I can thank Sidney, the delinquent preschooler, for propelling me in the direction of the juvenile court. Rodney and Donna, and the rest of the bedraggled New Haven road company of West Side Story kept me there. But it was Lee Anne whose seemingly mindless homicidal act drew me once and for all into a career in violence. I must also thank Lee Anne for bringing Jonathan and me together. Had Lee Anne Jameson, a thirteen-year-old black child from the wrong side of the tracks of Waterbury, not asked the principal of her school for permission to leave early and walk home, and had the principal not denied her request, Jonathan and I would have gone our separate ways—he to the groves of academe, I into private practice. But shortly after the principal denied Lee Anne’s request, a child lay dead on the school grounds and Lee Anne was nowhere to be found. The fatal consequences of the principal’s refusal to allow Lee Anne to walk home early brought Jonathan and me together in our very first collaboration in violence.
Lee Anne had not felt right all day. From the moment she awakened she knew something was wrong. Her head ached and things around her looked blurry. They didn’t seem quite real, and she wondered if she might still be dreaming.
As she made her way from the kitchen counter to the table by the window, she staggered slightly, and the checkered linoleum on the floor seemed to come up at her. She grabbed for the back of a chair and steadied herself. Maybe it was the smell in the kitchen. Something smelled rotten, dead. She looked under the sink to see if a rat had been stuck on the trap her uncle had set. She hated her uncle. She hated the way he lifted the little animals by the tail, then smashed them against the floor to kill them. The trap was empty.
“Are you crazy, girl? There’s no smell here except the coffee. Now finish your doughnut and get going. You’re gonna miss that bus,” Lee Anne’s mother looked up from her mug of coffee. “What’s the matter with you, girl? Lately you’ve been looking funny. Something wrong?”
“No’m.” Lee Anne took another bite of her doughnut. Suddenly a wave of nausea swept over her. She ran to the bathroom and emptied the contents of her stomach into the toilet bowl.
The nausea subsided. She stood leaning against the bathroom tiles, slowly breathing in and out. She began to sweat, and now a flood of anxiety washed over her. She didn’t even know why she was scared. Sometimes these scary feelings just came for no reason.
It was going to be one of those days. Lee Anne could tell. Something bad was going to happen. She just knew it. Lee Anne’s grandmother said that she had “the power,” that she was just like her great grandmother who could tell the future. Lee Anne’s brother said she was nuts. Lee Anne didn’t care what her brother thought. Something bad was going to happen, and she’d better protect herself. She flushed the toilet, put some peppermint toothpaste on her finger, rubbed her teeth, then rinsed her mouth. That tasted better. The nausea passed, but the scared feeling stayed.
Danger. She sensed danger. She pulled her large navy wool coat with the wide sleeves from its peg and slipped it on. As she passed the kitchen counter, on her way to the door, Lee Anne spotted the knife. It was a small paring knife. Her mother must have used it to cut open the package of doughnuts. Lee Anne moved toward the door, leaving the knife on the counter. Surely she wouldn’t need it today. Maybe no one would bother her today, and besides, school let out early. “Leave it there. Just leave it,” the gentle voice in her head advised. She started to button her coat.
“Get going, girl!” Her mother was annoyed.
“Take it. Take it,” hissed the deeper voice.
“Leave it,” cautioned the gentle voice. She hated it when they disagreed. They made her feel crazy, and all that arguing inside her brain gave her a headache.
“Take it.” It was the deeper voice again.
Swiftly, silently, Lee Anne slipped the paring knife, blade first, into the sleeve of her winter coat and bent her fingers around the end of its handle. Then she ran for the bus.
Usually, when these feelings came they lasted only a few minutes. Sometimes, when they lasted for hours she would come home and sleep them off. Sometimes she had nightmares and woke up shaking. Other times she fell into a deep, dreamless sleep, and when she awakened the feelings were gone. This particular morning the feeling seemed to hang about her like an evil spirit.
On days like this school made no sense. It was impossible to concentrate. She would see the teacher’s mouth move, but could not hear or understand what the teacher was saying. Sometimes her spirit left her body. She could feel herself float to the ceiling. There she would stay, suspended, looking down on herself, seated in class. Sometimes she spaced out completely. She was somewhere else. Somewhere safe. People told her that her eyes were open, but Lee Anne saw nothing.
In first grade, this happened so often her teacher told her mother to take her to the doctor. Maybe she was having fits. The doctor said there was nothing wrong with her that a dose of mineral oil and a good spanking couldn’t put right. Her uncle took care of that.
Lee Anne was forever complaining of aches and pains. First it was her stomach, then it was headaches. But the doctor never found anything wrong. After a while the doctor stopped listening. He figured she just didn’t like school. He said she was a hypochondriac. Her brother said she was a goof-off.
“Lee Anne. Lee Anne!” At first her teacher’s voice was so soft it seemed to be coming from miles away, then suddenly it was so loud it hurt her ears and made her jump. “Lee Anne, you’re daydreaming again. Answer the question.” Lee Anne could not answer the question. She had not heard it. “Lee Anne, pay attention for a change.” Teachers were always getting mad at her.
Gym was the worst period. She hated the locker room. Lee Anne hated taking off her clothes. The shorts and cotton T-shirt made her feel exposed, unprotected. People could see the scars on her arms and legs. There were a few on her back. Her uncle had a temper when he drank. Sometimes the buckle of his belt made her bleed. Then it left a mark. Lee Anne couldn’t remember where most of the scars had come from. When the other girls at school asked, she would make up something. “Oh, that’s where my cat scratched me,” or, “That must be where I burned myself on the stove.” “That’s where I fell off the sled.”
Today gym was out of the question. There was no way Lee Anne was going to undress today, no way she would leave her coat in her locker. She needed her coat. It was thick and roomy. It had two big pockets. It had wide sleeves with a silky lining that gathered at her wrists. She could hide anything she needed in the sleeves. Wrapped in her winter coat, she was safe. This year she wore it late into spring, long after the other girls had cast aside their heavy coats in favor of sweaters or jean jackets.
Last month, in the locker room, when Lee Anne leaned over to tie her sneakers, she was sure that someone behind her had laughed and had called her a bad name. A week ago, she heard someone call her mother a whore. But when she turned to confront her tormentor, nobody was there. “Stop playin’ tricks on me,” she had yelled at the air. “I know you’re hidin’ behind them lockers.” The next day, for the first time, Lee Anne brought a knife to school. She knew she would not use it. She would never use it—of that she was sure. It just made her feel safe to have it. After that, whenever Lee Anne woke up with those funny feelings, whenever she felt something bad coming on, she carried a knife.
Today was a knife day.
On knife days, of course, Lee Anne could not take gym. Her T-shirt was too flimsy, her shorts too tight to conceal a knife. And Lee Anne needed a knife. Not to use. Never to use. Just sort of like a good luck charm, she told herself. Today Lee Anne had to get out of gym.
At one-thirty, just before gym class was to start, Lee Anne made her way to the principal’s office. Staring straight ahead, she moved past the secretary’s desk, pushed through the frosted glass door, and, unannounced, entered the principal’s office.
“Mr. Hamill, I have to go home.” The principal looked up from the newspaper on his desk. He was obviously not surprised.
“Lee Anne, not you again? What’s the matter with you this time? Now don’t tell me you can’t go to gym ’cause of your period. You said that last week.” As it happened, today really was the first day of her period. Things got worse just before her period. But she couldn’t use the same excuse she had used the week before. Besides, she wasn’t even sure why she needed to leave school. She just knew that she did.
“Mr. Hamill,” she blurted out, “something bad is going to happen.”
“Darn right, something bad is going to happen! You’re going to flunk gym if you keep this up. That means you’re going to be left back.”
“No, Mr. Hamill, I mean it. Something bad is going to happen. If I stay in school, something bad is going to happen. I have to go home.” Lee Anne’s fingertips played over the handle of the paring knife that she had transferred from her sleeve to the pocket of her coat, the coat that she had not taken off all day.
“Lee Anne, you have to go to …” Mr. Hamill looked up from the half-finished crossword puzzle. Today’s was a tough one. (He almost always finished the Waterbury Republican puzzle before the last bell.) He stared at the frail adolescent standing before him, shivering in his overheated office, clutching her heavy coat to her skinny frame. Something that he couldn’t quite put his finger on made him reconsider. Perhaps it was something about her eyes. She was facing him but looking through him. He put down his pencil and pushed the newspaper to the side of his desk.
In the weeks to come, when the police would force George Hamill to reflect back on that brief encounter in his office, to rethink his fateful decision, all he would be able to come up with was, “I guess maybe she looked a little out of it.… But there are rules.”
No, he mustn’t let her get out of gym. A principal can’t keep making exceptions.
“Lee Anne, I’ve had it with you.” The principal looked at his watch. “I don’t have time to discuss this with you now. Go to …”
“I can’t go to gym, Mr. Hamill. I know something bad will happen. Let me go home.”
“What are you afraid will …” he started to ask what she was afraid of, but realized he didn’t much care. There was just no reasoning with some adolescents. His tone became more authoritative. “Nothing will happen, Lee Anne. Now get into that gym.”
“Mr. Hamill, let me go home.”
Exasperated, unwilling to do further battle, the half-finished crossword puzzle beckoning, George Hamill relented. “Oh, forget it, Lee Anne. Flunk gym. Flunk school. Just go and wait on the front steps. The school bus will be here in an hour.” Then, as an afterthought, “I want you to talk to your guidance counselor about this tomorrow.”
“I need to go now, Mr. Hamill. I can’t wait an hour. I’ll walk.”
“Take the bus, Lee Anne. We are responsible for you. Wait and take the bus.” The least he could do was make sure that this spacey kid got home safely.
Weeks later, when Jonathan and I spoke with Lee Anne about the events of that day, she remembered the voices in her head that morning. She also recalled most of her meeting with the principal; she had no recollection, however, of leaving his office. Nor did she recall sitting on the school steps, waiting for the bus. People who saw her there said she just stared off into space. When the yellow bus finally pulled up in front of the school, her one girlfriend, Kesha, had to shake her before she realized that it had arrived.
Slowly, as if in a dream, Lee Anne moved toward the idling machine. She felt that everyone was staring at her. She hunched her shoulders and turned up the collar of her coat so that it covered half her face, and dug her hands into her pockets. The anxious feeling was back. She felt for the knife in her pocket and managed to maneuver it back up her sleeve. But this time she turned it around so that the blade was facing outward.
“Whatsa madda wit you? You out of it, Lee Anne?” The voice was more teasing than nasty. It was her friend, Kesha. She recognized the voice. Or did she? No, it wasn’t her friend. Where had she heard those words before? Now she felt dizzy, the way she had felt in the kitchen that morning. She looked at the children moving toward the bus and wondered if they could tell what was happening to her. Their faces seemed to get closer, then to move away, then they got closer again. And the smell—that nauseating dead rat smell—rose from the pavement, gagged her, and made her want to throw up.
Someone stepped into her path and moved toward Lee Anne. It was Kesha. Was it really Kesha? The face looked different. Maybe it was someone pretending to be her friend. Everything was so confusing. Lee Anne grasped the handle of her knife.
“I asked you, whatsa madda wit you?” The face, which at first was far away, suddenly loomed large; it seemed to come right up into Lee Anne’s face. And the voice, the teasing voice of her girlfriend, now sounded different, loud, menacing.
Lee Anne stood up straight, her shoulders square. Then her right arm flew upward, the blade of the paring knife catching the light of the afternoon sun. “It sparkled,” one fourth-grader recalled. An instant later the arm, like the arm of a robot or a tin soldier, came downward, and the short blade penetrated the chest of the figure in front of Lee Anne.
It all happened so quickly that no one, including the victim, seemed to realize what had happened. Weeks later, when Jonathan and I asked Lee Anne why she had done it, why she had stabbed her best friend, all she could remember was the distorted face in front of her. And the young victim, whose heart had been pierced, stood dumbfounded for a good fifteen seconds before collapsing to the ground.
All attention now focused on the victim, who by now was coughing up blood. Lee Anne was forgotten as some teenagers who were gathered in front of the school rushed forward to help the dying girl. Only the younger children, who stood stock-still, afraid to move, would be able to describe Lee Anne’s behavior to the police.
“She looked like a zombie,” one of the more imaginative second-graders recounted.
“She just kept walking. That’s what she did,” another chimed in. “No, she never ran. She just walked away,” a fifth-grader volunteered.
“She looked kind of like she was walking in her sleep.”
“Yeh, that’s right. She was like sleepwalking.”
The last anyone saw of Lee Anne that afternoon, she was walking in the direction of a churchyard. To this day her whereabouts for the next several hours have remained a mystery. Neither she nor anyone else has been able to account for them.
Jonathan and I probably would have been able to discover what had transpired during those crucial hours, had we used hypnosis. But in those days the use of hypnosis was frowned upon. At the Yale University School of Medicine, neither of us was even taught how to do it. The Yale Department of Psychiatry was still heavily Freudian. Freud had abandoned hypnosis, therefore so had Yale. And for better or for worse, Jonathan and I were from Yale.
It was almost nightfall when Lee Anne finally came to her senses. She had walked miles from her school, and she found herself on the doorstep of complete strangers. They allowed her to use their telephone. She called her mother to come and pick her up. Instead, the police arrived, booked her, charged her with the murder of her best friend, then deposited her at the juvenile detention hall.
Having managed (with the help of the chief probation officer and the blessing, believe it or not, of Judge Lindsey) to squeeze enough money from the state of Connecticut to start a small child psychiatry clinic at the Juvenile Court, I found myself its one and only psychiatrist. Therefore, it fell to me to try to figure out the cause of Lee Anne’s sudden violence. I had to make sense of a senseless murder.
There was a time back then when Jonathan and I, working together, thought we had an explanation. Now, looking back, I’m not so sure we were right.
Interviewing Lee Anne reminded me of the war movies I had seen as a child, of the Nazis interrogating American prisoners. Lee Anne volunteered nothing. She limited her responses to “Yes, ma’am” and “No, ma’am,” making me feel that each of my questions was an assault on her inalienable right to privacy. Was she mocking me with her incessant “ma’am”? I couldn’t be certain. Perhaps she was afraid of me. Whatever the explanation, Lee Anne had secrets and was not about to relinquish them to me.
No problem. It was the beginning of my work at the Juvenile Court Clinic. I was still green enough to think that Lee Anne’s family would help me. It went without saying that Lee Anne’s mother, Wanda, would share with me her insights into the forces at play on that fateful afternoon, when her daughter plunged a knife into her best friend’s chest. Thank goodness, I thought, for one potential ally.
Sometimes I am embarrassed by my own naivete. I assumed that Lee Anne’s family would trust me, take me into their confidence, and bare for my examination the secrets of their household. Over the quarter-century since then, I have learned that, when dealing with murder, nothing goes without saying. Nothing can be assumed.
Lee Anne’s mother sat in my office, and that’s just about all she did. Sat. If Lee Anne was withholding, her mother was almost mute. I could see immediately where Lee Anne had acquired her cryptic style. My questions were met with one syllable: no. No. No. No. No. No. I found that I got a bit further if I just sat silently. Once, during a silence, Mrs. Jameson volunteered that her daughter had always been a dreamer. She said that Lee Anne was also a loner. Lee Anne and her make-believe friends could play alone for hours. Mrs. Jameson could hear Lee Anne acting out the different roles—the sweet fairy godmother, the whimpering baby, the wicked villain. Lee Anne was a good actress; when she played the role of the villain she sounded just like a man. Once, during our interview, Mrs. Jameson mused, “You know, Doctor Lewis, my daughter lives in a fantasy world.”
I nodded. Maybe now that Mrs. Jameson was a little more relaxed, she would answer my questions with more than one syllable. “So how do you explain what happened?” I ventured.
Mrs. Jameson paused. She began to shrug her shoulders, then seemed to reconsider. “Sometimes, Doctor Lewis,” she looked down, self-conscious, “sometimes I think Lee Anne must have been possessed.” The mother continued, “Sometimes I think she is possessed.” So this was Mrs. Jameson’s take on the murder. Some explanation! I, inexperienced, blind to the possible implications of this deceptively banal statement, let it pass. Today, twenty-five years later, it is hard for me to admit that I just let it pass. It was I, not Mrs. Jameson, who changed the subject.
“Does anyone in the family have a temper?” I asked.
Abruptly, the door to communication shut. No, nobody in the family had a temper. No, nobody had ever harmed or threatened Lee Anne. No, Lee Anne never got angry. Well, almost never. Maybe sometimes. But that wasn’t like her. She was really a quiet child, a good girl. Everyone would tell you that; at least everyone in her family would. No, Wanda Jameson had no idea why Lee Anne had carried a knife to school. No, Lee Anne had never done that before. No. No. No. No. No. Wanda Jameson sounded to me exactly like those accounts in the New York Post of neighbors interviewed the day after a child has slaughtered his entire family. “Mrs. Jones, who lived next door, described the boy as a quiet lad, a good boy. He always took out the garbage for his mother.”
I was frustrated and angry. Why wouldn’t this woman help her own daughter? It just didn’t make sense. Years would pass, and Jonathan and I would evaluate many more Lee Annes, before we would come to appreciate how much the families of children who murder have to hide. Only after Jonathan and I had evaluated a group of juveniles condemned to death, after we had tried to talk with their parents, their brothers and sisters, struggled in vain to reconstruct their pasts, would we understand that many of these families would rather see their children put to death than reveal what had happened behind the closed doors of childhood. What is more, we would find that many of the adolescents themselves preferred death to exposing their abusive parents. And even after having recognized this peculiar phenomenon, it would take us years to develop ways to penetrate or get around the ingenious barricades to communication that young murderers and their kin instinctively know how to erect.
I was not about to give up on Lee Anne’s mother, not just yet. Perhaps if I took a less threatening tack things would move. I decided to strive for a medical rather than a psychiatric tone. Besides, it was important to learn whether any injuries to Lee Anne’s central nervous system had diminished her ability to control herself. Brain injury can do that. Maybe a medical approach would enable Mrs. Jameson to relax and furnish a little useful information. I took a deep breath and pressed on.
“Now, Mrs. Jameson, I’d like to ask you some medical questions about Lee Anne. How was your pregnancy? Any problems?” I was pleased with the matter-of-fact tone I thought I had achieved. Wanda Jameson’s lips began to form the inevitable “no,” then she paused and thought for a moment. At last I was beginning to reach her. I listened attentively.
“It seems to me I may have had some problems.”
“Problems?” I asked, balancing interest with nonchalance.
That did it. The conversation ended. Instead of facilitating communication, I had managed to terminate it. What had I done? I had simply repeated Wanda Jameson’s last word, just as I had been taught to do. I had kept things wide open, left it to her to fill in the blanks. Big mistake. Wanda Jameson was no dope. She could smell a trap. She, like her daughter, was not about to discuss “problems,” at least not with me. I was still years away from achieving the kind of straightforward give and take that makes an interview flow. I had not yet got out from under my nondirective, Freudian training. I blew it.
“No. Now that I think about it, it must have been with my other pregnancy, with her brother.”
Right. Where to go from here? “How about illnesses?” I ventured. “What sorts of illnesses has she had?” I would avoid yes-no answers.
“She was a healthy child.”
Right. “Accidents?”
“No.”
“Injuries?”
“No.”
I couldn’t believe it. The very first time I saw Lee Anne it was impossible to overlook the scar on her forehead. Then there were the dark stripes on her back and the keloids on her upper arms. Where had these scars come from? When I asked Lee Anne, she had shrugged and said she did not know. How, in the face of this evidence, could her mother say that Lee Anne had never had any accidents or injuries? Mendacity. I, like Big Daddy in Cat on a Hot Tin Roof, smelled mendacity. Then how come your little girl has all those marks all over her? I wanted to scream at the woman. How could a mother stonewall this way when her child’s future was at stake? I could not understand it. In those days there was a lot I could not understand. I had much to learn, not just about murderers but also about their families. I did not yet have the skills to make mothers either comfortable enough or guilty enough to spill the beans.
If the Jameson family would not talk to me, perhaps there were other ways to learn about Lee Anne. Surely some record of those injuries must exist. Some of them had to have been treated somewhere.
Reluctantly, Mrs. Jameson signed permission for me to obtain her daughter’s hospital records. I could pick up photocopies of them on Friday. I would set aside an hour or two on Sunday to review them. To my surprise, when I went to retrieve the records, I was handed two thick volumes. How, I wondered, had such an allegedly healthy young girl managed to create such a mound of medical paperwork?
Sunday morning at nine o’clock, fortified with a mug of coffee and half a toasted bagel with cream cheese, I sat down with pad and pencil and opened volume one. For the next seven hours I barely moved. At four that afternoon I turned over the last page of volume two and walked to the phone. I had managed to fill the pages of an entire lined pad of paper with notes. My fingers ached from clutching the pen. I took a deep breath, stretched, and smiled. I had something to run with.
Lee Anne’s medical records started off with a bang. The very first entry revealed more relevant information than all of the hours put together that I had spent with Lee Anne and her mother. I discovered that before Lee Anne was born, during her mother’s pregnancy, her mother had been treated for syphilis—syphilis, that ancient scourge that attacks in utero the organs of growing babies. What is more, Mrs. Jameson had also been hypothyroid. This condition had not been recognized until she was well into her second trimester. Here was a medical problem bound to put a lid on any child’s intelligence. Lee Anne’s was not an auspicious start in life.
Adding injury to insult, neither labor nor delivery was uncomplicated. By the time she was wrenched by forceps from her mother’s narrow pelvis, one clavicle had been fractured and the soft bones of Lee Anne’s cranium had been squeezed together. Interns attending the birth, trained to recognize potential problems in bonding between mothers and critically ill newborns, kept encouraging Lee Anne’s mother to pick a name for the struggling infant. Two years after our daughter Gillian’s birth, Mel and I were encouraged by a pediatric resident to name our struggling, ten-weeks premature, three-and-a-half-pound son. It made for bonding, he said. We named him David. Twenty-four hours later, David died. Wanda Jameson, unlike Mel and me, was determined to wait a day or two before naming her daughter. It was nip and tuck whether the infant would survive, and she did not want to become too attached.
Compared with that opener, the subsequent entries in the medical record paled. At least that’s how it seemed to me. There had been accidents and injuries, but two-year-olds are notoriously clumsy creatures. It takes a watchful eye and a quick reflex to protect a toddler from himself. Why nature bestows gross motor skills on children before bestowing judgment is to me an evolutionary riddle.
Nowadays I read a medical chart the way I read a detective story. Clues to behavior hide behind every scrawl. But twenty years ago a medical chart was just one more tedious obstacle to get through on the way to what seemed to me to be the real work: interviewing the patient and family. I look back and my ignorance appalls me.
Bored, almost resentful, I forced myself to scribble down the date and the nature of each bump and bruise, every cut and burn. Often I couldn’t even figure out just what brought Lee Anne to the hospital. For example, when she was four, Lee Anne arrived at the emergency room with a large bump on her forehead and two black eyes. She told the doctors she had fallen off a swing; her mother told the nurse that Lee Anne had fallen down a flight of stairs. Whatever the cause, I figured that it accounted for the hitherto enigmatic scar on Lee Anne’s forehead. Then, six months later, Lee Anne was treated for a burn. Lee Anne told the doctors that she had burned herself on the stove; her uncle, who brought her to the hospital, said she had been playing with a hot iron. None of the doctors ever noticed the discrepancies, not even I when I first reviewed the charts.
Only now, as I review my own notes, now, after having evaluated dozens of similarly violent children, do these inconsistencies spring up at me and have meaning. I look back, embarrassed at the many times, as an intern and resident, I accepted a parent’s implausible explanation for a particular injury. It was a car accident. It was a terrible fall. Today it seems obvious that so many of the wounds I dismissed as accidental were the consequences of deliberate batterings, sometimes torture. But in those days I was starting my own family. I had young children, and I suppose I could not see what I could not bear to see.
As Lee Anne approached puberty, the nature of her hospital contacts changed. She began showing up at the clinics and at the emergency room for what were dismissed by the doctors as inconsequential symptoms. Her stomach hurt. Her head hurt. She felt dizzy. She felt like throwing up. After a while all of the entries began to sound alike. Over and over, I read the dry, emotionless accounts of Lee Anne’s visits to the hospital.
“This nine-year-old female presents with the chief complaint of abdominal pain.”
“This nine-and-a-half-year-old child presents with the chief complaint of nausea and stomach pains.”
“This ten-year-old girl comes to the emergency room with a chief complaint of headaches and stomach pains.”
This child. This girl. This female. Where was Lee Anne? Each event was treated as though it stood alone. It seemed that no one ever paused to review the whole chart. Had they just weighed it, the mass would have raised suspicions. Hospitals are busy places. Doctors are busy people.
After more than a dozen visits for ostensibly imaginary problems, a frustrated pediatrician concluded that Lee Anne’s problems had to be psychological. He called in a child psychiatrist. The brevity of the consultation note (eight lines) suggested to me that the psychiatrist was bored, was in a hurry, or was annoyed. I imagine Lee Anne had been as forthcoming with him as she was with me. One interview convinced the psychiatrist that Lee Anne was “manipulative” and “attention seeking.” He advised the pediatricians to play down her complaints. As he put it, “Try to avoid secondary gain.” Psychiatrists love terms like secondary gain.
My eyelids grew heavy as I, too, struggled to pay attention to the endless list of hospital visits for vague, elusive aches and pains. My coffee mug had long since been drained, and I found myself nodding off. The importance of the early accidents and injuries, the later somatic complaints, completely eluded me.
Then a short note toward the very end of volume two awakened me. The handwriting was different; it was legible. Could this be the communication of a physician? I looked for the signature. Just as I thought: it was written by a medical student and countersigned by an M.D. The note read as follows: “Lee Anne Jameson, a twelve-year-old black female with a long history of vague complaints, came to the pediatric clinic today with a chief complaint of headaches and dizziness. During this visit she stared off into space and could not be aroused for several seconds.” A similar entry, dated two weeks later and written in the same hand, reported: “Today again Lee Anne lost consciousness for no apparent reason, and she fell to the ground. Blood pressure normal. R/O (rule out) a seizure disorder. Plan: Get EEG.” The student actually used her name. Lee Anne was a person to him, not a case. I flipped through the remainder of volume two, seeking the result of the encephalogram. None was to be found. In fact, there was no indication that the pediatrician who countersigned the chart note paid any attention to the medical student’s observations. An electroencephalogram had never been performed. Now I was wide awake.
Suppose, I thought, the medical student was onto something. Just suppose that he, unblinded by preconceived notions about manipulative patients and secondary gain, had seen something no one else had been able to see. Suppose that Lee Anne did have something wrong with her brain. Could that have had anything to do with her violent act?
One year before Lee Anne Jameson plunged a knife into her classmate’s chest, two doctors up at Harvard—a neurosurgeon and a psychiatrist—had reported finding abnormal electrical activity in the brains of some of their episodically violent patients. Vernon Mark, the neurosurgeon, and Frank Ervin, the psychiatrist, had inserted electrodes deep into the brains of these aggressive individuals. They found that these patients had episodes of violence that coincided with abnormal electrical discharges, localized in the most ancient structures of their brains. We humans share these brain structures with alligators and other primitive, unfriendly creatures. At the onset of these episodes, patients experienced auras—that is, weird feelings. Some complained of odd perceptions and sensations. Others described being assailed by vile odors. In other patients, the sweet smell of perfume presaged an episode. Some patients saw blinding light. Others experienced nausea and vague abdominal pains. Some felt dizzy. And some patients reported feeling as though they were reliving past events. Was it possible that Lee Anne’s premonitions of danger, that her complaints about foul odors and dead rats, her episodes of dizziness and her history of vague stomach pains, were auras heralding a seizure?
I sat for several minutes, pondering the medical student’s neat, legible script. Then I rose from the couch, walked to the phone, and dialed Jonathan’s number.