14. Kai
Kai
Ihave never been nervous about a patient walking into my office.
Concerned, yes. There have been patients whose names appearing on my schedule required preparation beyond reviewing a file, people prone to violence, severe instability or the kind of unpredictable behavior that makes maintaining awareness of exits less paranoia than professional responsibility.
I have worried about whether someone would return after a difficult session, whether medication was working, whether a patient I sent home with a safety plan would actually use it if the night became worse than expected.
Nervousness is different.. Nervous is what I am now and for all the wrong reasons.
I glance toward the clock in the lower corner of my computer screen and immediately resent myself for doing it because I checked less than three minutes ago.
Julia’s appointment begins in twenty-seven minutes.
The letter has been inside her house for three days.
Assuming she found it Monday morning when she left for work, which is almost impossible not to assume considering I placed the fucking thing directly against her front door.
She has had three days to read it, decide what it means and determine what she intends to do about the anonymous man who informed her — in handwriting and sealing wax like a psychopath with an unfortunate appreciation for presentation — that he watches her.
I lean back in my chair and remove my glasses long enough to rub the bridge of my nose. This may genuinely be the first time in the history of psychiatry that the therapist is more apprehensive about what the patient intends to disclose than the patient is.
There are several files open across my desk, all of them selected less because they require immediate attention and more because apparently my solution to committing increasingly unethical acts in my personal life is to compensate by becoming extraordinarily productive at work.
It isn’t working. My attention keeps drifting toward the closed office door.
She could have called the police. The thought has visited often enough since Monday that it should probably produce more fear than it does.
Instead, every time it appears, some deeply defective part of my brain responds with the same calm confidence that I left nothing tying the letter to me.
No fingerprints I’m particularly concerned about, no clinic stationery, nothing identifying.
The paper and envelope were purchased with cash from a store nowhere near my office or home.
Although the fact that I am even cataloguing those details inside my own head should serve as fairly conclusive evidence that my sanity has packed its belongings and left without forwarding information.
I should transfer her. That would be the responsible decision.
Refer Julia to a colleague, provide whatever clinical history is necessary for continuity of care, remove myself from her treatment entirely and find a psychiatrist of my own before I progress from anonymous correspondence to whatever diagnostic category comes after standing in woodland outside a patient’s house several nights a week.
I know several excellent physicians. Unfortunately, imagining sitting across from any of them and explaining why I require treatment creates an almost physical resistance inside me.
Hello. I’ve become obsessed with one of my patients, followed her home repeatedly, watched her through her windows and recently left an anonymous letter informing her she belongs to me.
There probably isn’t a billing code specific enough for that.
I put my glasses back on and force my attention toward the email open on the screen.
The subject line reads MORRIS, DANIEL — UPDATED FAMILY COURT ORDER, and unlike Julia, Daniel represents a problem I am actually qualified to address.
The message comes from the court liaison assigned to his case.
I’ve already read it once this morning, but I start again because anything that forces me back into the part of my brain that still functions professionally is welcome.
The judge has approved limited supervised visitation with Daniel’s daughter, two scheduled visits each month at an approved family-services facility, with no unsupervised contact and no direct contact with his former wife outside communications facilitated through attorneys or the parenting coordinator.
His ex-wife retains sole physical custody and primary legal decision-making, and she and their daughter have been accepted into a trauma-recovery program, specializing in survivors of domestic violence and children exposed to chronic household intimidation.
The liaison notes that my reports contributed to the court’s decision.
Not because I declared Daniel safe, which I most certainly did not, but because the progress documented across our sessions demonstrates something more useful than the empty remorse he offered during our first meeting.
He has begun identifying his own behavior without immediately attaching his former wife’s actions to it as justification.
His language has changed. Not consistently, and certainly not enough that I would support unsupervised access to his daughter yet, but enough that the court has determined controlled contact may be appropriate.
Progress doesn’t erase what he did. It simply establishes the possibility that he may eventually become something other than the man who did it.
I read the final paragraph again, my attention settling fully for the first time all afternoon.
Daniel’s daughter has reportedly expressed interest in seeing him.
That part sits differently. Children have an extraordinary ability to continue loving people who terrify them, something adults often misinterpret as evidence that the harm could not have been severe.
I learned young that those things have almost nothing to do with each other.
I place both hands on the keyboard and type my response, confirming receipt of the order and requesting clarification regarding whether Daniel’s individual psychiatric treatment remains court-mandated under the revised arrangement or whether it transitions into voluntary continued care alongside the intervention program.
I also ask for the updated conditions governing reporting, because custody decisions may have changed while my obligations as a treating physician have not.
The work steadies me. Facts usually do. I finish the email, read it once for anything that could be interpreted ambiguously and click send just as the familiar muted sound of the outer office door reaches me. My body reacts before I consciously identify why.
Julia.
I hate that I know. I hate it considerably more that I’m right.
Several minutes later, Mara appears briefly in the doorway and tells me Julia is here.
I thank her without providing any additional reason for the slight pause before the words, and when the door closes again, I glance once at the clock.
Five minutes. Ridiculous. I close Daniel’s file, straighten the papers on my desk that don’t require straightening and move toward the sitting area before I can find another meaningless task.
By the time the door opens again, I am exactly where I am supposed to be.
Julia steps inside. For the first few seconds, I do nothing except look at her face.
She looks much as she usually does when she comes here, although there is a slight distraction behind her eyes that I recognize almost immediately.
Not dissociation. Nothing resembling the distance that frightened me after our second session.
She is present, oriented and aware of the room, but part of her attention remains somewhere else.
Then I take into account the rest of her.
The denim dress is fitted through her waist and hips before falling to just above her knees, simple enough that there is absolutely no professional reason for me to continue noticing it after the first glance.
Naturally, I noticed it anyway. The dark blue makes the copper in her hair more obvious, and when she bends slightly to set her bag beside the chair she always chooses, the fabric pulls across the curve of her ass in a way that sends an immediate and deeply inappropriate thought through my head.
Jesus fucking Christ.
I redirect my attention toward her face before she straightens.
Apparently obsessively stalking my patient was not sufficient ethical deterioration.
Now I’m cataloguing how good she looks in denim while waiting to hear whether she plans to report my anonymous alter ego to law enforcement. Excellent work, Doctor.
“Good afternoon, Julia.”
“Hi.” Her smile arrives normally enough, although a fraction later than usual.
Interesting.
She sits and crosses one leg over the other, smoothing the skirt over her thigh before settling back into the chair.
I take the seat opposite her and pick up my notepad, although I’m acutely aware of the fact that for the first time since she became my patient, I am carrying information into this room that she does not know I possess.
That alone should disqualify me from being here.
“How was your week?”
“Busy.” She exhales as she says it, resting one hand loosely over the other in her lap. “Monday tried to kill me before eight in the morning, but things improved from there.”
The answer sounds light enough, yet she rubs the pad of her thumb slowly against the place where the bite mark has long disappeared from. She moves the thumb from that place and starts rubbing her fingernail. I have never seen her do that before.
“What happened Monday?”
For one dangerous second, her eyes meet mine so directly that I wonder whether she knows.