Excerpt From Compound Fractures
The Doctor's Doctor, Therapy
One session stood out. It was our second one.
replayed the session in my head at least ten times. It was when my perspective changed. The day I got suspicious. On occasion I went back over it to see if there was a nuance I missed. Other times the loop replayed
itself, an earworm, a melody my memory couldn't cut loose.
It's not in my personality to recall moments of assurance with much clarity. What I tend to recall vividly are my doubts and my fears. That therapy
loop earned the replays because it was the session when my doubts and my fears began to crystallize, when I went from thinking that I might be in over my therapeutic head to wondering what the hell I might have
gotten myself into with Dr. Alan Gregory.
Or as I called him, my patient.
My name is Delilah Mary Travis. My friends call me Lila. Most of my patients call me Dr. Travis, or Delilah.
Gregory called me Lila. But we weren't friends.
It was the third week of January.
The session had been fitful. I felt no rhythm in his words.
As the end of our time approached I said, "I don't
know what happened that morning. The day of the fire. The morning of the shooting. Moment by moment. You may think I know. You may wish I knew. You may want to proceed as though I know what you need me to know. But
I don't know."
He didn't reply. That happened frequently with us.
During Alan's previous visit I'd asked him why he'd picked me to be his therapist. He said it was because he wanted a therapist he
didn't know—he knew almost everybody in town—and because someone he trusted had once said good things about my work. I'd asked him why he didn't go to Denver; there had to be therapists there he didn't
know. He said it was too much for him then. An almost three-hour round trip? He said he couldn't do it.
I began to think he'd been less than honest. I began to believe he chose me because I was inexperienced.
He thought he could manipulate me.
I said, "I imagine it will be tender for you, sharing the story. But at some point you will need to tell me those details."
He stood. His timing was impeccable; he
rose within seconds of the precise forty-five minute mark. As a therapist he had sat through a million forty-five minute hours. After the first few thousand or so he'd undoubtedly internalized the session
I had not. My hours in the consultation chair were still in high triple-digits. The clock I relied upon was digital. It was not visible from his seat.
"Who does, Lila?" he replied. "Know?
What happened, I mean."
Who knows? You're going existential about that? You were there, I wasn't. If I had been there I would know what the hell happened.
I kept the rant to myself. I said, "Are
you unsure what happened that day?"
No dissociation, please. I don't have the chops for fugue. Not your fugue.
His face adjusted into an expression I couldn't interpret. He had a few of those.
Then he said, "Am I 'sure'? A lot of certainty is squeezed into that syllable. Certainty is elusive for me. Death? Certain. Everything else? Uncertain."
"Okay," he said. "Here's part of
what happened that morning that you don't know. That maybe no one else knows." He took a deep breath. "My wife was in my office to caution me about a development in a case she was working. When she came to see me
she didn't understand the implications of what she had learned. She thought she did, but she did not. She was being generous, maybe loving—I go back and forth about that—by warning me about legal action
that was coming against someone I know."
"Taking that person into custody. For questioning. Or arrest. Like that."
"Thanks," I said. Why I thanked him I did not know.
told her that if she were to start arresting people she would have to begin by arresting me."
I was disbelieving. I'm sure I looked it. I said, "You?"
He said, "It's complicated. This may help: After
Lauren told me what she was about to do I knew the time had arrived to reveal some secrets I'd been keeping from her. I did that—I revealed some things I had done."
That sure clears things up. I said, "You're being vague."
"Intentionally. I am revealing I have secrets, but I am not revealing those secrets."
"Trust?" I said. Not exactly a therapeutic reach on my part. It was like a meteorologist forecasting rain seconds after she opens her umbrella.
"Yes. Lauren recognized the implications of what I told her. I knew she would, but I had hoped that my admission might alter the tilt of her heart. In my favor."
To him, his failure to trust me required no exploration. I felt it as a wound.
"I was wrong," he said. "Lauren was angry. Not understanding. All that my revelation changed for her that morning was her thinking about whom to arrest."
Alan Gregory was one of those people who confused me when he told me things intended to alleviate my confusion. By then that wasn't news for me.
I said, "She was going to arrest you? When she was shot?"
"Not at the beginning of her visit but yes, by the end. When she was shot."
His shoulders fell. Some amount of tension disappeared from his temples and his jaw. He seemed relieved to have breached this wall with me. We made brief eye contact. The intimacy of it all stunned me. Part of me melted with his glance, as though for that instant alone our arteries shared the same pumping heart.
He shook his head like he was as amazed as I was. His breath was shallow. "That morning? The fire up the street? Don't forget the fire."
My breathing was shallow too. The mirroring was not intentional. No, I had not forgotten the fire.
In a way that I don't think I had ever felt before in my time as a therapist, I was aware that a patient was sharing a dangerous secret with me. Not just a sensitive truth—that's routine—but a dangerous one. Dangerous for him. And possibly dangerous for me.
Alan Gregory woke to foreboding every morning of his life. To help him I would need to understand his foreboding. Perhaps even to feel it.
I said, "Could you please sit back down, Alan?" If he considered me a peer he wouldn't put me in the position I was in. I knew that. I didn't like it.
"Our time is up," he said.
I swallowed a sigh. "That's my call. This is my office. I am your therapist." I shouldn't have had to remind him of that. We'd work on that issue later. The list of what we would work on later was becoming unwieldy.
He nodded. But he remained standing. He seemed more paralyzed than defiant.
"Your wife was about to have you arrested for what?"
"Something serious," Alan said. "A felony. I can't discuss it."
He sat down. "I will tell you what I told Lauren that morning: my caution has to do with clean hands." He looked at his hands as though he couldn't not look at his hands.
With monumental self-control I managed not to look at my hands. I was aware that his wife was shot not too many moments after he told her whatever he told her that morning. Apparently about clean hands.
"Yours?" I asked. "Your clean hands?"
He stood back up. "No," he said. "Yours."
That did it. I looked at my hands. I said, "Sit please." He didn't. Shit. "She had a reason to arrest you? The felony?"
"You say 'definitely' yet you continue to be vague. You seem to be admitting . . . what, guilt? Yes? Are we talking about trust again? Right now? Between you and me?"
Air escaped his nostrils in a little huff. "Guilt? No question. Right and wrong. Morality? That's murky. Between us? Of course it's about trust."
He paused. I look back now and I wonder about that pause. I think he was telling me something. But I was missing it.
He tried to explain. "Trust is not only an issue between you and me. It was there between my wife and me. Maybe it is there between my friend—or friends—and me. There is a lot on the line here beyond my mental health. Culpability. Survival. Freedom. All of those."
Before I could acknowledge that gravity, he refocused on the mundane. He said, "We need to talk about your notes. Session notes, process notes, whatever. And supervision."
sit. If you don't I am going to have to stand." He sat. I said, "Thank you. What about supervision? What about my notes?"
"Are you being supervised on this case?"
I had never before been asked that
question. Few patients know that supervision—oversight of a treatment by a senior practitioner—exists as an option for their therapist. But Alan Gregory knew. He was one of those senior practitioners. In
Boulder he was a supervisor.
"This therapy?" I said. "With you?" He nodded. "No. I am not being supervised."
"If you change your mind—about supervision—will you agree to inform me? I can't
have what I tell you leave this room. Not even to a supervisor. Clean hands?"
"That's irregular," I said. "You know that."
"It's essential. Without that assurance, I can't proceed. Won't."
need to think about it. We can discuss it next time. What about my notes?"
"I would like you to make them sparse," he said.
"Short? Or, or lacking detail? What kind of sparse?"
He nodded. Then
he shook his head.
I made a so-wtf face. If I'd had a supervisor she would have been directing me to continue to work on maintaining a therapeutic expression. They all did.
He said, "Lacking content. No names. No facts. No he-said, I-said. Process? Go to town. Whatever's helpful."
"I don't show my clinical notes to anyone, Alan. Ever. You don't have to worry."
His eyes were dismissive. "I wouldn't be here if I thought you would. I am concerned about people who would look at them without your consent."
I felt a chill. Huh? I looked at my hands again.
He said, "You may not have experience with those people. I do."
"I don't," I said. With another patient, I would not have admitted that. Alan Gregory was not another patient.
"Those people may know that I am coming to see you for therapy," he said.
It is typically no more a presence in my body than my liver, but my heart suddenly became an entity in my chest. Bump bump. Bump bump.
began to question things I should have questioned sooner. My mind reassembled fragments and pieces he had allowed to leak out along the way.
A wildfire. Arrest. A gun. Shots in the back. A witness. His
partner. A felony. A little boy. Trust. A leg wound. A wife in ICU. A cabbist..
Oh shit. And . . . holy shit. The felony. Trust. Guilt? I realized what he was admitting to me. I began to speak. My breath caught in my throat. I tried again.
I said, "You had a motive? That morning? To shoot your wife, didn't you?"
"If you choose to stop treating me, I understand."
"I asked you a question," I said.
Bump bump. Bump bump.
looked out the window. "My request about your notes?"
Jesus. Did you hear what I just asked you? "Uh, I will be careful. I will take a look at what I've written. Next time we can talk about what I decide about shredding and starting over. Did"—
"Handwritten or digital?" he asked. "Dictated? I hope you don't have them in the cloud."
"If you shred it needs to be cross-shred, not strip-shred. Separate the confetti into piles. Dispose of the piles in different places. Or set the shreds on fire. Either works."
My patient wanted me to torch my notes. I added paranoia to his differential diagnosis. Great. This is great.
did you have a motive to shoot your wife?"
Without any further hesitation, he said, "I did. That's the problem. At some point, they'll figure that out. He certainly will. And he won't let go. That, by the
way, is the exact sort of thing that can't go in your notes."