A Fatal Debt (2 page)

The fact that Harry was still in his clothes was a cause for concern, and I noted the hovering presence of Pete O’Meara, the ER security guard, who was standing by the door looking unhappy. He had a big, jowly face and was capable of subduing most patients who looked threatening, but he’d met his match in Harry.

“Hello, Mr. Shapiro,” I said. “I’m Dr. Cowper, the attending psychiatrist. I’d like to have a chat, but would you mind changing into a gown first? It’s hospital procedure.”

Harry raised his head and I saw his dark eyes for the first time. I knew then why Pete had backed off. They were like the embers of a fire that had died down but would flame up if prodded. Of all Harry’s
qualities, his ability to intimidate was the most striking. Even then, in that state, I wouldn’t have tangled with him. He was powerfully built and trim, as if nervous energy had burned off all excess fat. His eyes were set deeply into a lean face with a sloping forehead and an aquiline nose. He looked like a Roman centurion who headed a merciless legion that had just fought its way through Gaul, taking no prisoners.

“This is bullshit,” he muttered. “I’m not a lunatic.”

“Of course not,” I said. “But we have rules in place to protect everybody. You’ve been in the security line at the airport, haven’t you? You don’t want to be the one guy who makes a fuss.”

That was my usual line, and it wasn’t a bad analogy—we were also wary of hidden weapons. Harry hadn’t been to LaGuardia in a long time, I later found out, but it worked. He gazed at me for a few seconds before nodding.

“Okay, let’s get on with it,” he growled.

“Good. Mr. O’Meara will take your things and get you a gown, and I’ll ask the nurse to take some blood. Then I’ll return.”

Back in the doctors’ room, I found Maisie examining Harry’s chart, which had just been spat out by the computer. All the patients got their blood pressure taken and their insurance checked before they reached us.

“I don’t think he’ll have trouble paying the check,” she said.

“See if there’s room at the Four Seasons, just in case.”

That was our name for York East, a six-bed ward on the thirteenth floor that was a high-rent version of Twelve South for those who paid $700 a day on top of insurance for better amenities. The food was fancier and they got their own rooms, with en suite bathrooms, although the doors were locked just as firmly against their departure. It was more like a hotel, but there was no checking out.

“Who was that on the phone?” I asked.

“Sarah Duncan. Mrs. Shapiro rang her before they came in and she wanted to know what was happening. I said you had things under control.”

Sarah Duncan was Episcopal’s president, a silver-haired Chicagoan who had elevated her briskness to a managerial art. I recalled
that Nora Shapiro sat on the Episcopal board, which muddied things further—it meant that Duncan’s career was in her hands. Glancing at Harry’s chart, I saw that he was fifty-eight and had been treated at Episcopal before, but only for routine things such as colonoscopies. His blood pressure was a little high and he was on Lipitor, but he was otherwise in good health.

Back in room four, Harry was still on the cot but now in a gown, and a nurse was wheeling away the phlebotomy cart, having drawn his blood.

“So,” he said. “Dr. Cooper, is it?”

“Yes. It’s spelled Cow-per, but the
w
is silent,” I said, feeling as ridiculous as I always did when I had to explain my name.

“Some fancy British thing?” he said acidly.

“Perhaps you could explain why you’re here,” I said.

Harry paused to consider and his head dipped. He looked flat and he talked slowly, both symptoms of depression. I was already getting a sense of what was going on in his head. It looked like a male midlife crisis of the kind we dealt with day in, day out. I’d have to check what was under the surface, but I wasn’t too concerned. He was probably in more mental pain than he’d ever experienced in his life, but it would pass.

“Not so great,” he said glumly. “Things have been tough. I lost my job.”

He stared out into the hallway and I waited in case he had more to say, but he remained silent. He wasn’t telling me any more than he had to, which made getting an exact fix on his condition more difficult. I ran through the standard list of questions.

“I’m going to ask some things about your state of health, Mr. Shapiro. How’s your appetite?”

“Okay. I eat.”

“Do you drink?”

“A little. A glass of wine with dinner.”

“Take any drugs?”

“Nothing like that.”

“How much sleep do you need at night?”

“I can get by on five hours or so. I used to be in the office by six a.m., get ahead of the day.”

“Before now, have you been through long periods of feeling sad or hopeless?”

“I’ve never been that way.”

“Ever had prolonged periods of feeling excited, with lots of energy, as if you were on top of the world?”

Harry regarded me levelly, having realized where I was leading. Many patients who arrived with depression had undiagnosed bipolar disorder, and their manic phases had been mild enough to be adaptive—to take them to the top. I’d known a few Wall Street patients like that, and a couple of doctors, too.

“I’m not crazy. I told you.”

“I don’t mean to suggest that. I have to ask you one more question. With all you’ve been through, have you had any thoughts of ending your life?”

He paused as if he needed to consider the question carefully, which was telling in and of itself.
That’s why his wife brought him here
, I thought.

“I couldn’t do that to Nora,” he said at last.

“Good,” I said, although his answer hadn’t been straightforward and he was not telling me everything. I had enough to make a start on helping him to feel better, anyway. “I’m going to prescribe you a tranquilizer that will help you to relax. I’ll ask the nurse to bring it. Meanwhile, I’ll have a word with your wife, if that’s okay.”

I walked out of the cubicle and went through a locked door at the end of the hallway to the waiting room beyond. There, perched on a dirty chair under a dismal fluorescent light, was Nora Shapiro. Harry hadn’t come as a surprise, but his spouse did. She was younger, perhaps forty-five, but she didn’t fit the archetype of a thin, blond second Wall Street wife—she looked more like a teacher or a professor. Her dark brown hair spilled out over a catlike face with wide, high cheekbones, and she wore studious tortoiseshell glasses. She looked up at me gently, her eyes soft and melancholy.

Some wives I’d seen in that chair had been gripped not only by the
uncertainty and anxiety of a spouse whose loved one is ill, but by barely controlled anger.
You don’t understand
, one of them had told me.
This wasn’t the deal
. The woman had tolerated long hours alone, having to bring up their children by herself, run the household, and attend boring dinners and look as if she were enjoying it. In return, she’d had the status of being married to an alpha male who kept her in wealth and status, with New York foundations and boards competing for her favors. She hadn’t signed up to find her husband transformed into a weakling who’d lost his self belief.

Nora didn’t look like that. She displayed no anger or resentment at her enforced presence in the ER. The only thing that emanated from her was love and concern for Harry, as if nothing he could do would sap her affection for him. There was something about her, patiently awaiting news of her distressed mate, that touched me. That was how a spouse should be, I’d always believed: my mother had been like that. Until she’d been betrayed.

“Mrs. Shapiro? I’m Dr. Cowper. I’ve just seen your husband and I’ve come to have a chat, if that’s all right.”

“Thank you, Doctor.”

Nora twisted her hands together nervously as I sat down by her. She wore an antique silver ring on one finger with an intricate pattern etched on it. It looked as though she’d found it herself in an out-of-the-way shop, not just snapped it up automatically at Tiffany’s. She gazed at me plaintively, as if we were old friends and she trusted my counsel.

“I thought I should bring Harry in, just in case,” she said. “Was I right?”

“I’m sure that was best. Can you tell me what worried you?”

“I don’t know how to describe it. He lost his job, you know. It was so unfair what they did to him. That was last fall. After that, he seemed to deteriorate, to drift out of reach. He got much quieter than he’d been before, and he looked as if he was in pain all the time. He kept on waking up in the night. I sometimes found him pacing around our apartment at three in the morning. He couldn’t stand what had happened.”

“What made you come here?”

“We went to East Hampton for the weekend. We’ve got a place out there. I went out for a walk on the beach this afternoon, and when I came back into the house, I heard music from his study. I went through and he was sitting there staring out of the window. He was holding a cocktail glass and …” She rummaged in her handbag. “This was on the table.”

As she said it, she pulled a shiny object out of her bag and passed it to me. I looked down to find a nickel pistol with a walnut grip lying in my hand. It had a stubby barrel with a notched sight at the end of the barrel. I noticed that it said M
ADE IN
I
TALY
on the side. It felt cold and heavy, and I almost let it fall to the floor in shock.

“Pete?” I called, getting up from the waiting room chair with the gun still in my hand and taking a step backward. I rapped on the locked door. Pete opened it and I held the gun out grip first, not aiming it at him. I didn’t know gun etiquette, but I sensed that wouldn’t be the right thing to do.

“Is this safe?” I asked.

Pete took the gun and examined it, then slipped a catch and slid the magazine out of the stock. He handed the two parts back to me separately.

“That’s fine. The safety’s on,” he said. “Beretta Cheetah. Nice weapon.”

I couldn’t think of a reply to that, so I just nodded and he stepped back inside the ward. I sat next to Nora again and tried to carry on with our conversation as if nothing abnormal had just happened. It was common for Pete to find knives on patients as they came in, but I’d never been handed a gun before.

“Whose weapon is this, Mrs. Shapiro?”

“It’s supposed to be mine. I mean, I’ve never used it. I wouldn’t know what to do with it. The permit’s in Harry’s name. There were some break-ins nearby and he said we needed one in case I was alone. He kept it in his study, locked in a drawer—”

Nora gasped, unable to complete her sentence, and her eyes filled with tears as her pent-up distress overwhelmed her. I felt sorry for her,
having to carry this responsibility for a man who’d never needed to be protected before.

“I need you to store this somewhere safe,” I said. “It’s important that your husband can’t get at it for now.”

She nodded, still gulping. “I can do that. I’ve got a safe for my jewelry. Harry doesn’t know the combination.”

“Please put it there right away,” I said, handing her the gun and the magazine and watching her put them back in her bag alongside her makeup and her ordinary things. “You were absolutely right to bring him here.”

An understatement, of course. A middle-aged white male with several symptoms of major depression including suicidal ideation who’d been drinking and had a gun? Never mind his importance to the hospital and Duncan’s involvement: if that was not a slam-dunk admission for danger to self, nothing was. The women who talked about suicide weren’t generally the ones to be worried about—it was the lone man who never said anything but walked into the woods one day and ended it all. The only issue was whether it would be voluntary or if I would have to commit Harry against his will.

“You’ve been very understanding, Doctor. I’m so grateful to you,” she said.

She reached forward and placed her hand on the back of mine. Her palm was warm, and as she rested it there briefly, I could see tears in her eyes. I wished that I could cure her husband for her then and there, but I believed we could bring him back to decent health within a month or two. After excusing myself, I went to check with Maisie. Good news: there was a bed in York East. I dreaded to think of Duncan’s reaction if I’d had to force Harry to bunk in a shared room on Twelve South with a psychotic.

Some people, however, are hard to please.

“No fucking way,” Harry responded to my suggestion that he sign himself in. He was still in room four, now standing in his gown. It trailed halfway down his legs, leaving his calves bare, and his shiver had gotten worse.

“Mr. Shapiro, I do understand your feelings, but I’m in no doubt that it’s best for you to be admitted so we can help you immediately.”

“What if I refuse?” he said, glaring truculently at me.

It was a tough question, to which the true answer was:
I’ll have to lock you up
. I tried to phrase it more gently. “To be honest, I’m very concerned about your state of health, and it’s my duty to protect you. We do have powers to admit you involuntarily.”

“That sounds like a threat,” he said, his nostrils flaring.

“I wouldn’t put it that way,” I said soothingly. “I really do think it is best, for all sorts of reasons, for you to be with us. Your wife told me that she found you with a gun this afternoon, and that concerns me greatly.”

I hoped that my mention of the weapon might extract the truth about what he’d been thinking in that room, but he didn’t respond directly. His head dipped until it hung limply between his shoulders. He sighed, the fight leaving him.

“I need to talk to Nora,” he said.

Ten minutes later, the deal was done and I was on the phone to the charge nurse in York East. We didn’t send ER patients up with a full report, just a summary of the initial diagnosis and a mental status exam. Danger to self, danger to others, unable to care for self—whatever was our reason to admit them to a closed ward, rather than just send them away with some pills and an outpatient appointment. When they were assigned to an attending and a team resident, they would be examined again. My job was almost done.