Chapter One

Why psychiatry?"

I've heard the same question posed in different forms by friends, family, and even complete strangers. As often as not, implicit in their tone is the insinuation that something must be a little off-kilter in my own head for me to have wound up as a psychiatrist. I used to shrug off the suggestion with varying degrees of politeness. But standing under the shower's lukewarm spray, I realized I wasn't sure anymore. My psychological closets were full to the point of bursting. And the same was true of more than a few of my colleagues.

The ringing phone jolted me from my introspection. I considered ignoring it but then it occurred to me that I'd been in the shower for more than half an hour. Even my obsessive-compulsive patients would have to concede that by now I was clean. So I stepped out of the stall and slid out of the bathroom.

I reached the phone on its fifth ring—one too late. I waited until the voicemail light flashed on my phone and then I played back the message. "Doc, it's Dev," said Homicide Sergeant Ethan Devonshire in his unmistakable low-pitched Southern drawl. "Not the best way to tell you this, but Stanley Kolberg was found dead in his office. He was shot in the neck, and uh . . ." He left the word-picture unfinished. "Anyway, we're at the scene now. We could use your input. Can you call me on my cell as soon as you get this?" He paused. "Sorry."

Still damp, I sat on the edge of my bed, forgetting my towel. Conflicting thoughts and emotions swam in my head, but I forced myself to focus on the prospect of joining Dev at Stanley's office—an office I'd once shared with the victim. It made no sense for me to become professionally involved in his murder investigation. But call it shock, or maybe just morbid curiosity, I wanted to go to the crime scene. I needed to see what fate worse than a bullet to the neck had befallen Stanley and stopped Dev's description in mid-sentence.

I rose from the bed and wandered over to my dresser. When I reached for the top drawer, the photo on top caught my eye. I picked up the five-by-seven frame. Stanley had taken the action shot of Loren and me on the thirty-foot sailboat. Life jackets on, we had struggled to keep straight faces and look nautical, but we ended up looking just goofy. And happy. I looked from the photograph to the mirror in front of me. Still no gray hairs, and the lines had deepened only slightly at the corners of my mouth and eyes. But the mirror didn't tell the whole story. I felt as if I'd aged a lifetime in the five years since Stanley had snapped the photo. If Lor were still alive, I doubt she would have aged a day in the interim. Then again, maybe I wouldn't have either. God, I missed her.

After positioning the frame back in its spot, I threw on a pair of khaki trousers and a shirt that dampened on contact, not necessarily from the shower, and headed out the door to my garage. I climbed into my car and said my little prayer. It worked. The engine of the silver 1988 Honda Accord coughed a few times, sputtered, and finally lapsed into its familiar unhealthy rumble. Tomorrow I'm going to replace this piece of crap, I promised myself. I'd made that promise so often it was becoming a mantra.

I pulled into the underground parking lot of my old office building, which still had no gate despite multiple complaints from the tenants. Using the key I hadn't bothered returning when I quit the practice, I let myself in through the basement door. More than a few drug addicts also had let themselves in through the same door with the aid of a crowbar. Medical buildings and their promised cache of drugs and syringes draw junkies like pollen attracts bees; thus the complaints.

Even before the elevator doors opened on to the third floor, I could hear the commotion emanating from Stanley's office. I walked out into the sterile, fluorescent-lit hallway, passing a dental office and two family practices. At the end of the corridor, a door was ajar. The two shingles on the door read: stanley kolberg, m.d. and calvin nichol, m.d. Beneath them the paint was faded in a shape and size matching the other two placards. That was where my own shingle, joel ashman, m.d., used to hang.

I pushed the door open and walked into the waiting room where I saw the first of the "bunny men." Crime-scene investigators from Seattle's Medical Examiner's Office wear white overalls, gloves, and foot covers to all crime scenes, but it is their white hats, worn with goggles and sometimes earphones, that make them look like mutant rabbits.

I watched the bunny men scour the walls and floors, using their infrared and violet-blues, and God-knows-what other equipment. To me, it looked like an Easter egg hunt gone awry. But I knew what the CSI guys were looking for—residues, fibers, and, most of all, a blood corpuscle or hair follicle or single sperm cell or any tantalizing scrap of DNA that under a microscope might divulge a social security number or zip code. They didn't acknowledge me, but I wasn't surprised; I'd long ago decided that the bunny men didn't have much time for bodies above room temperature.

Following the din, I rounded the corner and almost slammed into Dev coming the other way. Ethan Devonshire—"Dev" to everyone but his wife—was tall with broad shoulders and a slight paunch. Below his unruly salt-and-pepper hair, he had a round face with deep laugh lines, shallow acne scars, and perpetually amused gray eyes. This evening, he'd worn jeans with a collared pullover. As always, Dev had erred on the casual side, but in his defense, it was after midnight.

His weathered face broke into a sympathetic smile. "Sorry about your friend."

I nodded my thanks. "Can I see him?"

Dev reached over and patted me on the shoulder. I turned toward Stanley's office and took another step down the hallway. "But Doc"—Dev's voice stopped me—"It's kind of grisly. Sure you want to see it?"

With a nod, I began to approach Stanley's interview room at the end of the hallway, stopping only when I reached the wide-open door.

I had walked onto worse crime scenes, but I froze in the doorway. This time, the victim wasn't a stranger.

The sheer volume of blood astonished me. No surface was spared, but the floor bore the brunt. Near the center of the room, the green carpet had blackened in a ring encircling Stanley Kolberg's barely recognizable corpse.

Stanley lay in a heap in front of his desk. Of all the distorted anatomy, his arms were the most jarring sight. Twisted above his head and obviously fractured at the wrist, his right hand appeared to have hold of its own forearm. Though not as deformed, his left arm shot out unnaturally above his head, hand turned over, as if trying to pat down the carpet with its bloated fingers.

I took in the other details with growing nausea. Stanley's face was a battered pulp. With all the tissue that oozed down from his forehead, I couldn't tell whether his eyes were open. His nose deviated badly to the right, and his lips were swollen to the width of bananas. Crusted blood matted his hair and stuck to his beard.

In one of those bizarre reflex-associations, I wondered again why so many of my male colleagues wore those Freud-like beards. It was Stanley—no one ever shortened it to Stan—who'd once explained: "All other physicians have uniforms. OR scrubs, white coats, stethoscopes, and what have you. Helps sell the whole shtick to the public. But what do we psychiatrists have? Nothing. So we grow beards like Sigmund's." Then he smiled and winked conspiratorially. "Besides, most of us shrinks are a wee bit fucked in the head, no?" Stanley was as academic as they came, but when he wanted to emphasize a point, he'd slip into a folksy idiom and pepper it with expletives.

An excited voice pulled me back to the moment. "You get a load of that, Joel?"

I looked over to my right to see the chief crime-scene investigator, Nate Schiff, now standing beside me. Schiff was one worked-up bunny. He jabbed a finger at the hemorrhagic wall inside the room. "Check out the wall!"

I glanced at the red streak that arched across the wall like the band of a rainbow.

"A real pumper," Schiff exhaled. "Only one thing gives you a spurt like that. An arterial bleed. And a big one, to boot!" He whistled appreciatively. Schiff wasn't morbid the way some people who work around the dead were, but he had a scientist's appreciation for the mechanics of his study, which happened to be murder scenes.

I viewed Stanley, but I couldn't spot a wound through the layers of blood and tissue. Reading the uncertainty on my face, Schiff brought two fingers up to his own neck as if checking his pulse. "The carotid. The second-biggest artery in the body, after the aorta." Having been through medical school this wasn't exactly news to me, but I didn't interrupt Schiff; he was on a roll. "A fresh-cut carotid will spray close to ten feet. Drain a gallon or two in less than a minute. Like slicing open a garden hose!" He pursed his lips and made an unnecessary whooshing noise.

Schiff stepped into the interview room. I took a breath and followed him. Avoiding the dark patches on the carpet, we kept moving until we reached the victim's feet. From up close Stanley looked less like roadkill and more like the man I knew, which made the whole tableau that much more disturbing. To distract myself, I concentrated on forensic details. "Only one shot?"

"Only one that hit him." Schiff shrugged. "But our guy fired another. The stray up in the wall." He pointed at a small crater in the drywall above the door behind us. "Don't have a clue what that was all about. No one's that bad a shot from in so close."

"Stanley was standing when he was shot?"

"You can see exactly how he went down . . ." Schiff swept a hand over the room, looking more like an interior decorator pitching colors than a CSI technician describing an execution. "The victim is standing right in front of his desk. Bam!" He fired an imaginary shot from his fingertip. "He takes it off the side of his neck, reels, and spins to his left. Now blood's spurting out at a mean pressure of 120 mm of mercury. Just follow the spray. See how the blood trails down the wall, over the chair, and onto the carpet?" Schiff pantomimed Stanley's collapse. "The victim's dropping as he spins."

"And the other injuries? Obviously, they're not just from his fall."

"Not unless he fell from an airplane." Schiff chuckled. Then he cleared his throat and looked away, remembering, I assume, that the deceased and I were friends. "I figure once he's on the ground, our perp gives him a real nasty working over."

"With what?"

"Dunno. Something blunt. A pipe? Maybe heavier. Not a pistol-whipping." He shrugged. "The pathologist should be able to fill in the rest."

"Was he beaten before or after he died?"

"Can't tell. Autopsy should help there, too."

Schiff shifted from foot to foot. I could see he was getting antsy. There was more to find in this gold mine of physical evidence, and he probably didn't want to miss a strike chatting with me. I asked him for a moment alone. And with a quick nod, he was gone.

I stood and stared at the remains of the man who had influenced my life more than almost any other. A man who had come to remind me so much of my father that at times I had confused the two. I saw past the mutilation and visualized Stanley's youthful face—not handsome, but distinguished—with bushy eyebrows, hazel-brown eyes, long nose, and a beard that was darker than his uniformly gray hair. His face commanded respect, but could still convey sympathy, understanding, and trust. Especially trust. Many, many people over the years had willingly put their lives in those hands that now lay mangled above his head.

A familiar voice broke the silence. "Doc?"

I looked over to see that Dev had joined me. Beside him stood a woman almost his height but lacking any trace of his paunch. Her tawny blond hair was clipped back away from her face. With a strong chin, her face was on the narrow side, but her milk-and-honey complexion and scattering of freckles set off her high cheekbones and intense green eyes. The soft lines etched in her forehead and at the edges of her lips suggested she was more experienced and older than the twenty-something rookie she first appeared to be. She glanced at me with a brief nod before turning her impassive gaze back to the victim.

Dev regarded me with uncharacteristic somberness. "You okay?"

"Could be worse." I cleared my throat and shrugged, fighting off the torrent of emotions. "It could have been me."

Dev chuckled softly, but I thought I caught a disapproving glance from his colleague.

As if to get out of Stanley's earshot we stepped out of the room and talked in the hallway, but the door remained open, leaving a clear view of the body. "Dr. Ashman, meet my new partner, Detective Claire Shepherd." Dev pointed from me to her. "Claire's just joined Homicide."

I stretched my hand out to her. "It's Joel."

"Nice to meet you, Joel." Claire met my hand with a firm handshake, but maybe because of my earlier remark, she didn't reciprocate my smile.

"Doc consults for Homicide," Dev explained in a Southern twang that more than twenty-five years of living in the Pacific Northwest hadn't masked. "Does our psychological profiling. Once in a while, he's useful."

"Stop gushing, Dev. You're embarrassing me."

Dev's smile faded. "Joel and the victim were friends," he said to Claire. "They used to share a practice."

Claire frowned and her green eyes widened sympathetically. "Oh, Joel, that's awful."

"Yeah," I said, breaking off eye contact.

"Hate to drag you down here so late." Dev cleared his throat. "I thought you could might give us an early lead on the investigation."

"I was up anyway," I said noncommittally.

The businesslike squint creasing Dev's forehead told me that we'd just moved beyond condolences. "Doc, what's your take on this?" He pointed at the carnage in the room.

I tried to focus—the crime scene is the chassis on which all psychological profiles are built—but the mix of feelings and memories clouded my assessment. All I could muster was: "It doesn't look like the work of someone who stumbled across Stanley while pulling a break-and-enter."

"No shit," Dev grunted.

"So how did he get in?" I asked, stalling.

"Smashed the glass by the entrance," Dev said. "Wasn't even the good stuff. This building has no alarm. Security around here is a joke."

"You don't know the half of it." I told them about the overly accessible garage, and the trouble we'd had with previous break-ins. Then I got back to his initial question. "The killer shot Stanley in the neck, and then went to the trouble of beating him badly enough to kill him twice over . . ."

Claire nodded without taking her eyes off the cadaver. "Overkill."

"Exactly," I said. "Pure rage! And I don't think we're talking about a jealous spouse or cheated business associate. It's even more irrational than that."

Dev nodded. "You're talking about one of his nut-job patients, aren't you?"

I wasn't in the mood to take issue with Dev's politically incorrect choice of terms. "You've got to consider his patients. Stanley worked with all comers."

Claire cocked her head. "How so?"

"Nowadays, most psychiatrists sub-specialize. Private practice, geriatrics, the institutionalized, forensic psychiatry, and so on. Not Stanley, he did it all. The man is—he was—a giant in the psychiatric community."

"Nobody jumps to mind, huh, Doc?" Dev asked.

I hesitated.

Dev picked up on my indecision. "Doc?"

I needed more time to sort it out in my head, so I said, "Divorced for years. No children. Did well, financially. And for the most part, he was well liked."

Eyes narrowed, Claire viewed me quizzically. "‘For the most part?'"

"His colleagues respected him," I said. "His patients could be another story."

"Oh?" Dev chewed his lip. "Why's that?"

"Stanley was interested in anger management. In fact, he was a pioneer in the field."

Dev thumbed at Stanley's pummeled corpse. "I think it's possible our killer has anger-management issues," he said dryly.

"And Stanley used to consult at Western State Hospital." I turned to Claire to explain. "That's where they keep violent offenders with psychiatric diagnoses. The so-called forensic psych patients."

Claire nodded politely, but it struck me that she would've known about Western State. I mentally kicked myself for coming across as condescending, and then wondered why I cared how I came across to her on this of all nights. "I used to work with those forensic patients, too," I said. "Believe me, you wouldn't want some of them bearing a grudge against you."

"We ought to find out if any of them have been released lately," Dev said.

Claire pointed at the violent tangle of Stanley's arms. "Joel, what about his hands and wrists?" she said. "What's the significance of that?"

"Sometimes you see bizarre positioning like that with ritual murders." I shrugged. "But the rest of the scene doesn't fit with ritual homicide."

Staring at Stanley's fractured wrists and crushed fingers, we lapsed into a brief silence. "I hope our perp left an easy trail," Dev finally sighed. "I can tell you already, we're looking at a long suspect list."

I gazed at the splatter on the wall that traced the path of Stanley's final tumble.

"You two were close, huh?" Dev rested his hand on my shoulder again.

Without taking my eyes off the wall, I nodded. "Over the years, we shared an office, a partnership, and a close friendship."

What I hadn't figured out how to tell them, yet, was that we'd once shared a patient. Technically, she was Stanley's patient first. Then she became mine. And remained so, up until the moment she plunged off the Aurora Bridge.

I first laid eyes on Angela Connor a year, almost to the day, before Stanley's murder. The night I met her, I was working my regular on-call shift at Swedish Hospital's Emergency Psychiatric Unit.

Watching the security guard unlock the door to Angela's quiet room, I wondered what awaited me on the other side. More often than not, people locked inside quiet rooms (desolate little spaces, designed to safely hold patients who were at risk to themselves or others) are anything but quiet. But when the guard opened the heavy door, I found Angela sitting silently on the mattress atop the bench built into the wall with her knees drawn and a blanket wrapped around her from the neck down. She didn't look at me as I approached. Even when I sat down at her feet at the edge of the bench, she stared straight ahead and rocked gently, as if still alone.

"Angela?"

No reply.

"Angela, I'm Dr. Ashman."

Still nothing.

"I'm a psychiatrist."

She grunted a laugh, but showed no sign of acknowledging me.

One of the wonderfully simple rules of the psychiatric interview is: If you have nothing useful to say, keep your mouth shut. I took advantage of the silence and studied my new patient, while she continued to ignore me.

Angela's short hair stood in disarray on her head. Her tired face bore no makeup, and her lips were cracked and bloody. In spite of her unkempt appearance, I could see she had striking features: high cheekbones, upturned nose, full mouth, blue-gray eyes, and short, jet-black hair. From looking at her chart, I knew that she was twenty-five, but if I hadn't seen it, I would have guessed younger.

After a couple of silent minutes, Angela finally blinked. "When can I leave?" she asked in a voice that was hoarse from having had the endotracheal tube of a ventilator recently pass through her vocal cords.

"Angela, do you understand what it means to be held here for evaluation?" I asked.

She shrugged. "Doesn't mean I have to talk to you."

True. According to state law, we can involuntarily hold anyone for seventy-two hours who we deem a potential danger to themselves or others. In that time, we can restrain, drug, force-feed, or even subject them to electroconvulsive therapy, but we can't force them to talk.

"Tell me, Angela, why amitriptyline? You're not even prescribed that."

Another shrug.

"Why not just swallow your prescription's worth of Fluquil?"

"Have you ever seen anyone die of a Fluquil overdose?" she asked.

"No."

She bundled the blanket tighter around her.

"But you're not dead," I pointed out.

"Not this time," she said. "They told me I came close."

"Very close," I agreed. If not for an astute ER physician, a ventilator, and an intravenous drip of sodium bicarbonate and potassium, no question, she would have died. But aside from a deep burn on her upper back—attributed to passing out too close to an electric baseboard heater—she'd survived her overdose physically unscathed.

"Do you plan to take another crack at it?" I asked.

Angela dropped her head into the blanket and sighed.

"What would you try the next time?"

"A gun? A rope? Carbon monoxide? What does it matter?"

"As you pointed out, some methods aren't that successful."

"I don't make two mistakes in a row," she said without looking up.

"What other mistakes have you made?"

"What a typical shrink's question!" She shook her head. Then, for the first time in fifteen minutes, she lifted her face to me, and her eyes challenged mine. "If you have to know, my last big mistake was talking to one of you."

Mentally filing the provocative comment to address later, when and if I could establish trust, I changed subjects. "Angela, where did you grow up?" Interview rule number two: When in doubt, go for the childhood.

"Here we go." She groaned and broke off the eye contact. "Let me make this easy for you. I grew up here in town, in an upper-middle-class, stable family. Daddy was a successful lawyer, Mom a housewife. Two siblings—an older sister and a younger brother. All in all, I was a happy, well-loved little girl." She paused, then added, as if as an afterthought, "Okay, Dad was fucking me from eleven on, which didn't help, but hey, no one's got the perfect childhood. Right?"

Accusations of incest don't shock me anymore, but I don't ever remember one being couched in the same context. I managed to keep the surprise off my face, sensing that no reaction was my best approach.

"High school was a breeze," she continued, as if she'd been describing a tediously routine upbringing. "No eating disorder. No drug or alcohol issues. Never was date-raped or anything. I went to college back east, Queens College, on a scholarship. Needed a break from the old man, you understand." Again, she looked up and challenged with her eyes. "Graduated summa cum laude. With my marks and Daddy's connections, I could've gone to law school anywhere, but I chose not to."

"How come?"

She dropped her eyes back to the blanket. "You're thinking it was because I didn't want to validate Daddy by following in his footsteps, right?"

"You don't know what I'm thinking."

She ran a hand through her short hair. "Chances are, you're thinking what a great fuck I would be."

This time I couldn't hide the surprise. "Where did that come from?"

"It's my life story. Men always want me. Truth be told, it's a blessing most of the time."

"What happened after college?" I asked, grabbing for a semblance of rapport.

Ignoring my question, she broke into a half-smile. "I don't mind you thinking about me like that. You're very cute in that intellectual way." Then the smile disappeared, and she added in a smaller voice: "Just don't hurt me, okay? I couldn't deal with that again."

With warning bells blaring inside my head, I rose from the bench. "Angela, I think it's best if I find you a female psychiatrist."

She said nothing until I reached the door. "I don't want another shrink."

"The fact is, Angela, you have to talk to someone."

"I want to talk to you . . . please, Dr. Ashman."

There was nothing special in the words, but something in her voice—a glimmer of vulnerability that I hadn't heard up to that point—struck me. I felt a sudden pang of sympathy for her. Or maybe, subconsciously I'd already noticed the glaring similarities between Angela and a girl from my childhood. Whatever the reason, I turned and walked back to her bed. "You've got to understand that my concerns for you are strictly on a professional level." I met her stare. "Am I clear?"

"Crystal." She nodded. "No more nasty talk."

"Okay, after college . . ."

"Oh, God." She rubbed her face in her hands. "Odd jobs. A couple of short-term relationships. One with a girl. But much as I like the concept of lesbianism, I'm just not wired that way . . ."

And so it went. Salvo. And countersalvo. I left the one-hour interview frustrated and exhausted, and not much enlightened for my effort. By the time I reached the back desk, Angela's old chart awaited me. She had only two previous psychiatric admissions; her most recent was a year earlier for a month-long stay at University Hospital. The faxed records reiterated what Angela had told me, but the University team had never found anyone to corroborate her incest story. Her discharge diagnosis read: "Major depression with suicidal ideation and probable BPD." I sighed when I read the initials that stood for borderline personality disorder. Exemplified by patients with unstable relationships, frequent suicide gestures, and hopeless responses to therapy, that three-letter acronym has the power to send a chill up a psychiatrist's spine. Mine, anyway.

Mulling over the interview as I scribbled notes, I realized Angela wasn't a typical suicidal patient. Putting aside the psychotic or the merely attention-seeking, people seen immediately following a genuine suicide attempt act remarkably similar. Most are either regretful about the failure of their attempt or indifferent to it. The depressed are easy to spot, because their mood is contagious; after five minutes with them, you begin to feel like stepping in front of a train.

But Angela exhibited neither the despair nor the indifference typical of the depressed. Even at the time of the interview, I had the feeling she was assessing me—deliberately baiting me and then judging my reactions—as much as I was her. I didn't have a handle on Angela, and that troubled me.

Much about Angela troubled me. As frank as she had been for a first interview, I knew I was just scratching the surface. But already I was convinced that Angela was a tortured soul. And it wasn't merely my professional opinion. From the moment I met her, Angela reminded me of Suzie, the girl who had inadvertently cut short my childhood.

I fought off a chill. And I wrote off the visceral sense of unease as simply the remnant of a sad memory.

I was so wrong.

Copyright © 2006 by Daniel Kalla