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As the days grew shorter, Lilly sank into a depression that rivaled those of the great poets. She stopped walking. She fired her nanny. Dishes piled up in the sink. One of the children got lice, and she didn’t even know it until the school nurse sent home a note and a bottle of Pronto shampoo.
How did that make you feel? Zee never even had to ask the standard shrink question. She already knew the answer. Lilly felt all the most destructive emotions out there—fear, judgment, inadequacy—as if there were some secret to parenting that she’d never been taught.
“Look,” Mattei had told Lilly’s husband when he’d dragged her in to see the famous doctor in what amounted to his last hope for his wife. “Most places they give you a pill, they send you on your way. I’m not going to do that.” Zee could see the look of relief in his eyes as Mattei explained the process. First they would wean Lilly off all her meds, and then they would be able to see just what they were dealing with. In the meantime Lilly would be given a complete physical and all the standard tests, checking thyroid and estrogen levels, and even a dexamethasone-suppression test to rule out Cushing’s, though both Mattei and Zee were already pretty sure what the diagnosis would turn out to be.
“We already had a physical,” the husband said, confused by some of the terms Mattei was using but clear on this one. He gestured to the folder he had presented her with earlier.
“I want you to have it at Mass General,” Mattei said.
They agreed. Then Mattei asked Lilly one more question, one she asked all of her patients.
“Where were you when you had your first panic attack?”
There was a long silence. The husband, who usually answered every question for his wife, looked baffled.
Everyone waited for Lilly to speak. Finally, after the silence was so awkward that the husband was getting nervous, he started to make suggestions to Lilly. In church, maybe? Or at the market? Maybe at the beach with the kids?
“Let your wife answer the question,” Mattei said.
“I don’t know where I was,” Lilly said. Her voice was flat.
“That’s bullshit,” Mattei said privately to Zee after the session ended. “Everybody knows.”
Chapter 5 (#ulink_5d3de3eb-f0af-5ff3-817c-7b8b6019ac2b)
The parking lot across from the Old North Church in Marblehead was already full, so one of the funeral directors waved Zee down a side street where there were more spaces. When she turned the corner, she caught a flash of ocean so bright her eyes throbbed with it.
The pallbearers were unloading the coffin as she climbed the steep granite steps. She hurried ahead, into the wide expanse of church, taking a seat in the back row. An old woman moved aside to make room for her, dragging her cane across the wooden bench with a scraping sound.
There were photos of Lilly everywhere.
Zee had to swallow hard to keep from crying. She hadn’t cried yet; up until now all she had felt was shock. And guilt. She recognized Lilly’s children from photos. They sat in the front pew, the little girl unaware and chatting; the boy, who was reputedly so spirited, sat apart from his father and sister, staring straight ahead at the plain white wall. Zee couldn’t take her eyes off the boy. His stoicism stole her heart. She almost expected him to salute the coffin like the famous photos of John-John Kennedy, though she knew it would not happen.
Mattei had prescribed lithium to Lilly at their third session. She diagnosed Lilly with bipolar 2 disorder, probably with a chromosomal element, she said, and definitely with panic. Mattei treated Lilly alongside Zee for the first two months, until she was certain the medication was working. So often during manic periods, patients were tempted to discontinue their medication. It was very important to monitor both the meds and the dosage. When Mattei was certain that the drugs were properly dosed and were being taken, she turned the case over to Zee.
It had taken Lilly several months to start talking. But when she finally did, it was like opening the floodgates at Salem Harbor after a nor’easter. She didn’t stop. Her childhood had been ideal, she said when Zee asked. There was no abuse of any kind and no history of alcoholism. Her mother and father had a wonderful relationship. And Lilly loved her husband. Maybe not more than life itself, the way he said he loved her, but she did love him. She spent the next three sessions talking about how and why this was true.
“I was having sex.” Lilly hadn’t answered Mattei’s question until her sixth month of treatment with Zee. So it took a moment for Zee to understand the implications. “When I had my first panic attack . . . I was having sex with Adam.”
It was before Lilly had told her the story of Adam. At first Zee thought that she meant her husband. But her husband’s name was William, not Adam. Lilly watched for Zee’s reaction. She expected to be judged. But Zee didn’t flinch.
“Tell me about Adam,” was all she said.
It was about this time that Zee stopped sharing all of Lilly’s stories with Mattei. Her case discussions, which had always been so detailed, began to have their sharper edges rounded over, so that they would more easily merge into the general. There were more discussions about the symptoms, the phases and progression of disease, than about the details of each case. For her part, Mattei thought this was a good step, that Zee was gaining confidence as a therapist. Sensing that she could handle the caseload, Mattei began to send more patients Zee’s way.
By June it was apparent either that Lilly had stopped taking her medication altogether or that the dosage Mattei had prescribed was insufficient. Lilly was in the middle of one of the most clearly manic periods Zee had ever witnessed.
Lilly’s feet were moving again. She never slept. She spent huge sums of money. Her food bills alone for the elaborate guilt feasts she was cooking for her family were running about $750 a week—for two adults and two children, both of whom were picky eaters. Lilly no longer remembered why she’d ever needed a nanny in the first place. She could easily handle two young children. And her trysts with Adam were getting more and more daring. With no nanny on board, Lilly had taken to sneaking Adam into her house in the late afternoons, claiming that the place needed some repair work, first on the playroom shutters and later on a crooked piece of crown molding in the living room that had bothered her for years.
Lilly and Adam had sex on every horizontal surface in the house. Hearing their cries of passion one afternoon and thinking that someone was hurting the children, a neighbor called the police. As the cruiser pulled up in front of the house, Adam went out the back door of the basement, hurrying across the yard by Black Joe’s Pond and down Gingerbread Hill, pulling on his work clothes as he ran. The police were waiting for him at the bottom of the hill, where his red truck was almost always parked these days. He knew them all, had gone to high school with a couple of them.
“Everyone knows what you’re up to,” one of the cops told him. “Why don’t you try to keep a lower profile?”
There were some stifled smiles, maybe even a pat on the back from the cop he knew.
“They don’t exactly disapprove,” Adam had said to Lilly when she freaked out about the cops. “One of us? Messing with some rich guy’s wife?”
It was the first time Lilly had felt uneasy about what she was doing and the first time she felt bad for her husband. Sweet William, who had never done anything to deserve this. For the first time during her long affair with Adam, Lilly felt shame. And the minute the shame cloud descended, things began to fall apart.
At Zee’s direction Mattei wrote a script and added a sedative to take the edge off and a light sleeping pill to keep Lilly’s feet from wandering. When Lilly complained of weight gain from the lithium, they switched her to an antiseizure medication.
It was difficult to say when Mattei started to become suspicious. “Tell me what’s going on,” she asked Zee directly. “I don’t mean with the symptoms, I mean in her life.”
“She’s been having an affair,” Zee confessed, feeling her face redden.
“And you didn’t tell me this because . . . ?”
“Doctor-patient confidentiality.” Zee knew that this was a hot button with Mattei, who claimed to have enormous respect for doctor-patient confidentiality.
“What’s the real reason?” Mattei said.
“That is the real reason,” Zee insisted.
“Is the affair still going on?”
“Yes,” Zee said.
“What else is she doing?”
“What do you mean, what else?”
“Is she drinking, is she doing drugs? What other kinds of risky behavior is our so-called Mrs. Perfect indulging in?”
There was some triumph in Mattei’s voice as she asked. She’d begun calling Lilly “Mrs. Perfect” ever since William’s initial goddess-like description of her. No one was that perfect, Mattei had told him with Lilly right there. Perfect was a huge burden for any woman.
“Just the affair.” Zee was aware that her stomach was churning. She wished she hadn’t said anything. Her face felt hot and red. She wanted to throw up. In all the cases she’d treated so far, nothing like this had ever happened to her. It was as if she had just confessed to the infidelity herself.
“Maybe you should take back this case,” she said.
Mattei seemed to think about it for a while before making her decision. “No,” she said. “I don’t have time to take on another patient. And you’re not getting out of this that easily.”
Zee sat quietly as she waited for Mattei to mull over their plan of action. She thought about getting up and walking out of the office and never looking back. It had become her fantasy lately. Not yet five years into her practice, and she was already having burned-out escape fantasies. Not a good sign.
“We’re upping her meds,” Mattei said, reaching for her pad. She slid a prescription across the desk.
As the new dosage of antiseizure medication started to work, Lilly seemed to come back to mid-range. During the next several sessions and into the early fall, she drove herself to Boston and spoke in her sessions with Zee the way a more normal patient might have. She talked about going back to college, or at least taking a class or two. She talked about the competitive process of getting her son into their private school of choice.
She had stopped seeing Adam, she told Zee. It had been very difficult for her. The medicine hadn’t changed the fact that she thought she was in love with him. She said she believed that Adam was the great love of her life, her soul mate. But she was trying hard to do the right thing. For her children. And for the man who used to be referred to simply as “my husband” and who had now taken on the permanent moniker of “Sweet William.”
It seemed to work. Right up until Halloween weekend, when (as she later put it herself) “all hell broke loose.”
First Lilly’s cat had disappeared. She’d looked everywhere, hanging posters all over town, calling all the neighbors. The children were upset, especially her daughter, who’d planned to carry the black cat she had named Reynaldo with her as part of her witch costume. But by Halloween night there was still no sign of the cat, and so her daughter had refused to wear the costume Lilly had made for her and refused to go trick-or-treating until Lilly took her downtown to buy another one.
It had been raining intermittently on Halloween, so instead of paper bags Lilly had given them pillowcases in which to collect their candy, but her daughter was still little, and her pillowcase hung too low and dragged along the sidewalk as they went house to house. The kids had wanted to trick-or-treat alone, insisting that they were only going to the neighbors’ homes, that they wouldn’t leave Gingerbread Hill. But Lilly wouldn’t hear of it. Terrible things happened to children all the time: razor blades in apples, kidnapping. No town was immune, not even Marblehead. She had always taken them trick-or-treating, and she wanted to go along. She even had a costume picked out for herself—or half a costume, at least. She still had on her jeans, but from the waist up she was Snow White, or a rather Disneyfied version of the famous beauty. She wore a black wig with a red bow, a half-length pink cape, and a blue shirt with puffy sleeves. In her hand she carried an apple.
She was actually excited about going. But at the sight of Lilly dressed up and ready to walk with them, her daughter started to cry. “I’m not a baby!” she insisted. And so Lilly walked behind them, staying in the shadows, watching while they knocked on the doors of her neighbors, and eventually eating the apple she carried house to house, dropping the core into a neighbor’s compost pile.
When they got home, it was past their usual bedtime, though William was still at work. She had hoped to keep the children up long enough for him to see their costumes, but tomorrow was a school day. They had their baths. She tucked them in. As she started down the stairs, she heard a noise from the basement. She decided it was the wind, slapping the French windows they’d recently had put in. It had happened before. The house had a walk-out basement, which they’d had remodeled a few years back. But the new windows were faulty; they often didn’t close properly. She’d already had two of them repaired by Adam. She’d been meaning to speak with him about fixing this final one, but she hadn’t gotten around to it before she stopped seeing him.
William returned home later that night, but Lilly wasn’t there. The children were asleep. At midnight he called the police and reported her missing. They told him he’d have to wait forty-eight hours before they got involved. Though they didn’t share their information with him, the police had a pretty good idea where she might be.
Lilly didn’t come home until two days later. When she did, she was sullen and down-cycling. She wouldn’t eat. She had several bruises. No matter how many times she was asked, she would never say where she’d been or what had happened.
After the emergency room took care of her injuries, Zee had Lilly admitted to a Boston psychiatric hospital on an involuntary seventy-two-hour hold.
Lilly’s three-day stay turned into three weeks. Zee went by every other day. One weekend, when Lilly wasn’t expecting her, Zee showed up. Lilly was in the lounge, a book in front of her. Instead of reading, she was staring out the window.
Zee paused to watch. Lilly was looking at a red construction truck, idling outside in the parking lot. Zee recognized it immediately. She had walked out of the office one day after Lilly’s session in time to see her getting into that same truck. Adam clearly knew who Zee was, and the look he gave her as she walked by that day had sent a shiver up her spine.
“You have to get away from him,” Zee said to Lilly.
Lilly didn’t answer.
By offering advice Zee knew she had crossed a line with Lilly. A therapist is never supposed to tell a patient what to do. But it was a line Zee felt she had to cross.
Zee left Lilly and called security.
William didn’t know what had happened while Lilly was away. He could tell from the police reaction that they were not as worried as he was. “People walk out on marriages all the time,” they said.
He had convinced himself that it had been a kidnapping, from which his wife had narrowly escaped. He waited until Zee had been seeing Lilly at the hospital for almost two weeks before he couldn’t stand it anymore and came by the office.
He demanded to know what had happened to Lilly. “I know she told you,” he said.
“She didn’t, actually,” Zee said. “But even if she had, I couldn’t tell you.”
“I’m the one who brought her to you. I’m the one paying the bills,” he said.
“Lilly has to be able to trust me,” Zee said calmly. “Doctor-patient confidentiality.”
It was the only time she had seen William angry. “What the hell am I paying you for?” he demanded.
The sound of his raised voice brought Zee to her feet. Mattei got to the door in time to see him hurl a glass paperweight across the room, shattering it against the far wall.
“Do you need some help in here?” Mattei asked Zee.
William looked confused and embarrassed. “I was just leaving,” he said.
“Let me see you to the door,” Mattei said.
“I’m sorry,” he mumbled to Zee.
Mattei held the door for him, shooting Zee a look as they left.
Two days before Lilly was scheduled to be released, both Zee and Mattei were called to the hospital. Lilly’s hospital psychiatrist sat across from a social worker named Emily, whom Zee recognized from the Department of Social Ser vices.
“What’s going on?” Zee asked.
“We’re here because of Lilly’s physical injuries,” Emily said.
“What physical injuries?” Zee asked.
“The ones she initially presented with,” the social worker said.
“Lilly refuses to talk about them,” the staff psychiatrist said.
“She told me she fell,” Zee said. “On Halloween night.”
“That’s what’s on her admission records,” the psychiatrist said. “ ‘Suffered a fall on Halloween night due to slippery rocks.’ ” She looked at the others. “It was raining pretty hard on Halloween.”
“The bruises aren’t consistent with a fall,” Emily said. “They seem more like a beating.”
“You think she was beaten?” Zee asked.
“This is routine procedure,” Emily said. “Especially when the woman doesn’t give an explanation consistent with her injuries.”
“Lilly is scheduled to be released in two days,” the psychiatrist said. “She’s stable, her medications are properly dosed, and she’s showing no signs of depression.”
“I would respectfully disagree on that last point,” Zee said. “I think she seems depressed. She’s normally much more communicative.”
The psychiatrist paused to consider. “There is one point that makes me agree with you, Dr. Finch.”
“Only one?” Zee was getting annoyed. “What’s that?”
“Lilly does not want to go home.”
“Which plays into our suspicions of spousal abuse,” the social worker said.
“It’s not William,” Zee said.
“But if she’s afraid to go home . . .” the social worker said.
“She doesn’t feel safe at home.” Zee turned to Mattei. “If she was abused in any way, it’s Adam.”
“Who’s Adam?” Emily asked.
“Lilly was having an affair with him several months ago. He was here the other day.”
“Maybe the husband found out about the affair,” Emily suggested. “Maybe that’s what made him violent.”
