And then he stopped.
“You’re hired,” Mavis said. She pulled the jug of white cheap-shit out of the well and sloshed some into Catfish’s glass. “On the house.”
Just then the door opened and a blast of sunlight cut through the dinge and smoke and residual Blues and Vance McNally, the EMT, walked in and set his radio on the bar.
“Guess what?” he said to everyone and no one in particular. “That pilgrim woman hung herself.”
A low mumble passed through the regulars. Catfish put his guitar in its case and picked up his wine. “Sho‘ ’nuff a sad day startin early in this little town. Sho‘ ’nuff.”
“Sho‘ ’nuff,” said Mavis with a cackle like a stainless-steel hyena.
Depression has a mortality rate of fifteen percent. Fifteen percent of all patients with major depression will take their own lives. Statistics. Hard numbers in a very squishy science. Fifteen percent. Dead.
Val Riordan had been repeating the figures to herself since Theophilus Crowe had called, but it wasn’t helping her feel any better about what Bess Leander had done. Val had never lost a patient before. And Bess Leander hadn’t really been depressed, had she? Bess didn’t fit into the fifteen percent.
Val went to the office in the back of her house and pulled Bess Leander’s file, then went back to the living room to wait for Constable Crowe. At least it was the local guy, not the county sheriffs. And she could always fall back on patient confidentiality. Truth was, she had no idea why Bess Leander might have hung herself. She had only seen Bess once, and then for only half an hour. Val had made the diagnosis, written the scrip, and collected a check for the full hour session. Bess had called in twice, talked for a few minutes, and Val had sent her a bill for the time rounded to the next quarter hour.
Time was money. Val Riordan liked nice things.
The doorbell rang, Westminster chimes. Val crossed the living room to the marble foyer. A thin tall figure was refracted through the door’s beveled glass panels: Theophilus Crowe. Val had never met him, but she knew of him. Three of his ex-girlfriends were her patients. She opened the door.
He was dressed in jeans, sneakers, and a gray shirt with black epaulets that might have been part of a uniform at one time. He was clean-shaven, with long sandy hair tied neatly into a ponytail. A good-looking guy in an Ichabod Crane sort of way. Val guessed he was stoned. His girlfriends had talked about his habits.
“Dr.Riordan,” he said. “Theo Crowe.” He offered his hand.
She shook hands. “Everyone calls me Val,” she said. “Nice to meet you. Come in.” She pointed to the living room.
“Nice to meet you too,” Theo said, almost as an afterthought. “Sorry about the circumstances.” He stood at the edge of the marble foyer, as if afraid to step on the white carpet.
She walked past him and sat down on the couch. “Please,” she said, pointing to one of a set of Hepplewhite chairs. “Sit.”
He sat. “I’m not exactly sure why I’m here, except that Joseph Leander doesn’t seem to know why Bess did it.”
“No note?” Val asked.
“No. Nothing. Joseph went downstairs for breakfast this morning and found her hanging in the dining room.”
Val felt her stomach lurch. She had never really formed a mental picture of Bess Leander’s death. It had been words on the phone until now. She looked away from Theo, looked around the room for something that would erase the picture.
“I’m sorry,” Theo said. “This must be hard for you. I’m just wondering if there was anything that Bess might have said in therapy that would give a clue.”
Fifteen percent, Val thought. She said, “Most suicides don’t leave a note. By the time they have gone that far into depression, they aren’t interested in what happens after their death. They just want the pain to end.”
Theo nodded. “Then Bess was depressed? Joseph said that she appeared to be getting better.”
Val cast around her training for an answer. She hadn’t really diagnosed Bess Leander, she had just prescribed what she thought would make Bess feel better. She said, “Diagnosis in psychiatry isn’t always that exact, Theo. Bess Leander was a complex case. Without compromising doctor-patient confidentiality, I can tell you that Bess suffered from a borderline case of OCD, obsessive compulsive disorder. I was treating her for that.”
Theo pulled a prescription bottle out of his shirt pocket and looked at the label. “Zoloft. Isn’t that an antidepressant? I only know because I used to date a woman who was on it.”
Right, Val thought. Actually, you used to date at least three women who were on it. She said, “Zoloft is an SSRI like Prozac. It’s prescribed for a number of conditions. With OCD the dosage is higher.” That’s it, get clinical. Baffle him with clinical bullshit.
Theo shook the bottle. “Could someone O.D. on it or something? I heard somewhere that people do crazy things sometimes on these drugs.”
“That’s not necessarily true. SSRIs like Zoloft are often prescribed to people with major depression. Fifteen percent of all depressed patients commit suicide.” There, she said it. “Antidepressants are a tool, along with talk therapy, that psychiatrists use to help patients. Sometimes the tools don’t work. As with any therapy, a third get better, a third get worse, and a third stay the same. Antidepressants aren’t a panacea.” But you treat them like they are, don’t you, Val?
“But you said that Bess Leander had OCD, not depression.”
“Constable, have you ever had a stomachache and a runny nose at the same time?”
“So you’re saying she was depressed?”
“Yes, she was depressed, as well as having OCD.”
“And it couldn’t have been the drugs?”
“To be honest with you, I don’t even know if she was taking the drug. Have you counted them?”
“Uh, no.”
“Patients don’t always take their medicine. We don’t order blood level tests for SSRIs.”
“Right,” Theo said. “I guess we’ll know when they do the autopsy.”
Another horrendous picture flashed in Val’s mind: Bess Leander on an autopsy table. The viscera of medicine had always been too much for her. She stood.
“I wish I could help you more, but to be honest, Bess Leander never gave me any indication that she was suicidal.” At least that was true.
Theo took her cue and stood. “Well, thank you. I’m sorry to have bothered you. If you think of anything, you know, anything that I can tell Joseph that might make it easier on him…”
“I’m sorry. That’s all I know.” Fifteen percent. Fifteen percent. Fifteen percent.
She led him to the door.
He turned before leaving. “One more thing. Molly Michon is one of your patients, isn’t she?”
“Yes. Actually, she’s a county patient, but I agreed to treat her at a reduced rate because all the county facilities are so far away.”
“You might want to check on her. She attacked a guy at the Head of the Slug this morning.”
“Is she in County?”
“No, I took her home. She calmed down.”
“Thank you, Constable. I’ll call her.”
“Well, then. I’ll be going.”
“Constable,” she called after him. “Those pills you have—Zoloft isn’t a recreational drug.”
Theo stumbled on the steps, then composed himself. “Right, Doctor, I figured that out when I saw the body hanging in the dining room. I’ll try not to eat the evidence.”
“Good-bye,” Val said. She closed the door behind him and burst into tears. Fifteen percent. She had fifteen hundred patients in Pine Cove on some form of antidepressant or another. Fifteen percent would be more than two hundred people dead. She couldn’t do that. She wouldn’t let another of her patients die because of her noninvolvement. If antidepressants wouldn’t save them, then maybe she could.