Dangerous. Dr. Lecaros had described Wykell as dangerous.
That language wouldn’t have been used without an incident or a shared patient. Lecaros would not have used inflammatory language without a very good reason. Attorneys were often preceded by their reputations, and it stood to reason therapists were too, so I had phoned someone I knew would take my call—my own shrink.
“Thanks for seeing me on such short notice, Dr. Takeda.”
She was standing in the doorway to her private office when I walked in. It had been a couple of months since I’d felt the need for her guidance, yet her kind smile greeted me as if it had only been last week. She was a tiny, graceful woman, birdlike in stature, whose steel spine wasn’t immediately obvious. I loved that about her. There was something I enjoyed about women who were easily dismissed because of their looks, or size, or demeanor, but who, underneath the facade, could take down a country if they had to.
I imagined it said something Freudian about me, but I wasn’t sure I cared to know.
“Andrea, I always make time for you if I can. And will you please start calling me Janice. I think we’ve known each other long enough,” she said as we settled in to the club chairs in front of her desk. “So tell me what’s going on.”
“Actually, I’m not here today about my life. I need some professional input. There’s a story I’m working on, well, a potential story, and there are some things about it I don’t understand. I was hoping that you could give me a little background or perhaps a referral to someone else who does this kind of work.”
“I’m not quite sure what you’re asking.” She cocked her head slightly and crossed her hands on her lap. “I can’t offer a professional opinion on a patient that I have not treated. And if I had treated that individual, as you know, there are confidentiality requirements and expectations between a doctor and a patient.”
“No, I wasn’t clear. I’m not expecting you to discuss anything related to a specific patient or a diagnosis. And this is completely off the record. I’m looking for background. My questions are more about what would be normal under specific circumstances. And you may not be able to answer directly, but I thought at the very least, you might be able to steer me to someone who could.”
My words seemed to satisfy her apprehension, and her brow relaxed.
“Okay, tell me what you want to know, and I’ll see if it’s something that I can assist with. I’ll tell you if anything is out of my range of experience, or if I’m uncomfortable with the question and we can proceed accordingly. Sound good?”
Lavender wafted over from the essential oil diffuser she kept running on her bookshelf. I’d forgotten about it, the memory of the calming scent buried in my subconscious. Had that been the intent, or had I simply been too distraught during my visits to identify it? It was immensely pleasant and soothing. Sitting next to the diffuser, an amethyst geode. Perhaps there was something to the crystals and incense I needed to reconsider, but it was a subject for another day.
“Perfect,” I said, returning to the subject at hand. “I’m investigating a death. A young woman in her early twenties with a known history of heroin addiction. I’ve learned that she had been in rehab a number of times yet continued to relapse.”
“That certainly is not unusual, particularly with young people who have yet to grapple with the extent of their problems or who do not have family support. It can also be a function of the length of the addiction. If the individual has been addicted for some length of time and has only recently started to deal with their issues, those relapses can be quite a problem.”
“As far as you know, is there any gold standard of care when it comes to treatment?”
“We’re certainly all familiar with the in-patient residential treatment centers, and for many, that model remains quite effective, but that is such an individualized situation. This is an inappropriate analogy, but it’s like asking if there’s one best method for weight loss. What works for some won’t work for others. Different strokes for different folks, if I must continue with the bad euphemisms. But I’m not telling you anything you didn’t know already. Is there something specific here that you’re looking to gain knowledge of?”
As usual, she cut through the clutter.
“Indulge me for just another minute.” I wanted to make sure my base assumptions were on point. “And the tactics used during inpatient treatment are what?”
“I’m not sure I like the word tactics.” She smiled. “But I understand your point. Treatment has a number of stages. First, one must address the need for detox. Assessment of the physical condition of the individual patient at the point they come into the center. Obviously, talk therapy can be only minimally effective, if someone’s in liver failure, for example. So the first stage would be evaluating and stabilizing the individual as the drug or drugs of choice, work their way out of the body.”
“And that would include treating withdrawal symptoms, correct?”
“Absolutely. Those physical symptoms can be quite severe and quite painful. It’s an extremely vulnerable time. Ending the pain is a natural instinct for the addict. They know that their substance of choice is the quickest way to end what they’re going through, hence the cycle. Drugs and alcohol are self-medication for an underlying issue, after all. ”
My mind went back to the carriage house, to the images and products I had seen in the storeroom, the numerous hospital beds and IV hookups.
“Are patients typically given any kind of drug treatment to manage withdrawal symptoms?”
“Yes, medication-assisted treatment is still a common protocol for pain management during withdrawal, particularly from opioids, but this really isn’t my area of expertise. I would direct you to someone with more current knowledge for those kinds of details. However, we are all familiar with the existence of methadone clinics.”
“My understanding is that methadone is used primarily as a transition to sobriety. How is it administered?”
“Typically it’s prescribed as a tablet or a concentrate that can be ingested so the individual can manage their pain at home, but there are doctors who prefer to inject. And medication-assisted treatments can continue for quite some time, years even.”
“I believe there are other medications that serve a similar purpose. I have a vague memory of hearing about a drug for alcoholism that causes a severe adverse reaction.” She nodded. “Okay, and after detoxing, what’s typically the next step?”
“There are various types of talk therapy—cognitive behavioral therapy, group sessions, individual counseling sessions—and just as many opinions on the situational appropriateness of specific therapies within the psychological community.”
“In many ways, the work shares similarities with the type of work you and I have done. An individual has a problem or a repeated behavior set that has been used to address a deficit or to fill a void for something else that is missing. The patient and the therapist work together to discover the root cause and to help the individual learn some healthier behaviors or how to process whatever pain might have challenged their life.”
So far there was nothing that Dr. Takeda had said that wasn’t common sense, if one stepped back and looked at it logically. What could be so unique about Dr. Wykell’s treatment protocol that he stood to make his fortune from it? It sure as hell wasn’t talk therapy. My gut was still telling me he was performing experimental drug therapy. It was the only thing I could think of that would yield fast and, more importantly, profitable results.
“Have you heard about any breakthroughs, any new unusual protocols that might be under the radar but showing promise that wouldn’t be typical of the Betty Ford-type center?”
“I can’t say that I have any great expertise on the subject, so again, you’ll need to speak with somebody who is closer to the addiction treatment world than I am. But I have seen papers in professional journals suggesting work with things such as micro-dosing of LSD or psilocybin, better known as mushrooms. But don’t take that as gospel. I’m not up-to-date on the cutting-edge treatments, nor do I know what may have moved to clinical trials. The process is slow and cumbersome, but rightly so.”
Slow and cumbersome was not going to make Wykell wealthy. I supposed a small clinical trial was possible, but that would mean a lot of red tape and disclosure in a public record database. No, Wykell seemed too anxious. This was a behind-the-scenes operation.
“I can see those wheels turning, Andrea. Do you want to tell me what you’re thinking? Is there something specific about this story, this death, that has you puzzled? After all, we are sadly in an era where opioid overdoses are all too common.”
“The young woman who died apparently had a brief relationship with a treatment center here in Chicago. I’ve spoken to the director, and he purports to have a program with a very high success rate. He claims an eighty-five percent success rate. And cure is his word choice.”
“Those are remarkable numbers, however, I have to admit, I’m skeptical already. The only way to quantify results is through scientific methodology, which isn’t done at the treatment-center level. You’d need control groups, ongoing monitoring of blood and urine. Self-reporting doesn’t qualify as evidence-based medicine. Personally, I’d be skeptical of anyone who tried to put numbers to their outcomes. We’d all like to, of course, but we’re talking about human nature here.” She leaned back in her chair, twirling the stem of her reading glasses. “Do you have any insights into how he is achieving that? Or is this a one-off?”
“He’s being quite vague about the details of his program. Secretive even, but that’s just my gut feeling. It does seem odd to me that there wouldn’t be some indication of the treatment protocols if he does indeed have a verifiable level of success.”
“May I ask who the therapist is? Not that I can comment, but you’ve piqued my curiosity.”
“His name is Dr. Troy Wykell. He runs a center called the Renacido Center.”
I saw Janice flinch ever so slightly at the mention of his name. “Do you know him?” I asked, immediately intrigued.
“No, I don’t know him.”
“But?”
“But nothing. Somewhere along the way, his name has come up, that’s all,” she said, shrugging it off. “There are thousands of therapists in Chicago. Nothing more.”
“You reacted. Something about this guy made you flinch.”
I watched her face intently, but the moment of surprise was gone.
“I had no reaction. I probably just adjusted my posture. Don’t read anything into it.”
“Okay,” I said, not believing her for a minute. But I also knew she would never speak badly of another professional. “Is there some way I can check this guy out? I’m curious about whether there have been any concerns about his dealings with patients. Would the licensing board be the group that heard formal complaints, if there were any?”
She hesitated, seemingly struggling with something. “This woman that died, she was a patient of his?”
“He has admitted to me that he saw her for a brief period of time. In speaking with others, it sounds like it was more than brief.”
Janice reached over and pulled a sheet of paper out of a notepad. She jotted something down and handed it to me.
“What is this?”
“This is an attorney that I’m friendly with. He may be willing to speak to you. I understand that he had a run-in with Dr. Wykell, but that’s all I can say.”