CHAPTER SIX

"It’s a dilated pore of Winer,” Dr. Clark Clifford said upon examining the bump. Dr. Patel hadn’t seen a need to continue bandaging. There was no open bleeding or scab tissue, so there was no point. It was the single relief both Sandra and Tab had taken away from Dr. Patel’s. Now, Sandra was beginning to think the appointment with Clark Clifford, PhD, and renowned author of a dozen psychology books, might have been a mistake. So far, events had unfolded the same way they had in Tab’s visit with Dr. Patel.

Dr. Clifford crouched on one knee beside Tab. The boy sat on a dark faux leather couch. He seemed more comfortable than he had on Dr. Patel’s exam table. After being introduced to the bump, Dr. Clifford resumed his seat across from them. Sandra sat in a small chair to the right of the couch, not wanting to crowd Tab in case he needed to lie down like patients in the movies.

“I assume Dr. Patel did tests for concussion?” Dr. Clifford asked Sandra, who nodded. “So, we’re reasonably certain you don’t have a concussion. I agree with your family doctor, though. You should get a CT scan. It can be expensive, but better safe than sorry.”

“We’ll schedule it as soon as we’re home,” Sandra said. Both times the scan had been mentioned, her mind had automatically drifted to the family’s savings account. Their health insurance plan was basically a legal scam. “But what we’re here about isn’t—”

Dr. Clifford raised a palm. “I understand,” he said. “Let’s talk about the man you’re seeing in your closet at night, Tab. Can I call you Tab? Or do you like Tim better?”

“Tab’s fine.”

“Okay. Tell me, Tab, when was the first time you saw this man?”

“In the cellar the night of the big storm.” He rubbed his left eye with the tips of his fingers. Sandra and the boys had been away from home for nearly four hours, much of it spent in the car or in waiting rooms. It must be exhausting for him. Not to mention Jeremy, who remained in Dr. Clifford’s waiting room, away from his beloved internet.

“You could see him clearly? Like he was in the room with you? Or was he kind of there, but not all the time? Like a shape in a fog?”

When Tab did not answer, the doctor continued, “Did you ever look at the sun too long? You know how when you blink afterward you can still kind of see the sun’s shape if you look in another direction? Did he look like that?”

Tab shook his head, fervent.

“You’re going to need to describe him,” Sandra prodded.

He sighed. “I mean, I didn’t know he was in the cellar at first,” he said. “I only saw him later. He looked real to me. He was wearing this tan uh, jumpsuit, I guess? With a zipper going all the way up to your neck?”

“Coveralls? Like your dad wears sometimes?”

“Yeah! Coveralls. Not blue like Dad’s, though. And he was rounder than Dad is.”

“Okay. What did his face look like?”

“Kind of big around here.” Tab stroked his chin with his thumb and forefinger. “Wide, I mean. He needed to shave. I remember he had a red baseball cap on, but he had it pulled down over his eyes, so I couldn’t see them.”

“He has eyes?” Dr. Clifford asked. “It was my understanding when your mom told me about him that he doesn’t. Did you mean you couldn’t see them?”

“No! I mean he doesn’t have any. He didn’t hide them under his cap on the other nights I saw him. One night he said I was going to be his eyes, and he showed them to me. He had empty holes where his eyes were supposed to be.” He shuddered.

Sandra stretched a hand to him and squeezed his forearm. “It’s okay, Tab,” she said. “Remember as much as you can.”

“He told you that you were going to be his eyes?” Dr. Clifford asked. He scribbled on a legal pad propped in his lap.

“Yeah.”

“What do you think he meant?”

“How should I know?” Irritability had found its way into his voice, a precursor to frustrated tears in Sandra’s experience. “How should I know what he means by anything? I just want him to go away.”

“Of course,” Dr. Clifford said, softening. “Of course. I understand. Has the man ever told you his name or anything else about himself?”

Tab shook his head. He crammed the palms of his hands into his eyes and rubbed at them.

“Does he remind you of anyone? Someone from school or anywhere else?”

Again, Tab gestured negative.

“What about talking to you? Has the man in your closet said anything other than what you and your mother told me today?”

“Not much,” Tab said. “He said my cat Alfie was fine even though he wasn’t with us in the cellar.” His breath slowed. His eyes cleared.

“Is the cat fine?”

Tab nodded.

A smile curled Sandra’s lips, unbidden. “He’d do anything for that cat,” she said, and regretted it as soon as the words were out. Dr. Clifford seemed to be making progress with Tab. Distracting the boy with her thoughts and insights might cause him to clam up.

“Okay,” Dr. Clifford said. “Is there anything else? Has the man in the closet said anything scary to you? I mean, he sounds scary, but has he said anything upsetting?”

Tab considered this. “The thing about me being his eyes,” he said.

“Right. How about besides that?”

“No. Nothing I can think of.”

Dr. Clifford leaned back in his chair and, for the first time in what felt like hours, turned his attention to Sandra. Those eyes! Empathetic. Understanding. She became aware of every muscle in her face, struggling to control them so her expression didn’t give away her thoughts. She’d seen The Silence of the Lambs. Tim had coerced her into it. She didn’t know whether all psychiatrists had high-powered perception like Hannibal Lecter’s, but it couldn’t hurt to keep herself in check.

“It’s far too early to make a diagnosis, but I do have some thoughts about what’s going on,” the doctor said. “Tab? I’d like to talk to your mom alone for a few minutes, if that’s okay with you. But first, when you get home, I want you to try something for me. If the man appears in your closet again—”

“He will!”

Dr. Clifford smiled, patient. “Yes. When he appears in your closet again tonight, I want you to talk back to him. Ask him for his name. If he doesn’t give it, you give him one. If he says anything upsetting to you, argue with him. Okay? Talk back to him. Find out how he reacts.”

Tab’s eyes swelled in their sockets. “What if it makes him mad?”

“It might make him mad,” Dr. Clifford said. “But if I understand the situation, this man who stays in your closet lives there. Except for the one time you saw him in the cellar during a scary storm. Right?”

“Yeah.”

“Good. I think if he was going to hurt you, he would have already. It’s possible he’s scared of you, Tab. You’re a bright boy and your mom tells me you’re an artist. You have a potent imagination.”

“What’s potent?”

“It means strong, honey,” Sandra said.

“Right. It means strong. You’re stronger than this man in your closet. Now, I’m not saying it will be easy to talk back to him. But I think if you can do it, and you can keep doing it, he’ll leave. Do you think you can try talking back?”

Tab thought for a bit, then nodded. “I’ll try.”

“Good!” Dr. Clifford smiled, the broadness of it building mounds atop his cheeks. Sandra couldn’t help but regard his teeth, all straight and a brilliant white. Perfection. Tim refused to go to dentists. “Now, give me a couple of minutes to chat with your mom and we’ll be done.”

Tab slid off the couch and bolted for the door. He glanced over his shoulder to acknowledge Sandra only when she called after him to catch up with his brother in the waiting room. When the boy was gone, Dr. Clifford set his pen and legal pad aside. He crossed his legs and rested his hands one atop the other on his left knee.

“What’s wrong with him?” Sandra asked.

He chuckled. “’Wrong?’ Absolutely nothing. I want to continue seeing him, though. Tell me, does Tab do certain things with repetition, like washing his hands when he shouldn’t need to? Anything?”

“No. Not that I’ve noticed.”

“Does he need a lot of reassurance or comfort? I mean, more so than any other kid his age?”

Sandra shook her head. “No.”

Dr. Clifford scratched his chin. “I have some homework for you, too,” he said. “I want you to pay special attention to his behavior over the next couple of weeks. Regardless of how things go with the man in the closet, I’d like you to watch him for any signs of compulsion.”

“You think he has OCD?”

“Well, it’s possible, but OCD-type behavior can be a symptom of other anxiety disorders. The hallmarks of OCD are the obsessions and the compulsions that are used to relieve them. Repetitive handwashing because of a fear of contamination, chronic confessing to things he thinks he might have done wrong whether he did those things or not. Being overly scrupulous, in other words.

“Tab seems to be going through a fearful phase right now, seeing someone who isn’t there. It doesn’t necessarily mean he has an anxiety disorder or personality disorder or anything. It might be a natural response to something going on in his life. You said you and your husband have been arguing. Then there was the flood. Maybe this ‘man in the closet’ is how Tab’s mind presents things he doesn’t yet know how to cope with. When he learns coping, they’ll go away. That’s one of the reasons I asked him to try talking back, to name the man. Whatever the outcome is might tell us more about what we’re dealing with.”

He cupped his right knee in both hands. “No physical test can determine whether it’s OCD or generalized anxiety or something else, not in the way medical doctors test for things. There are a few things to watch for, though. If Tab is prone to strep infections—”

Sandra sat up straight. “He is! He gets them all the time. He’s just getting over one, as a matter of fact.”

“Uh huh. Have you ever heard of PANDAS?”

“The bears?”

“No, it’s an acronym. It stands for,” he paused, eyeing the ceiling in recollection, “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Believe it or not, strep infections can cause the sudden appearance of OCD-type disorders or even tics. Practically overnight. Ages three through twelve is when kids are most susceptible.”

“So how do we know for sure?”

“For now, I’d like to see Tab a couple of times a month. Let me keep chatting with him. If he presents in ways other than the man in the closet, it will help guide us in the right direction. He probably won’t have every symptom, but be on the lookout for OCD-type things like we discussed. Look for ADHD symptoms, too, like fidgeting or an inability to pay attention. Trouble sleeping. Mood changes. Separation anxiety. Frequent urination. All of those could be indicators that we’re dealing with PANDAS.

“I should add that one instance of strep and the onset of OCD symptoms does not make a PANDAS diagnosis. Most kids get strep multiple times per year. If the anxiety symptoms worsen in close relationship with future infections, Tab might have PANDAS.”

“Do people with OCD hallucinate, too?”

“Well, not typically in a visual way. Sometimes OCD can cause some sensory or tactile—well, hallucinations, for lack of a better word. I prefer sensations. These sensations reflect the individual’s specific obsessions. It’s a little like when someone coughs and sniffles near you in a public place and there’s a sudden tickle in your throat. Not the same, but close. And a lot stronger.

“You mentioned Tab’s powerful imagination. People who have OCD and vivid imaginations are most often the people who experience hallucinations associated with the condition.”

A lightbulb switched on above her head. “Tab said he saw the bump turn into an eyeball,” she said. “The man in the closet has no eyes!”

Dr. Clifford nodded, thoughtful. “Right. So if Tab does have OCD, his obsession might be related to his eyes or his eyesight somehow. I can’t say I’ve had other patients with ocular obsessions, but it’s not out of the question. He’s an artist. His eyesight is important to him.”

Dr. Clifford leaned forward, elbows on his knees. “When you’re watching him, find out if he’s doing things he thinks protect his eyes. Find out if he has a classmate that’s going blind or needs glasses. Something mundane for us can be triggering for a child his age. Now, do you have any questions for me?”

“You said there was more than one reason you asked him to talk back to the man in the closet.”

“Ah,” Dr. Clifford said, leaning back again. “Yes. OCD can cause voices—again, for lack of a better term—inside your head to say nasty things to you. These nasty things can be harsh criticisms of themselves or extreme stuff, like trying to convince them they want to hurt themselves or someone else. The man in the closet could be a manifestation of this symptom. Many times, just learning to talk back to these voices can minimize them. It doesn’t make them go away, but it can help diminish them to a point. Either way, talking back to this man and naming him won’t hurt Tab.”

He stood, picking up his legal pad and pen as he did, and returned to the desk he’d been sitting at when Sandra and Tab arrived. Sandra got the message. The session was over. She beamed. “Oh, thank you!” she said, rising from her seat. “This has been so helpful.”

“Absolutely. Check with Beth on your way out and schedule another visit. No more than two weeks from now. It was nice meeting you. I hope both you and Tab get a restful night tonight, free of eyeless men in closets.”

He grinned.