Sean Logan became my patient exactly seventeen months before I began my work with the Kramer family. He was referred to me by a physician at the Naval Health Clinic in Norwich. This is the same doctor who sought Jenny Kramer’s records for her study of the treatment. She had followed Sean’s case closely upon his return. She had supervised his therapy sessions, allowing the hacks assigned to his case to misdiagnose him with PTSD. The symptoms were not dissimilar. Anxiety, depression, anger, suicidal thoughts. But this young man had been given a drug protocol in the field that was new and unpredictable. It was meant to reduce PTSD, not create it. And no one bothered to factor in his history with anxiety. It was not even listed in his records.
People wonder what is wrong with our health care system that we have fallen so far behind the rest of the civilized world. People blame it on our laws, or the drug companies, on the areas that have become “socialized” or the areas that are not “socialized.” Excuses, excuses. I don’t care what you’re getting paid or how hard you’re being worked. A patient sits before you. He has lost his arm in battle. He has lost his memory of the battle. Or, more precisely, it has been stolen from him. And now he has lost himself to his own mind. Is this man not worthy of your time? Is he not worthy of you taking a proper history—the kind I know you were taught in medical school, and again and again throughout your residency? There is no excuse. None at all.
Sean was asked one question: Have you or anyone in your family ever suffered from any mental illness? Sean answered no. He had never been diagnosed or treated for his anxiety and had spent most of his life believing it was just “who he was.” Until he came to see me.
I am angry. There is no use continuing the story without making this additional confession. I am angry that Sean Logan suffered for nine months before he was sent to me. I am angry that Jenny Kramer was given the treatment and that I was not employed to observe her in the months that followed. Surely the Kramers would have sought my help sooner had they known that right here in their little town a doctor was treating a man who had been given the same drugs and suffered as a result. What might have come to pass? I will tell you what. Jenny Kramer would have studied math instead of techniques for ending her life. She would not have taken a blade to her soft pink flesh and cut into her skin and then deeper into her veins until her blood spilled onto the floor.
Looking back on the months between the rape and the suicide attempt, it all makes sense to me now. Everyone in Fairview knew about the attack. But the use of the treatment to make her forget was not widely known. It was certainly not known to me. And yet, when I saw her around our town, the same way I had before, at the movie theater or the ice cream shop, I was surprised by her demeanor. Not that there is one way a rape victim should behave. I have treated victims of trauma for most of my career. I suppose it is odd, my work with the criminals in Somers and my work with victims of the same crimes they have committed—rape, murder, assault, domestic abuse. It makes perfect sense to me. Most of the men in Somers were victims before they were criminals. You would be surprised at how many people have been victims of trauma. Most of them (unless they have become criminals) seek help years later, when they have stopped moving and settled down into a family life. It is then, while they sit at their desks or drive their children to school, that the pain resurfaces. My practice in Fairview is thriving. The line outside the metal door in Somers grows longer each week.
I cannot pinpoint what it was about Jenny that did not ring true. Is it enough to say for now that after all my years as a psychiatrist, I know it when I see it? And while I am confessing things, I will add to the list that it bothered me. Knowing something was not right but having no business to inquire—it was not easy to sit with this. I wanted to know why no one was treating her. I wanted to know why she did not behave the way I would have expected. I wanted to know why I could not see the rape in her eyes. Not knowing was causing me to question myself and my professional competency. As angry as I was with the local medical community when I learned the truth, I was admittedly relieved that my observations had been correct. And I was beyond eager to help.
Charlotte Kramer came to see me while Jenny was still in the hospital. Dr. Markovitz had refused to release her without a course of therapy in place—a therapist on board and a plan for her care. Charlotte did not resist. Whatever responsibility any of us, including Tom and Jenny, might ascribe to her for Jenny’s suicide attempt, Charlotte took it on tenfold. Soaked in her daughter’s blood, she spoke to Detective Parsons about how she found her daughter. And while she managed to cover her tracks with regard to Bob Sullivan, I believe she was sincere about her feelings of remorse.
I sat with her in the family lounge. It was like déjà vu. I couldn’t believe something else had happened to that poor girl. But Mrs. Kramer was different this time. I remember on the night of the rape, she was all dressed up for some dinner party. Even after hearing the news, she kept her composure. Tom Kramer was another story. Christ, was he a mess. Both times. Just a sloppy wet mess. Mrs. Kramer sat on the couch, crossed her legs, and folded her arms in a very ladylike way. But she was shaking. I remember watching her right hand as it lay over her left wrist, both of them resting on her knee. She was fighting it hard. I asked her to just tell me what happened, start to finish. She nodded and said something formal like, “Certainly, Officer.” I mean, I’d been talking to this family for months, even before I found the blue Civic. Probably once every few weeks, you know, keeping them up to date on the investigation, asking about how Jenny was doing.
There wasn’t much to tell before the car showed up again, what was it—ten weeks after the suicide attempt? But I knew Tom needed it, so I made the effort. I probably talked to Tom more than Mrs. Kramer, but still. There’s a familiarity there now. But she addressed me like we’d just met. Anyway, she took this long breath and then … I’ll never forget it … she used both hands to smooth out her blouse—this white blouse that was completely soaked in her daughter’s blood. And then she reached up to her face to brush a piece of hair back across her forehead, and the blood, it just got smeared there across her forehead and she didn’t even notice it. It was as if she was still going through the motions of normal behavior but she was so distraught that she didn’t even see what she was doing—getting the blood all over her hands and then her face. I just wanted someone to come in and hold her until she finally let it out.
Detective Parsons continued, reading from his notes what Charlotte said to him:
She said she had seen a light on in the pool house bathroom. There’s a small window and I guess she was out in the yard to check on some fallen tree branches so she could tell the landscaper what needed to be done. She caught a flash of light coming from the window. So she went to turn it off. That’s when she found her daughter. She did not go into the details. She let out a little cough to clear her throat and said that she called 911 from her cell phone, which I guess she had with her, and then she wrapped Jenny’s wrists in the towels. Probably saved her life. Hard to say, but at that stage, seconds counted, and it was ten minutes before the paramedics arrived. I was writing all this down in my notebook. At one point, she stopped talking. I thought she was letting me catch up with my writing, but even after I lifted my pen, she was silent. I looked up then, looked at her, and this very thin stream of tears was coming down both sides of her face. It was so odd because there was no other indication she was crying. I mean, Tom was like a contorted twisted ball of flesh, his eyes, his mouth, his brow all scrunched up and bright red. But Mrs. Kramer was just staring blankly with these little waterfalls coming down, dripping onto the bloody shirt. And she said then, when I looked up at her, and I’ll never forget this either, she said, “This is my fault. I did this. And I’ll fix it.”
Dr. Markovitz immediately consulted with the Naval Health Clinic and the woman doing the study on the treatment. He said she had mentioned other trauma victims who had received the treatment and how she had been following their progress. She was, apparently, shocked that Jenny had tried to take her life. I find this disingenuous. She knew full well what torment Sean Logan had suffered when he returned home without his right arm or his memory. She had followed his treatment at the clinic, the chronic insomnia, the rage attacks against his wife and in front of his son. He had withdrawn from his friends and family and cut off contact with everyone he knew in the navy. His symptoms were complicated by the underlying anxiety, which before had been self-medicated with exercise, drinking, and sex. The clinic had put him on Prozac and lorazepam, and these had muted the symptoms of the anxiety. Had he come to me before the mission where he lost his arm, I may very well have prescribed the same drugs. They could not understand why he was not getting better. But that’s because they were missing two crucial pieces of information. First, his chronic anxiety predating the mission. They assumed his anxiety symptoms were a result of PTSD. Why, I might have asked them, would he have PTSD when he had no memory of the events? Wasn’t that the whole reason for giving him the treatment? Infuriating. Second, they were unaware of the deleterious, anxiety-producing side effects from the treatment itself—from the dislodging of the emotional and physiological experience from the factual memories
Sean described his mental state like this. This was when he first came to me. His humor and lightness would not return for many months. He refused to wear a prosthetic. I think he wanted the world to see him as defective or damaged, because that was how he felt inside. You will surely notice the similarities to Jenny Kramer.
I lie in bed at night. The acid in my stomach is gone. The meds took that away—along with my personality, I’m told. I’m not that fun guy anymore. But I’d take that, you know. I’d fucking swallow that down and ask for another if I could stop this other thing. I look at the empty space where my arm should be, and then I close my eyes and try like all hell to remember that day. They gave me the report, but who the fuck knows? We were sweeping for this one bad guy. There was solid intel. Eight of us went in. We had air cover, and a corps unit was on its way. We moved through the streets, breaking off in pairs. The unit was ambushed right after I broke with this other SEAL, Hector Valancia. The corps found him dead next to me. Half his head got blown off. We took it from an IED. I was unconscious. Mangled arm. They got me out. Took off the arm. Then gave me the drugs. I can’t blame them. I signed off on it. We all did. Shit, if someone asked you, “Hey, if you get fucked up in the field, do you want us to give you some drugs to make you forget all about it?” Fuck yeah, I do! But now, all of it is just a story. It’s no more real or unreal to me as any other story. It feels like there’s a ghost inside me—the ghost from that afternoon, and he’s pissed off, just raging inside my body, searching for the story, not the words from the report, but the images of my buddy dying beside me, and the blood seeping from my shredded flesh, it rages for the memory of the pain that I must have felt when the bomb went off, even for a second. This ghost is a strong motherfucker. He just gets bigger every day and it’s like there’s no room for anything else. When I try to hold my son, when my wife tries to hold me, nothing can get in. Then there’s just broken plates, a scared kid, my wife in tears. I’m a monster.
Charlotte Kramer called me after getting my name from Dr. Markovitz. As I’ve said before, she and her husband were eager to employ me. I met with her in my office before agreeing to take the case, although I knew I would be compelled to do so. How could I not? My involvement with Sean, my growing knowledge of the treatment, both its pathology and the potential countertreatment, my work with victims of trauma and crime and my proficiency with medications—I don’t think I’ve ever been more suited to treat a patient than I was for Jenny Kramer.
And I will say one more thing on my proficiency treating survivors of trauma. It is an aside, really, but I was myself the target of an altercation when I was a young boy. I do not disclose this to my patients, because there must be boundaries. But there are times when they say things to me, things like You don’t know what it feels like or I can’t explain how I feel now, when I want to tell them that I do have some idea. Of course, few of us escape childhood without some bullying or aggression, or worse. Most of us can identify to a degree with these survivors of more serious crimes. Still, my patients cannot see me as anything less than a rock. I cannot cry with them. I cannot get angry with them. I cannot let them know they affect me in any way. They must be free to pound their fists into my gut without the fear that they will break me.
I know you have detected my soft spot for Charlotte. I recognized it myself the moment she walked into my office and sat elegantly on my sofa. Please do not misinterpret things. I am not, nor have I ever been, “attracted” to her in an inappropriate manner. It’s simply that I knew, from everything about her, the way she held her back so straight, the way she spoke with a slight affectation, her neat clothing, the tucked-in blouse and pressed trousers, hair pulled so tightly in a bun, even the words she chose, that the story of Charlotte Kramer was going to be rich. I knew that it would be difficult but that I would uncover it, that she would reveal it to me, and that the extent of her emotional scars and the skill it would take to reach them would present a deeply satisfying professional challenge. I have no qualms admitting this to you or anyone else. It is no different from a lawyer relishing a complicated criminal defense. Or a builder reconstructing a home after a fire or flood. Is there empathy for the client? Of course. But legal, psychological, structural—whatever the problem the client has, the professional employed to solve it is not at fault for enjoying the task. That is why we joined the profession, is it not?
At our very first meeting, we spoke for an hour. During that time, she began to trust me to treat her daughter, and I would later use that to open her own vault of secrets. I could sense it. It is essential, and every competent practitioner has acquired the skill to do it. It requires strict adherence to boundaries, compassion, and an appropriate degree of distance. I did not flinch when she told me about the rape, the treatment, the strained year, and the attempted suicide, even though my thoughts were spinning with all the implications, which I have already described. Jenny Kramer had been a puzzle I could not solve, and now I had been given the pieces.
I met them all at the hospital the next day—Charlotte, Tom, and Jenny. I met with Lucas at my office sometime after that. He has gotten little of my attention as I recount the story. But I did speak with him and I did consult with both Charlotte and Tom frequently about how they should parent him during this crisis. It would take far too long to explore the deleterious effects events like these can have on siblings. Neglect, withdrawn love, and emotional denial are every bit as toxic as outright abuse. I made sure Lucas was spared that fate.
Jenny had been moved to the psych ward, where she was under a mandatory forty-eight-hour watch period before she could be released. There was recognition in her eyes when she saw me, and she even smiled slightly to acknowledge this. I’ve seen you in town.
She said this, and I realized that it was the first time I had heard her voice. She did not sound anything like what I’d expected. That may be a strange thing to say, but we all do this, we all impute certain missing variables to people we meet based on our preconceptions or past experiences. I was expecting Jenny’s voice to be high pitched, maybe even childlike. But it was not. It was deep, slightly raspy, as you might expect from a middle-aged blues singer. It is not uncommon. Think about it—you will surely have before you one or two people from your life who have this type of voice.
She wore a hospital gown, tied in the back, and a robe her parents had brought from home. There was no sash, for obvious reasons, so it hung loosely around her in the wheelchair. I could see the white bandages poking out from beneath the sleeves.
Tom was eager to meet me. He stood and shook my hand vigorously, as though he could shake the cure for his daughter from my limbs. We are so happy we found you.
Tom was sincere. We all sat down and they looked at me, waiting for something brilliant to emerge from my mouth.
“I’m happy to help, if I can.” I said, “But, Jenny. I have to ask you one very important question.”
She nodded. Tom looked at Charlotte, who seemed to reassure him with the look she returned. They both nodded at me, and then I continued.
“Jenny. Do you want to remember what happened to you that night in the woods?”
I will never forget her face in that moment. It was as though I had solved the mystery of the universe, discovered the truth about God. She knew when I spoke these words what she hadn’t known before but what was suddenly crystal clear. And her expression carried relief and gratitude so profound—I will never have a more satisfying moment in my professional career.
She nodded her head, choking back tears, but then they just exploded out of her. Yes! she said.
Then she said it over and over as her father hugged her, her mother wrapping her arms around herself.
Yes, yes, yes …