Текст книги "A Fatal Debt"

Автор книги: John Gapper

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John Gapper
A Fatal Debt

1

New York City has a light of its own, a dazzling glare that is utterly unlike the soft, cloud-strewn summers where I grew up. I once found its intensity disturbing, like the city’s, but I miss it now. It was glowing on that May morning as I stepped from my apartment building. Sun shone on the budding leaves in Gramercy Park and illuminated the Art Deco gargoyles of the Chrysler Building in the distance along Lexington Avenue.

My gym was nearby, a box with windows on one corner of Irving Place, filled day and night with New Yorkers pounding on long lines of running machines. Some watched monitors and wore earpieces, cords dangling from their ears and swinging in time with the rhythm of their runs. It was a Sunday at the end of a surreal, stressful week-one filled with fraught events that I hoped had been resolved. I walked slowly, trying to relax, letting those events filter into my subconscious.

Two men were playing chess on the sidewalk as I passed. They were both slim and scraggy with thinning hair, and one had a trimmed white beard. As they played, they kvetched about the state of the city, the rise in subway fares, and gentrification on the Bowery. The one playing black prodded a knight forward at the white king, and as he released the piece, the other swooped his queen across and seized a rook with two fingers. The clack of the white queen’s base being slammed on the board echoed across the street.

“Ach,” Black tutted to himself.

“You didn’t see that?” White cried.

The first ten minutes on the treadmill when I reached the gym were painful-my muscles creaked, my throat burned. At about the fifteen-minute mark, the urge to stop was succeeded by a state of boredom, and my thoughts drifted. I always felt this moment, before I started the countdown to the end, when the experience became soothing. As that small but pleasurable window opened, I glanced over the monitor tuned to Fox News on a nearby machine.

Then I jabbed at the red “Stop” button.

The screen revealed a live feed from a news helicopter-the image of a police chase or maybe a crime in progress. The camera shuddered as it circled, but the scene was clear enough: Harry Shapiro’s house in East Hampton. There was the lawn by the dunes, the blue pool, the squares and circles of the cedar-shingled roof, the chairs on which we had sat. The seats were vacant and no one was in sight-only house, lawn, dune, beach, and black-and-white vehicles jamming the drive. His Range Rover was parked by the house, apart from the melee.

“You using this machine, man?” someone asked me from my left. Without noticing, I had climbed off my own and drifted toward the screen.

“No,” I said. “Go ahead.” Other channels were showing the same image, but I tuned to Fox, with its red banner at the bottom of the screen: DEATH IN THE HAMPTONS. The news anchors, when I put on the headphones hanging on the machine, were talking excitedly but not making much sense, as if in the grip of mania.

“We’re going to Bruce Bradley,” said a woman’s voice, “who is at the scene. Bruce, what can you tell us?”

The shot cut to a man with a blue blazer and a bland face, standing at the entrance to the lane where Harry lived and looking professionally grave. In the distance I could see the low, misty outline of Harry’s guesthouse.

“Melissa, I’m in East Hampton, the Long Island beach town known as a retreat of the wealthy,” he said sonorously. “Detectives were called to a house down this lane last night, where they found a body, I’m told.”

The woman anchor started to ask something, but a man’s voice cut over her. “Bruce, this is Jack. Can you tell us the identity of the victim?”

“The police are not saying, but my sources tell me that the deceased is a banker who was well known on Wall Street.”

“Jesus,” I said-loudly, because of the headphones. A woman on a machine nearby looked over at me reprovingly. “Sorry,” I said, holding up one hand. It was shaking from the rush of fear as I put it on the handrail.

For weeks afterward, that anxious feeling of the world breaking up around me was never far away; even now, whenever I’m in New York, a quick glimpse of Fox News can make my heart rattle. It was more than the threat to my livelihood: it was a sense of being wrenched from the frame I had around me, the detachment I had built from other people with all their disordered emotions. Love. Jealousy. Despair.

Hatred.

After pulling off the headphones, I stepped down from the machine and started to walk back to the changing rooms. Near the door to the workout room, I was hit by a wave of dizziness and sat down to place my head between my knees. I didn’t need to watch any more: I already knew what had happened. Harry Shapiro had killed himself. I also knew, with absolute certainty, that I was to blame.

When Rebecca was on duty, she would sometimes return home in the early hours and sit silently in the kitchen before coming to bed. I’d know then that a patient had died on the operating table. We shrinks don’t lose many patients, so we never get used to it in the way that a surgeon must. Patients of mine had killed themselves before, but, unhappy as it made me, I’d never believed it was my fault. They’d been in a chronic condition, had been battling their death wish for a long time, and I’d done all that I could to help.

Harry was different. I’d known he was in danger, and I’d let him die. I’d allowed myself to be bullied and bribed into failing him.

My head was still between my knees, but saliva had stopped running in my mouth and I could feel the dizziness starting to ease. I raised my head to see a gym trainer looking at me with concern, thinking that I must have overdone it on the machines. I grimaced at him as if he were correct, got up, and grabbed a towel. Then I went to the showers and stood under one for a long time.

2

Harry arrived at Episcopal when I was on Friday night call. I was up on Twelve South, trying to lure a paranoid schizophrenic out of a seclusion room, when Maisie Knox paged me from the psychiatric emergency room.

The schizophrenic had arrived a few hours before on a gurney from Central Park, where he’d been shouting at traffic and worrying the dog walkers. After administering a shot of Haldol and Ativan, the cocktail of antipsychotic and tranquilizer we used to subdue dangerous patients, I’d admitted him on his Medicaid gold card-no need to tussle with an insurance company trying to save money. When he’d revived an hour later, he was quieter but still obstinate.

Maisie was a fourth-year resident with a combination of looks-gentle eyes and an unruly lock of blond hair that she tucked behind one ear-serenity, and, most alluring of all, competence. I was happy to hear her voice, but being paged meant disruption of some kind and I’d selfishly hoped to get through the rest of the shift without that.

“There’s a patient here you should probably see,” she said when I got to a phone. Her tone was as steady as ever, but I detected something: nervousness? excitement?

“What’s wrong with him?”

“He’s depressed.”

“I’m feeling a bit down myself. Can’t he wait?”

“I don’t think he can.”

I started to get irritated, despite my soft spot for Maisie. There is an order to things in the ER. First a nurse, then a resident, and only then the attending. I was supposed to be in charge, and I couldn’t run around after every disturbed person who decided to walk in off the streets. You only had to ride the subway to realize how many of those there were.

“Who is he?” I said, sighing.

“It’s a Mr. Harold Shapiro. Harold L. Shapiro. And his wife, Nora Shapiro, brought him in,” she said, as if the names settled the matter. And they did.

“I’ll be there in a minute,” I said.

Don’t make exceptions, we were always taught, it never works out well. But if there was anyone who had to be treated as a special case, it was Harry Shapiro. I didn’t know him, although I’d read something in The New York Timesabout him losing his job as chief executive of a Wall Street bank in the financial crisis. The piece suggested that he’d deserved it, that he’d never realized the risks his bank was running. I knew one thing, however. At that moment, I was standing in the Harold L. and Nora Shapiro Pavilion, a wing of New York-Episcopal Hospital that held various wards, including Twelve North and South.

The Shapiros had donated $35 million to the hospital, allowing it to thrust itself out over the FDR Drive, and a plaque on which their names were etched greeted every driver who drove north through the tunnel beneath. So they were not to be taken lightly, especially if he was ill. I’d experienced what happened when donors came into the hospital they had funded. Furtive calls would soon follow from administrators or even board members. Don’t go out of your way, they would say, but do everything you can. We usually took the hint.

I decided to leave my schizophrenic by himself for a while. He was safe enough, even if he wasn’t coherent. When I got down to the ER, I found Maisie in the doctors’ room at the end of the corridor.

“Yes … yes … I’ll make sure he knows,” she was saying on the phone in the tone of someone already fencing with authority.

Maisie looked at me inquiringly, and I shook my head. I didn’t want whoever it was second-guessing the treatment before I’d even seen the patient. She silently held up four fingers: room four. I found Harry sitting on the cot in the room, wearing a Polo Ralph Lauren shirt, pants, and a blazer. His shoulders were hunched, his head bowed, and he was shivering. It could have been a symptom of anxiety, but it was ice cold in there. I swear they kept the rooms refrigerated. We often asked maintenance to fix it, but they never had.

Room four was identical to the others on the corridor: it had a hard cot dummy-proofed to prevent anyone from using it to harm themselves or the staff, a plastic chair, and a glass panel facing the hallway so the nurses could examine the occupant at leisure. Its distinguishing feature was a bad oil painting of a red-roofed Italian seaside town, screwed to the wall in case anybody tried to do some damage with it, on which one literacy-challenged occupant had scratched: “Train to Tijooana.” Maintenance hadn’t fixed that either.

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 wis 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 MADE IN ITALY 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.

“I’m admitting a fifty-eight-year-old male with a differential diagnosis of adjustment disorder with anxiety and depressed mood, or major depression,” I said, running briefly through Harry’s symptoms and affect. “His spouse is supportive and will visit tomorrow.”

Stepping outside, I saw Pete pushing Harry in a wheelchair toward the elevators as Nora watched their retreat. Everyone we signed in was wheeled up to the wards with their notes on their laps to make it harder for them to escape on the way. It was the last I thought I’d see of him.