. Or worse, that he might have gathered from the gauze and Leo’s unwashed hair that something was wrong with Leo, which meant what? That Archer had a comrade-in-arms?

‘Fuck you,’ Alex Trebek said.

‘Do you need any help, doctor?’ the guard with the shaved head asked.

‘No, no.’ He would try to pretend the guards weren’t there, since just looking at them somehow made the situation in his head worse. He sat down across from Archer. ‘Archer, do you remember the questions I asked you last time?’

‘Sure, but I remember what we talked about after that more clearly. You told me about your sister and I told you about my brothers and growing up in Louisiana.’

‘OK, well, those questions were preliminary questions so I could get in your head a little. Now we’re going to do what’s called the SCID-5. It’s an interview that determines what diagnostic category from the DSM-5 you fit into.’

Archer nodded. ‘Everything’s got an interview,’ he said. ‘Everything’s got a test. And I never pass the test.’

‘I have a feeling you’ll pass this one.’

The interview took over an hour, during which Leo officially diagnosed Archer with schizoaffective disorder, bipolar type. Archer had delusions and both auditory and visual hallucinations; he had definite periods of elevation in mood; the murder had been committed during one such period of elevation, when the paranoia was running particularly high and Archer hadn’t slept in over five days. After some prodding, it came out that his wife had divorced him because the delusions, and Archer’s refusal to seek help, had gotten to be ‘too much’. He only saw his children twice a month, and then only in the company of a social worker. This was because he had attempted suicide shortly after the divorce, and the judge had determined him unfit to care for his children until he became more stable. Troublingly for his case, he had never once neglected his duties at the restaurant.

‘What kept you going back to the restaurant?’ Leo asked.

‘Money,’ Archer said sullenly. ‘I’m not going to leave good money sitting on the table.’

‘Even when you were hallucinating corpses and ghosts? Even when you were convinced the president was coming to kill you?’

‘Please. That man’s not any more fit to be president than I am to raise my kids.’

One of the guards cleared his throat loudly. Without looking at them, the acoustics of the room were such that Leo couldn’t tell which one it had been.

‘I can testify that you have schizoaffective disorder, but I can’t help you much beyond that,’ Leo said. ‘You certainly meet the diagnostic criteria, but the jury will wonder why you were still behaving rationally during the time of the murder.’

Archer leveled his eyes at Leo.

‘They’ll wonder why, if you’re as sick as you are, you were capable of going into work and earning money.’

‘Earning money isn’t rational.’ He spoke slowly – perhaps the interview had tired him. ‘Going to work isn’t rational. None of this bullshit is rational. All that’s rational, doctor, is wanting to be a naked human being sitting in the sun drinking peach nectar while you’re surrounded by the ones you love.’

‘I’ll kill you if you don’t kill yourself first,’ Alex Trebek said, followed by a growl.

Leo took a Lyft to the red line and then rode it back north. He got out two stops before he normally did and walked to Clark Street, which had been cordoned off for some kind of summer festival. Middle-aged white people in tartan shorts clutched plastic beer steins and stood talking in groups of three or four, pulling out their phones to confirm or disconfirm something one of them had said. A band of youngish men played ‘Sunshine of Your Love’ on a raised stage. As Leo wove among the crowd, he felt his phone buzz.

Grace: I’m outside your place. Where are you?

He re-pocketed his phone and walked up to the salon where he and Richard got their hair cut. It was owned by a woman named Mrs Thahom whose husband had died in a construction accident and whose grown children had left Chicago and rarely visited her. She decorated her windows with the stenciled drawings of men and women in business jackets and floral dresses that Leo associated with beauty parlors in the 80s. When he opened the door, her two-note electronic doorbell sounded. She came rushing out from behind a screen on which had been painted a triptych of rice farmers.

‘Leo! Leo, my god!’ she said, and held him by the elbows. She turned his right wrist over, inspecting the gauze. ‘How are you, my dear?’

Leo’s phone was buzzing. He ignored it. ‘I was thinking of getting a haircut.’

She looked briefly at the top of his head and shook her own. ‘You don’t need a haircut. How are you? Tell me how you are.’

There were no other patrons in the shop. Leo grasped Mrs Thahom’s elbows back. ‘Was I here last week?’

‘Yes! Yes, darling, you were here and you did not seem like yourself! I kept calling to you and you walked right past me, like you were on some kind of a mission. And your arm – your poor arm was bleeding! So much blood!’

‘Did you see anyone attack me?’

Mrs Thahom looked momentarily confused. ‘Attack you? Who would attack you?’

‘Well, my arm was bleeding.’

‘No, no one attacked you, darling. You were just walking –’

‘I think I was attacked, Mrs Thahom. It couldn’t have been far from where Richard and I live.’

She nodded. ‘Maybe you were. There’s a neighborhood crime watch, you know?’ Her excitement redoubled. ‘I saw Richard, too! He came to get you. But if you don’t mind, darling, it didn’t look like a random attack.’ Her eyes widened. ‘It looked as if someone had sat you down and tortured you. Was your wallet missing?’

‘No.’

She pointed to his briefcase on the floor. ‘Anything from there?’

He shook his head.

‘So you weren’t robbed, my dear.’

‘But there are attackers on the North Side who aren’t out for money,’ he insisted. ‘There’s that man in Rogers Park who just went around killing people. Remember? He shot the man walking his dogs and the kid who was jogging?’

Her eyes widened further. His phone was buzzing again. ‘Yes, I remember,’ she said, her voice almost a whisper. ‘Do you think it was him?’

Then the sliced halves of his brain slid back into place. It was clear to him now what he had to do. He had been chosen to stop more harm from happening. All those beatings he’d taken, Max’s knees in his back, shouting himself hoarse in defense of his mother as she got older and slower and sadder: it all added up to this, this noble mission, this quest to reduce harm on as large a scale as possible. What had chosen him to do this, he didn’t know. But it made sense.

‘Mrs Thahom, my sister’s waiting for me,’ he said. ‘I have to go.’

She pulled him into a tight hug. She was three inches shorter than him, so he kissed her on the forehead as if she was his grandmother.

Grace was sitting on the stoop playing with her phone, slouched forward like a teenager. It amazed Leo how she managed to look so young despite being so old. She stood when she saw him. She was still wearing her black Hard Rock Cafe T-shirt.

‘You’re late,’ she said.

He went up the stairs past her, unlocked the door, and went in.

‘You’re late,’ she said again, following him into the foyer. ‘I was sitting there for like twenty minutes waiting for you. Did you run late at the prison?’

‘No,’ he said, and went into his study. He got a notebook out from a drawer in his desk and began to write in it: Today I realized that I am going to keep people safe in a way far more meaningful and with far more human impact than the practice of psychiatry.

Grace was standing somewhere behind him. ‘What are you doing?’

But I must continue to practice psychiatry, or else I will lose my connection to whatever this is. Whatever this powerful thing is. Because it was through the practice of psychiatry, for better or worse, that I have come into association with this thing.

‘That’s more like it,’ Alex Trebek said, gentle this time. ‘Now you’ve got the idea. Now you know what you’re supposed to do.’

She was standing over his shoulder. ‘What are you writing?’ He tried to brush her away, but she was undeterrable.

I need to better understand this. I am a protector, like Hippocrates, but now more like a hierophant, a super-hierophant.

‘Today I realized I am going to keep people safe . . .’ Grace read, and he slammed the notebook shut and stood to face her.

‘Stop it,’ he said stonily. ‘Stop looking at what I’m writing.’

‘I’m just trying to understand what’s going on here.’

‘Nothing’s “going on here”, Grace. You’re just in my house for no reason.’

Clutching the notebook to his chest, he went through the living room and into the kitchen. He hadn’t eaten since breakfast and he wanted to cut himself a hunk of the Manchego Richard had bought. But there were no knives in the knife block. He looked on the counter, in the drawers beneath the block. No knives.

Grace was leaning in the doorway. ‘Are you looking for a knife?’ she asked. When he didn’t respond, she walked up to the utensil drawer and withdrew a butter knife. ‘Richard hid all the knives.’

He grabbed the butter knife from her hand and threw it past her, into the living room, where it sent a vase crashing to the floor.

‘Jesus Christ, Leo! What the fuck is going on?’

‘Nothing!’ he said, and he felt near tears. ‘Why are you treating me like a child?’

‘No one’s treating you like a child,’ she said in the voice she used on the rare occasion when he and not she needed comfort. Then she was holding his undamaged wrist in one hand and he was trying to wrest it free: she was oddly strong, had always been. ‘We’re . . . stop it . . . we’re just worried about you.’

‘I’m worried about you,’ he howled. ‘I’m worried about everyone!’

‘Leo, if you calm down, we can have a conversation about this.’

He broke free and sank to the floor. He felt sick. ‘There’s a murderer in Rogers Park,’ he said. ‘And there’s a murderer in Cook County Jail.’

She squatted next to him. ‘There are murderers everywhere,’ she said. ‘People kill people all the time.’

‘Yes, exactly. And people hurt people. People beat people up, call people humiliating names. You wouldn’t know.’

‘What are you talking about I wouldn’t know?’

‘I can do something about it, if you’ll fucking let me,’ he said.

He sprang to his feet and went past her into the bedroom. She followed him. He could feel himself crying. He tore the comforter off the bed.

‘Fine, I’ll let you,’ she said. ‘But you have to eat dinner and go to sleep first.’

He lay in the bed, his hands between his knees, and cried into the sheets until his nose ran. Archer Armour had killed a man because he thought he would be killed. The Rogers Park murderer had quite possibly killed people for the same reason. But how to hold the mentally ill accountable when they’ve caused harm? How to do justice to the loss of a good and harmless human life? He had seen pictures of the mailman Archer had shot three times: blond, mid-thirties, acne-pitted, not unlike Donald Trump in the jaw. His family torn apart by grief. The mentally ill couldn’t be held responsible for their actions. But their actions had grievous consequences. The only way to fix it was to rid the mentally ill of their fear. He could do it. He would rid them of their fear.

‘Yes!’ Alex Trebek said. ‘Yes, finally! I’m getting through to you!’

Grace brought him a plate of crackers and Manchego, which he ate while she watched him. He was tired soon after, and fell asleep while she stroked his hair and sang ‘Wild Horses’, which their mother used to sing to them every night at bedtime until they were big enough to put themselves to bed.

 

V

When Leo woke up at 7:00, he saw Grace was asleep next to him, her T-shirt bunched up at her ribs and her hair knotted around her face. A bottle of Richard’s Glenlivet was open on the table next to her. He screwed the cap back on and put it in the hutch in the living room, where Richard was asleep on the couch, the blue wool blanket they’d bought on vacation in Scotland drawn up close under his chin. The shards from the broken vase had been cleaned up. Leo left for the office without waking either of them.

On the train, he balanced the notebook on his thigh and wrote: I began to get hints of my chosen status recently while doing a routine evaluation of a patient, Dillon Halliday, who presented as having pure OCD coupled with depression and anxiety. At first I was frightened. Now I understand what I am meant to do. The growling is gone, entirely gone, and what remains is a clear and supportive voice that may not be there but is fully aware of who I am and what I intend to do. What I am meant to do, rather.

‘Well done!’ Alex Trebek said. ‘Noble! You’ve living a noble life!’

At the office, he emptied the bottle of tiapride into the toilet, flushed it, and threw the container in the trash. Marsha was sitting at the front desk again. He locked eyes with her.

‘I’m happy to see you, Marsha,’ he said. ‘I really mean that.’

Marsha nodded. ‘Thank you, Dr Lihn.’ She may not have felt the same, but he could tell from her small smile and the way she raised her dull eyes to him that she had at least meant what she said.

Ellen stopped him in the hall to show him pictures of her son dressed as a pirate. Leo nodded, smiling, and when he didn’t say anything in response, she squinted at him.

‘How are you, Leo?’ she asked. ‘Your pupils look a bit large.’

He blinked. ‘It’s the sunlight.’

‘The sunlight?’ She paused, considering. ‘Do mine look large too?’

He shook his head. ‘It’s just how mine react to the sunlight.’

In his office, he wrote in the notebook: I feel bad for Ellen. She has to keep doing the small work of diagnosing and prescribing, diagnosing and prescribing, chipping slowly away at the massive ice block of human misery but barely scratching the surface of the real problem, which is fear. I wish for her sake that she could come to understand what the real problem is. I think in time she will. But by then, my work will long since be done.

Marsha buzzed him to tell him his patient had arrived. He went into the waiting room to retrieve Dillon and she lit up when she saw him, bounded after him into his office.

‘How’s the Luvox working?’ he asked.

‘Oh, so great,’ she said. ‘Like so many symptoms are just flat out gone.’

‘Any still remain?’

‘Well there’s the skin-picking, that’s still there.’ She rolled her eyes up to the ceiling as if this would help her itemize the various aspects of her psychological turmoil. ‘There’s some passive suicidal thoughts, some intrusive thoughts, but really things got a lot better after you prescribed the Luvox.’

‘I want to add three milligrams of Ativan for the skin-picking and intrusive thoughts,’ he said. ‘Take that whenever those things come up.’

She nodded solemnly. ‘I’d be taking it a lot, then, doctor,’ she said.

‘Then take it three times a day, at each meal. I’m going to increase the Luvox to 200 milligrams as well.’

‘Yeah, that sounds great!’

He made the notes on her chart and felt her watching him, probably wracking her brain for something she could say that would buy her extra time in his office. He decided to take care of that for her.

‘You know why I became a psychiatrist, Dillon?’ he asked.

Eyes wide, she shook her head.

‘Well first, it was because I wanted to help people. That’s why everyone says they want to go to med school, right? To help people. But then I realized that there’s a difference between helping the body and helping the soul.’

‘I completely agree with you,’ she said.

‘Because, even though the medical literature will try and tell you otherwise, and sometimes even I will get up in front of a classroom and try and tell my students otherwise, mental illness is something over and above a faulty arrangement of neurochemicals in the brain. The whole “chemical imbalance” thing is strictly materialist. Do you know what philosophical materialism is?’

She looked about to speak, but he couldn’t brook her hesitation. ‘It’s the concept, Dillon, that all that exists in this universe is matter, and that all that happens in this universe is matter moving around or changing other matter. But that can’t be true. You can’t point to serotonin traveling across a synaptic cleft and call that “happiness”, can you? Happiness is what you feel when you’re walking home from school and pass under a tree branch after it’s just rained and your sister grabs the branch and shakes it so that it’s raining a second time, but just on the two of you, and it’s one of those rare occasions when water and sunlight meet above your head, and you’re laughing and trying to push her over but she runs away – she’s always been taller than you – but then she lets you tackle her in the grass. It’s not the serotonin or dopamine that gets released as you laugh and see the sun through the raindrops, not the norepinephrine that helps you dodge the drops and chase after your sister, but rather it’s something that arises from the combination of those neurochemicals and the sunlight and the water and the feeling of the grass against your neck, some combination of all those things that produces something immaterial, something that we have named “happiness”.’

‘Yeah, I wish we could distill that,’ Dillon said. ‘I wish we could turn that into a pill.’

‘But that’s exactly my point: there’s no turning that into a pill, because it has no material form. You have to concoct this admixture of things and then happiness emerges as an epiphenomenon.’

‘An epiphenomenon?’

But he hadn’t heard her. ‘I want to thank you for making that initial appointment on the day you did. I want to thank you for coming into my office and telling me your story. Because it was by talking to you that I decided to undertake a study of the human mind that isn’t so materialistic. Do you know where fear comes from, Dillon?’

Dillon looked uneasy now, but she didn’t falter. ‘I’m not sure.’

‘I’m not sure, either. That’s exactly why I’m asking. I don’t know where it comes from and I don’t know if I ever will, but don’t you think it would help correct the course of human history if someone were able to come up with an answer? Not “fear comes from abuse during childhood” or “fear is what happens when you have an excess of norepinephrine in your brain”, but something that points at the exact epiphenomenon, the immaterial existence of fear? If we could find and replicate that, we’d know how to stop it.’

Dillon was silent, gripping the couch cushion with either hand. When she looked up, her face was twisted. ‘I’m not sure exactly what you mean, doctor. It sounds good, but it’s a little over my head.’

He looked at her – young, too tall, uneasy, outsmarted – and could see what she was feeling. There had once been a time in his life when he was constantly bumping up against the ceiling of his knowledge, faced with professors and attending physicians who seemed determined to prove him stupid. There had been many days when he’d gone back to his dorm humiliated, called his mother to tell her he was worried he just wasn’t cut out for medicine. And every time she’d said, ‘You know more than you think you do.’

‘You know more than you think you do,’ he said to Dillon, and wrote her a script for three milligrams of Ativan and 200 milligrams of Luvox.

She smiled and thanked him and hurried out of his office.

Alex Trebek told him to write in the notebook that to make the state or quality of happiness accessible to the people who needed it most – the people most capable of committing harmful acts, in other words – he would need to find every single person’s rainy tree branch and shake it over their heads. His last class at Feinberg had been canceled due to his attack, and so he would be delivering last week’s lecture tonight, a 90-minute expansion on his polymorphism lecture called ‘Inconsistency of G72 Haplotypes Among Bipolar Patients’. The provenance of the attack no longer mattered to him: whether it was the growler or the Rogers Park murderer or Archer Armour somehow escaped from prison, he was grateful for it. Grateful that whatever moved people to speak, think and act was moving him in this way.

The class was full when he arrived, absolutely no stragglers that evening. He hadn’t bothered to learn the students’ names because it was a class of fifty. One of them, a girl who always wore a suit to class and sat in the front row, leaned forward at her desk as he was sorting his lecture notes and said, ‘We’re happy to see you back this week, Dr Lihn.’ Her kind of overweening ass-kissing would serve her well in the medical world, Leo realized. Small people doing small things.

‘I’ve prepared a lecture for you today, but I’m afraid I need to diverge from the topic,’ he said. ‘And give you all a warning.’

There was a brief, collective intake of air. Students shifted in their seats.

‘I want to warn you that what you are trying to do, if done wrong, means nothing. You are saving no one. You are easing no pain. Do you understand? If you aren’t digging as deep as you can dig and unearthing the true cause of human suffering, the thing that has its origins in the spirit-symbols that lie beyond this cave of shadows we call “the world”, then you are doing nothing. Do you see what I mean?’

Heads bobbed.

‘So where does human suffering originate?’

A few hands went up. He chose a chubby one in a jean jacket.

‘Neurochemicals?’ the hand-raiser said.

‘Wrong! Who else?’

All hands lowered except for one. It belonged to a smirking mustache in the third row. ‘Qualia,’ he said.

‘I see you took a philosophy class in college,’ Leo said, his blood pumping, his head light. ‘Congratulations to you.’

Titters.

‘I was bullied and humiliated as a boy,’ Leo said, and gestured to himself. ‘I grew up in an era where it was still uncool to be smart, and it was – and remains – uncool to be poor, uncool to be an immigrant. But you know what haunts me most about my brutalization? I sometimes enjoyed it.’

‘What do you mean?’ the smirker asked. Leo ignored him.

‘I sometimes enjoyed it because I felt I deserved it. This is, I think, the beginning of a story we could tell about human suffering.’

The smirker raised his hand again. Leo continued to ignore him. ‘Did any of you hear about the Archer Armour murder?’

The class was silent. The girl in the front row raised her hand.

‘I did,’ she said. Leo realized she spoke with the faintest hint of a southern drawl.

‘What do you know about it?’

‘That a man with an obvious mental illness killed another man whom he thought was Donald Trump.’

‘Correct. Because he thought Donald Trump was going to kill him. Now, am I right to defend this man in a court of law?’

A voice from the back: ‘You’re not “defending” him, doctor, right? You’re providing expert testimony to his insanity.’

Leo resented the air quotes around ‘defending’.

‘Soulless prick,’ Alex Trebek said. ‘Self-satisfied soulless prick.’

‘Who’s a soulless prick?’ he shouted. ‘Who are you talking about?’ The class stared back at him.

Then he was looking into Ellen’s face. There were bright lights and she was wearing her lab coat. A portly woman with a facial mole stood behind her.

‘Shit,’ he said.

Ellen smiled. ‘You’re back! Stay with me, Leo. Do you know where you are?’

‘Shit,’ he said again. ‘Motherfucker.’

Ellen signaled to the portly woman and she limped around Ellen and affixed a blood pressure cuff to Leo’s right arm. He was wearing a short-sleeved gown so the gauze was completely visible. He let her take his blood pressure.

‘Wow, 110 over 65,’ Ellen said. ‘I’m impressed. Are you still running? Doing that morning regimen?’

‘Haven’t had the chance lately. More important things to do.’

‘Uh huh,’ Ellen said, shining a pen light into his eyes. She held an index finger up. ‘Can you follow my finger?’

‘I’m not doing a neurological exam.’

‘OK,’ she said, and obediently clicked off her pen light. She’d always had the better bedside manner of the two of them. That was the main reason he’d recruited her to his practice: she was an average clinician but a counselor par excellence. ‘You’re at Northwestern,’ she said. ‘It’s Monday, June 17th.’

He was lying on a skinny bed in a dark room. Outside, a nurses’ bay. He looked at Ellen.

‘I’m on the psych unit?’ he asked.

Ellen nodded.

‘I thought you only worked here on Tuesdays and Thursdays?’

‘I came in especially to see you. Richard called me.’

Leo pounded his fists into his thighs. The nurse started, but Ellen held her back. ‘You can leave, Margot.’

Leo sprang to his feet and shut the door behind Margot. ‘This is complete bullshit,’ he said. ‘You need to get me out of here.’

‘I can’t get you out of here, Leo. You’re on an involuntary hold.’

‘Who put me on an involuntary hold?’ he hissed. ‘Richard? Grace?’

‘They’re worried about you. And you know they don’t have the power to do that.’

‘You did.’

Ellen was silent.

He began pacing. ‘I was doing important work.’

‘I understand that.’ She parted the curtains at the room’s only window, offering them both a view of the hospital reflected in the windows of a slate-grey skyscraper. ‘But you need to rest in order to be able to do the really important work.’

‘No I don’t.’ He slowed the pacing. It wasn’t helping his case. ‘Please. I just need to get out of here. I need you to discharge me. We can both see I’m fine.’

‘Apparently this is the second time in two weeks you’ve been in the ER during a fugue state. I’m shocked they didn’t admit you at Rush.’ She propped herself against the windowsill and crossed her arms. ‘Why didn’t you tell me this was going on? I could’ve helped you.’

‘I didn’t need help.’

‘You know as well as I do that self-assessment isn’t an option in psychiatry.’

For a few moments they stared at each other. Leo felt the annoying esophageal jolt that always preceded a cry.

‘How would you feel if Matthew was locked in here?’

‘Why are you bringing Matthew into this?’

‘How would you feel if you were responsible for locking Matthew in here, Ellen?’ He sat back down on the bed and crossed his feet at his ankles, trying to look as presentable as possible. ‘I’m like family. Come on, you know that. I’ve known you for almost twenty years.’

Ellen shook her head. ‘You’ve been psychotic for over two weeks.’ She held up his notebook and he resisted lunging for it. ‘I’ve read this. They found it in your briefcase after you flipped a desk at Feinberg. You disappeared for two days. Richard found you pounding on the door to your condo this morning.’

‘I didn’t flip a desk.’

‘You did. You were yelling at someone the students said wasn’t in the room. The administration is debating right now whether to have you back.’

Leo rolled his eyes. Of course Feinberg was too thick-skulled a place for him to undertake a study of the human soul. ‘Fine,’ he said.

Ellen looked behind her, out the window, and then back at him. ‘You need to take medication for this. To not do so would be irresponsible.’

She was taller than him by an inch and wide-hipped. He’d met her husband once at a Rush reunion party – the husband had made cursory introductions, gotten drunk, and then ignored her. He was handsome, and had passed his bone structure on to Matthew. That bone structure looked strange on the face of a child.

‘You have no idea what I’m trying to do,’ he pleaded. ‘If you’ll just listen to me, I can explain it to you.’

‘We’re going to try fifteen milligrams of Abilify,’ Ellen said. ‘I have to get back to the office, OK?’

‘Ellen, listen, I don’t think this is necessarily something bad –’

‘Please try to rest,’ she said, and left him alone in the room.

He sat on the bed for as long as he could tolerate and then left his room and crossed over to the nurses’ bay, where he tried to plead his case to a nurse named Akkram.

‘I cannot let you go,’ Akkram said, the creases in his face moving in a menacing way. ‘You know that, doctor.’

He wandered into the day room. Two women, one a teenager and the other Leo’s mother’s age, were watching Maury Povich. A man sat at a table in the corner trying to assemble a puzzle of sunflowers. Leo picked up the lid to the puzzle box, studied it, and quickly found the three pieces the man was looking for.

‘You have to leave,’ Alex Trebek said.

‘I know I have to leave!’ Leo whispered. The puzzle man looked wearily up at him and then returned to his puzzle.

He had been 5150ed, he figured. Typical that no one had debriefed him on his rights as a patient. Ellen couldn’t be counted on to deliver on formalities, but then she probably figured he knew everything there was to know. And he did. He’d always dreaded getting calls from the psychiatrists and social workers at the hospital, informing him in clipped tones that his patient had been admitted and was under observation. The patient is taking 4 milligrams of Risperdal and 300 milligrams Wellbutrin daily, correct? Yes, he’d say. Has she exhibited any signs of agitation in the past two weeks? And here Leo would have to admit that he hadn’t seen the patient in the past two weeks, because the ones who got hospitalized were always the ones who missed their appointments. She is diagnosed bipolar type I, correct? He is diagnosed cyclothymic? She is diagnosed with major depressive disorder? He is diagnosed schizophrenic?  Yes, he’d say, and get ready for them to challenge his diagnosis.

When he asked for paper and a pen, Akkram gave them to him. He sat in the day room writing about Max and Archer Armour and the ripping of flesh and the healing properties of love. He wrote about how he had met Richard – on a boat at Navy Pier – and how the first time he’d slept with Richard he’d collapsed exhausted afterwards, beyond satisfied, and let Richard stroke his chin and tell him how beautiful he was. He wrote about the boyfriend with the crooked nose. He wrote about the movie Toy Story, which he remembered being impressed by in college. He wrote about Grace and his mother and sunshine through water. He wrote about the population of Cook County Jail – roughly 6,500 prisoners – and the high likelihood that they had all been in love. He imagined himself as St. Augustine writing his Confessions. He imagined that a plaque would be installed on the wall of this day room to commemorate what he had written there.

‘What are you working on?’ Margot said over his shoulder, trying to sound polite.

He hunched, hiding it from her. ‘A letter to my boyfriend,’ he said.

Margot’s face twisted. ‘Dinner’s in ten minutes.’

On the second day, Richard came to visit him. He was teary-eyed, bewildered: he’d never been on a psych unit before. Instead of talking, Leo spent the entire time watching Richard cry, holding his hands, and reminding him that he was taking the Abilify as prescribed (really he had been cheeking it and spitting it down his shower drain).

‘I don’t know what’s happening,’ Richard said, wiping his eyes with the back of his hand. ‘I don’t understand what’s going on, Leo.’

‘Nothing’s going on.’

Richard hiccoughed and sighed. ‘Then why are we here?’

‘Exhaustion. Exhaustion and stress.’

‘Exhaustion? Is this 1893? Are you going to take a salt cure?’ Richard shook his head. ‘This is something real. Something bad. Feinberg called to tell me you’ve been relieved of your lecture class.’

‘What a relief!’ Leo said, but Richard clearly didn’t like the joke. ‘You know I’m perfectly capable of keeping any of this from happening again. It’s just been two slip-ups.’

‘Ellen doesn’t want you back at the practice until you’ve been stable for at least a month.’

Leo’s throat constricted. ‘What?’

‘She doesn’t want you back. And she’s been getting calls nonstop from Archer Armour’s attorney. She doesn’t know what to tell her.’

‘She can’t keep me out of my own practice. This is insane.’

‘Your behavior’s insane,’ Richard said, drawing the attention of a few other visiting family members. ‘You have to promise me you’re going to focus on getting better.’

‘Well I can’t get better if you keep giving me bad news.’ Heat was prickling up the back of Leo’s neck. ‘I can’t get better if you’re sitting here across from me calling me insane.’

‘There’s only so much I can do! I can’t keep tabs on an adult man like he’s a baby.’

‘Oh is that what you’re doing?’

‘I’m trying to get you to take care of yourself, Leo.’

‘OK, I’ll take care of myself,’ Leo said, and stood up and walked out of the visiting room.

 

VI

Ellen didn’t return to the unit for the remainder of his stay: he had to plead his case to an attending psychiatrist with a thick moustache and wild eyes. The psychiatrist dumbly parroted Ellen’s directive, that he could be let out after the hold. Luckily, neither the psychiatrist nor the social worker cared about releasing him into the world alone. When the 5150 expired, he sat heading west through the Loop in the back of a Lyft, scrolling through the messages on his phone. From Richard: I’m sorry. I love you. From Grace: Hey I know you won’t get this but I hope you’re doing OK. Let’s have dinner when you get out. From Ellen: Please check in with me when you get the chance. He deleted all three messages.

He had gotten four emails from Archer Armour’s attorney, the final one explaining that she’d found a different expert witness because of his unresponsiveness. She mentioned hurriedly that this had been difficult to do mere weeks before a high-profile trial, and she hoped that Leo didn’t treat his other clients this way. Leo deleted these emails, too.

He called the office and got a secretary who wasn’t Marsha. For the first time, he regretted not being able to hear Marsha’s voice.

‘I’m calling about a patient.’

‘Which patient?’ the secretary who was not Marsha asked.

‘Dillon Halliday,’ he said. ‘Birthday 5-9-1992.’

‘One moment, let me pull up her file,’ the secretary who was not Marsha said, and made some swift typing noises. ‘OK, what did you need to know?’

He stumbled a moment. He hadn’t prepared a lie. ‘The patient is using a service that delivers her medications to her home, and I need her home address to write the script.’

‘1521 West Armitage Avenue, Chicago IL, 60642.’ She pronounced the words in a steady monotone. He pitied her for not knowing that such a service didn’t exist.

The Lyft dropped him off at Cook County Jail. He had work to do. No more fugues. He pinched himself, then smacked himself. A woman in a green frock coat passed him on the sidewalk and turned to watch him, snapping her head forward when he met her gaze.

‘That’s it,’ Alex Trebek said. ‘That’s exactly right.’

The security officer recognized him and informed him with excessive civility that he had not scheduled a visit. Leo told him it was an emergency and the officer responded that Archer was on work detail. He told him that he needed to retrieve Archer from work detail because he was concerned that Archer was at risk of suicide. He asked the officer if he was prepared to have another inmate kill himself on his watch. The security officer shrugged. Leo said he would sue.

‘Are you serious? What does it matter to you?’ the security officer asked, but by then he was already on his way to retrieve Archer.

Luckily for him, the medical examination room was free. The officer didn’t balk at Leo’s request to hold the meeting there. When Archer entered the room, attended by two guards, his forehead glowed with sweat. He was wearing a short-sleeved jumpsuit and his hair was unkempt. He’d been allowed to grow a mustache.

‘Where’s your briefcase, doc?’ he asked. ‘Why didn’t my lawyer tell me about this meeting?’

‘Don’t worry about that,’ Leo said. He wished the guards would leave the room.

‘Well thanks for getting me off work detail. It’s hot in there.’

‘You’re welcome.’

They looked at each other for a moment and then Leo patted the examination table. ‘Why don’t you come sit here?’

Archer obeyed. Leo did a patellar reflex test on Archer as the guards watched dispassionately.

‘Your reflexes are stellar,’ Leo said. ‘It’s good to see you’re still in prime physical shape.’

Archer raised his eyebrow and nodded. Then Leo grabbed his hand.

‘Archer, do you know what the whole point of this is?’

Eyebrow still raised, Archer shook his head.

‘Happiness,’ Leo said. ‘We’re all trying to be happy. You made some people very, very unhappy because of your own unhappiness. Can you remember a time in your life when you were really, really happy? Before all this began?’

‘Yes!’ Alex Trebek roared, so loud Leo was worried he wouldn’t be able to hear Archer’s response. ‘Yes, yes!’

Archer pulled his hand away. ‘What the fuck are you talking about?’

The guards were both watching, wide-eyed now.

Leo gave a quick sigh and leaned on the exam table, close to Archer. ‘I was recently given the gift of a unique and rare happiness, a command to help people expunge themselves of fear. I’ve gone through a lot of pain to get here, Archer. I know you’re facing life in prison, OK? Because, let’s be honest, you murdered someone in cold blood. You took a life. But the antidote to that is happiness. Forget what your lawyer is telling you, OK? You don’t need an insanity defense. You need to think of a time in your life when you were truly happy –’

‘Yes, yes, God yes!’ Alex Trebek was howling.

‘– you just need to think of that happiness and remember what it felt like. And if you can remember that happiness – Maybe a moment playing with your brothers? Or when your first child was born? Or the day you married your wife? – you will be able to apologize and your apology will be truer and more sacrosanct that this side-stepping your attorney is trying to get us to do. Do you understand? You will never harm anyone ever again! The fear will be gone!’

Leo had been looking so intensely into Archer’s eyes that he realized he hadn’t registered the expression on Archer’s face, which was one of disgust.

‘The fuck are you saying?’ Archer looked at the guards, who looked helpless. ‘What is he saying?’

‘I’m saying –’ Leo closed his eyes and remembered the sunlight through the water again, but then more memories came back. The memory of Richard tracing Leo’s lips with his thumb. The memory of his mother and Grace dancing to a Bee Gees record at Christmas. The memory of walking from the train to the office on a bright day in late April and spotting a bluebird’s head poking up over its nest, and seeing that head swivel in concentration, following him as he walked past the tree, and thinking that there were so many living things in the world besides himself. ‘I’m saying that you don’t need to live in fear! I’ve been doing this for thirteen years, and I can promise you, it’s all fear!’

Archer leaned away and sneered as if Leo were rotting and then the guards were on Leo and the door to the medical examination room was closing behind them. And the security officer was telling him that he was not allowed on the premises and that if he didn’t leave immediately he would be brought to the local precinct.

When he got outside, he didn’t call a Lyft. He had too much energy, too many things to do. He walked with purpose in the direction of Wicker Park. It was a beautiful day, a mild Chicago summer’s day, and everyone around him seemed to be celebrating their good fortune to be alive and healthy in this city in this season on this day. His phone was buzzing. It was Richard. He turned it off.

Just east of Homan Square, his vision began to scintillate and fuzz at the edges. He was scared, but Alex Trebek told him that it was all part of the process. A couple passing him on the street asked if he was all right. He told them he was happy to be alive and they should be too and walked quickly ahead of them, north and east, feeling the breeze from the lake growing stronger with his every step. There was a ringing in his ears – all part of the process, Alex Trebek said, nothing to be afraid of. Fear was the enemy. And Dillon was fear’s anathema. He would get to her and thank her and then maybe devise a way to distill their friendship into some healing agent, something he could bring to every clinical interaction he’d have for the rest of his life.

‘There’s a reason for everything,’ Alex Trebek reminded him.

Yes. A reason he’d seen her on the train. A reason the growling had seemed to come from her.

He was going fast: through East Garfield Park, through West Town, up into Ukrainian Village. The city was structured so that the poorer communities were closer to the prison, closer to the police black sites. That much should be obvious to any public defender.

‘The people there are doomed to fail,’ Alex Trebek said.

I’ll help them too, Archer thought, tripping over an unevenness in the concrete. I’ll even help the people who hate them. They’re all motivated by fear.

A little over an hour had gone by and he was in Wicker Park, at Damen and Armitage. He ran east on Armitage and watched the numbers go up: 1200, 1202, 1204. The vision in his right eye was threatening to quit. He pinched himself. The ringing dominated the noise of traffic.

1521 was a rambling, shabby Victorian with a chain-link fence to which four rusting road bikes had been chained. He climbed over the fence into the front yard. A young face was in the first floor window, black-haired with a shock of blond. He tried to look like his senses weren’t quitting on him. He stood straight and smiled at the face. The face emerged into the yard, wearing a sundress and jelly sandals, her arms out in front of her as if Leo were capable of sudden movements.

‘I’m here for Dillon,’ Leo gasped.

‘OK,’ the face said. ‘OK, who are you?’

He shook his head. ‘It’s too difficult to explain.’

The face looked nervous. ‘Listen, I really don’t believe in calling the cops, and you look rich, so I’m assuming you’re not going to rob us, but you’re making me feel unsafe and I need you to leave.’

Leo shook his head again and stared at his shoes against the concrete. ‘Dillon,’ he managed.

Another face came through the front door, this one barefoot and green-haired. ‘Hey, what’s going on?’ this one asked.

‘Emmett!’ the first one said. ‘I don’t know . . . this guy is here.’

Emmett walked carefully and slowly into the front yard, so carefully and slowly that Leo sat down from impatience and exhaustion. ‘Are you OK?’ Emmett asked.

Leo nodded.

‘Can you please leave?’

‘I’ll leave –’ he breathed deeply to catch his breath. He was falling out of shape. ‘I’ll leave when I see Dillon.’

Emmett and the face stood over Leo, talking in high-pitched voices. Leo focused on the front door, and as if by dint of his focus there appeared Dillon.

‘Oh my God!’ she was saying. ‘Oh my God, Dr Lihn!’

She rushed into the front yard, pushing past Emmett and the face. She knelt next to Leo.

‘Dr Lihn, are you okay? Why are you here?’

‘Tell her why,’ Alex Trebek said.

Leo sighed. His breath still wasn’t caught. ‘Fear,’ he managed.

‘Fear? What about fear?’ And then the look on Dillon’s face clicked into one of comprehension. ‘You mean what you were telling me last session? About why you became a psychiatrist?’

‘This guy’s a psychiatrist?’ Emmett asked.

‘Help me help him up,’ Dillon told Emmett and the face. ‘Then just let us sit in the kitchen for a second.’

Leo’s legs were weak. His vision flickered. This was something worse than being out of shape. He was slipping. Feebly, he pinched his thigh.

‘Dr Lihn, can you take a step?’ Dillon asked, and he could.

Inside was just as he imagined: the Ikea furniture, the bookcase of radical literature, the cheap appliances in the cramped kitchen. Emmett and the face were on one side of him and Dillon was on the other. They helped him into a wobbling chair at one end of the kitchen table and then Dillon said something to Emmett and the face and they were gone, their footsteps creaking up the stairs.

Dillon set a mug in front of him that warmed his cheeks. He sipped from it: mint tea.

‘I know it’s hot outside, I just always like to have tea to calm me down,’ she said. ‘Even in hot weather, it helps me calm down.’ She sat across from him, dipping down momentarily to adjust a faulty table leg. When she came back up, he was looking at her awkward face with its thin lips and crooked chin, her too-long arms constellated with scars, and it occurred to him that she, too, had been bullied and humiliated as a child. Of course she had.

‘I’m sorry,’ he said, shaking his head to try and dispel the ringing. ‘I tried to do more than I could.’

‘Sorry?’ Dillon asked. ‘Why are you sorry? Dr Lihn, you helped me so much. Seriously.’

Alex Trebek said something he couldn’t make out. The ringing was too loud. He started crying. He couldn’t understand why he was crying, or why it was sapping what little strength he had. He held his head in his hands. He had made a huge mistake. He was making a huge mistake. His license would be revoked.

‘Dr Lihn?’ Dillon was saying. She put her hand on his shoulder. ‘Dr Lihn? Are you OK?’

He shook his head and cried.

‘Dr Lihn, I don’t know what’s going on, but if this helps, there’s this song my mom made up that she used to sing to me when I got upset. I sing it to myself sometimes when things get really dark.’

She took one of his hands and sang in a whispery voice:

Take your hand in mine

Think of the future, not the past

We’re two of a kind

And our love will always last

 

Take your hand in mine

My funny girl, don’t be afraid

Take your hand in mine

And see the world of joy you’ve made

 The ringing quieted and he was able to lift his head to look at her. She was still holding his hand and she was smiling, the kind of smile his mother used to give him when she saw a future he couldn’t. She squeezed his hand.

‘You’re fine, Dr Lihn,’ she said. ‘I promise.’

And like sunlight through water, he was.

 

Image © VonderauVisuals

Making
Robert Macfarlane and Adam Scovell In Conversation