CHAPTER ONE
The first time I saw Heather Simeon, she was curled into a ball in the seclusion room at the hospital, a thin blue blanket tight around her, the bandages sharp white lines circling her wrists. Her blond hair obscured most of her face. Even then, she still gave off a sense of refinement, something in the high cheekbones barely visible through the veil of her hair, the beautifully arched brows, the patrician nose, the delicate outline of pale lips. Only her hands were a mess: the cuticles raw and bleeding, the nails jagged. They didn’t look bitten, they looked broken. Like her.
I’d already read her file and talked with the emergency psychiatrist who’d admitted her the night before, then gone over everything with the nurses, most of whom had worked in the Psychiatric Intensive Care unit for years, and who were also my best sources of information. I might spend fifteen minutes to an hour with each patient during my morning rounds, but the rest of the time I was at my office in the Mental Health building, treating patients who are out in the community. That’s why I like to bring a nurse with me when I first meet a patient, so we’re on the same page with the care plan. Michelle, a cheerful woman with curly blond hair and a wide smile, was with me now.
Heather’s husband had come home the night before to find her sprawled on the kitchen floor, the knife near her hand. When she was admitted to the hospital, she’d become agitated, crying and fighting the nurses. The emergency-room doctor ran a drug screen that came back clear, so she’d been given Ativan and placed in the seclusion room. She was under close observation on the monitor, and a nurse checked on her every fifteen minutes.
She’d been sleeping all night.
I knocked softly on the door frame. Heather rolled over and opened her eyes, blinked a few times. I stepped closer to the bed. She gazed up at me, licked her lips, which were dry and chapped, then swallowed. Her mouth parted as if she was going to say something, but only her breath escaped in a long sigh. Her eyes were dark blue.
“Good morning, Heather,” I said in my gentlest voice. “I’m Dr. Lavoie, the attending psychiatrist.” When I had my private practice up island, my patients called me Nadine. But since moving to Victoria to work at the hospital, I’d started using my title, had come to like the emotional distance—one of the reasons for my move in the first place. “Would you like some water?”
She was staring somewhere over my shoulder, her expression blank, devoid of sorrow or anger. She might not have succeeded in checking out physically, but she had definitely disappeared emotionally.
“I’d like to talk with you for a little bit if that’s okay.”
Her eyes skimmed past me, landing on Michelle. She pulled the blue blanket tight around her.
“Why…is she here?” Her voice was a whisper.
“Michelle? She’s one of our nurses.”
On the psychiatry floor, the doctors are generally in business casual, the nurses dressed more for comfort. Michelle tended to favor fun clothes, today a funky striped shirt with dark denim dress jeans. Unless you noticed the ID badge around her neck, you might not realize she was a nurse.
Heather’s body language was defensive, almost cringing under the blanket, her gaze flicking back and forth between us like a cornered animal’s. Michelle stepped back, but Heather still looked overwhelmed. Some patients felt ganged up on when we brought a nurse in with us.
I said, “Would you be more comfortable just talking to me?”
She gave a small nod as she worried a corner of her bandage with her teeth. Again, I was struck with the image of a wild animal trying to escape its bindings. I glanced at Michelle, signaling that it was okay for her to leave.
Michelle smiled at Heather.
“I’ll check on you later, honey. See if you need anything.”
I liked Michelle’s warmth with the patients, had noticed it before. She’d often sit and talk with them, even on her breaks. When the door closed behind her, I turned back to my patient.
“Can you tell me how old you are, Heather?”
She slowly said, “Thirty-five,” as she looked around, starting to become more aware of where she was. I saw the room through her eyes and felt bad for her: the small plastic window in the heavy metal door, the Plexiglas cover on the window with scratch marks down it like someone had tried to claw their way out—which someone had.
“And your name?” I said.
“Heather Duncan …” She shook her head, catching herself, but the movement was sluggish, delayed. “Simeon. My name now, it’s Simeon.”
I smiled. “Did you get married recently?”
“Yes.” Not yeah or uh-huh, but yes. She was educated, brought up to speak clearly. Her gaze focused on the heavy metal door. “Daniel…is he here?”
“He’s here, but I’d like to talk with you first. How long have you and Daniel been married?”
“Six months.”
“What do you do for a living, Heather?”
“I don’t do anything now, but I used to work in the store. We take care of the earth.”
I noticed her shift to present tense.
“Are you a landscaper?”
“It’s our job to tend and keep the land.”
I felt an uncomfortable flutter in my stomach about the phrase. It sounded familiar, and she’d also said it like she was reciting an expression she’d heard many times. She was repeating it, not speaking for herself.
“I heard you had a bad night,” I said. “Would you like to tell me what happened?”
“I don’t want to be here.”
“You’re in the hospital because you’ve been certified under the Mental Health Act. You tried to hurt yourself, and we don’t want that to happen again, so we’re going to help you get better.”
She pulled herself up into a sitting position, and I noticed how thin her arms were as she braced on the mattress, the veins popping. Her arms shook as if the effort of holding up her body up was exhausting.
“I just wanted it all to stop.” Her eyes filled with tears that weaved down her face, dripped off her nose. One landed on her arm. She stared at it as though she had no idea how it got there.
“What did you want to stop?”
“The bad thoughts. My baby—” Her voice caught and she flinched, gritting her teeth as though something had stabbed her deep inside.
“You had a miscarriage, Heather?” According to her file, she’d lost the baby a week ago, but I wanted to see if she would tell me more about it herself.
Another tear slid down and dropped onto her arm.
“I was three months along. I started bleeding …” She took a breath and let it out slowly through clenched teeth.
I paused, a beat of silence in honor of what she’d just told me, then said, very gently, “I’m sorry, Heather. That must have been very painful for you. It’s normal to have feelings of depression after losing a child, but we can help you manage your feelings so they aren’t so overwhelming. Your file said your doctor prescribed Effexor last year. Are you still taking it?”
“No.”
“When did you stop?”
“When I met Daniel.” I caught the slightly defensive tone and knew she felt guilty that she’d stopped taking the pills, ashamed that she needed them. People with depression often stop their medication when they fall in love, the endorphins creating their own natural antidepressant. Then real life kicks in.
“The first thing I’d like to do is put you back on the antidepressant.” My voice was casual: This isn’t a big deal. You’re okay. “We’ll start you off on a low dose and see how you do. Your file mentioned that you also went through a hard time a few years ago.” Her previous two suicide attempts had been with pills. She’d been found at the last second in each case, but now that Heather had progressed to more violent means, she might not be so lucky next time.
“You were referred to a psychologist. Are you still seeing him?”
She shook her head. “I didn’t like him. Daniel, is he okay?”
“The nurses said he stayed here all
night and only went home this morning to get some of your things. He’s back in the waiting area now.”
Heather frowned, her face worried. “He must be so tired.”
“I’m sure Daniel just wants you to get well. We’re here to help with that.”
Fresh tears made her eyes seem even bluer, like sapphires set in diamonds. She was so pale you could see every vein in her neck, but she was still hauntingly pretty. People often assume that beautiful people have no reason to be unhappy. It’s usually the complete opposite.
“I want Daniel,” she said. Her eyelids had begun to droop, the effort of talking draining what little energy she had left.
“I’m going to speak to him first, then we’ll see if we can arrange a little visit.” I wanted to get a sense of what kind of emotional shape he was in, so he didn’t make the situation worse.
“They can’t find me in here.” She said the words to the room as though she’d forgotten I was there and was just reassuring herself.
“Who are you afraid is going to find you?”
“I want them to leave us alone, but they just keep calling and calling.” She picked at her cuticles as she spoke, tearing at a small piece of flesh.
“Is someone bothering you?” Her file hadn’t said anything about paranoia or hallucinations, but psychosis is sometimes possible with severe depression, which Heather was clearly suffering from. But if she was also having problems with some people in her life, we needed to know about it.
She started to worry the bandage with her teeth again.
I said, “This is a safe environment—it’s a place for you to get better. We can bar anyone you don’t want to visit, and there’s a security guard on the floor at all times. No one can get to you.” If there was a real threat, I wanted to make sure Heather felt secure enough to tell me what was going on. If it was just paranoia, she still needed to feel protected, so we could begin to treat her.
“I’m not going back.” The last part was said as though she was warning herself. “They can’t make me.”
“Who can’t make you?”
She forced her eyes open, met mine with a flash of confused alarm. I could see her wondering what she’d just told me. Fear, and something else, something I couldn’t name yet, rolled off her body in thick waves, pressing into me. I fought the sudden urge to step back.
“I need to see Daniel.” Her head lolled forward, and her chin dropped onto her chest. “I’m so tired.”
“Why don’t you get some rest while I talk to your husband.”
She curled up under the blue blanket in the fetal position, her face to the wall, shaking even though the room was warm.
Her voice now barely a whisper, she said, “He sees everything.”
I paused at the door. “Who sees everything, Heather?”
She just pulled the blanket over her face.
When I walked into the visiting area, a tall man with dark hair leaped to his feet. Even unshaven, with shadows under his eyes and a rumpled dress shirt hanging outside faded jeans, Daniel was an attractive man. He was probably in his mid-forties, judging by the laugh lines around his eyes and mouth, but I had a feeling he was one of those men who grow even more handsome with age. Their child would have been lovely. I felt a wave of sorrow for them.
He strode toward me, a brown leather bomber jacket hanging over his arm and a knapsack hooked over his shoulder.
“How is she? Is she asking for me?” His voice cracked on the last word.
“Let’s go where we can talk privately, Mr. Simeon.” I led him down the hallway toward one of the interview rooms, skirting the janitor mopping the floor. I frowned when I noticed that the utility room behind him was unlocked and gaping, and made a mental note to mention it to the nurses.
“Call me Daniel, please. Can you tell me if she’s all right?”
“I’d say yes, considering. She’s having a hard time, but we’re doing everything in our power to help her. This is the best place for her right now.”
“There was so much blood …”
I felt bad for him, knowing what he was probably thinking: What if I’d come home ten minutes later? Why didn’t I see the signs? Families seem to fall into two categories: those that blame themselves and those that blame the patient. But they always need to blame someone.
“It must have been very upsetting to find her like that,” I said. “Is there anyone you can talk to? I’d be happy to suggest someone.”
A quick shake of his head. “I’m okay. I just want Heather to be safe.”
I thought about what Heather had just told me. Was someone harassing her? Or was his fear just related to what she had done?
“That’s what we want too.” I unlocked the heavy metal door to the interview room and waved Daniel into a chair.
He sat across from me. People might think that the ward would be decorated in soothing colors, a warm, nurturing environment, but the chairs, mismatched shades of pink, blue, and puce, have been there since the seventies. The desk was laminate, the edges cracked and peeling. A wood shelf stood against one wall with a few lonely books stacked haphazardly. Even the waiting area where he’d been sitting for so many hours was just a few chairs by the elevators. It’s an old hospital. But the funding isn’t there, and this isn’t meant to be a holiday.
“Did she tell you why she …” Daniel choked up, took a quick breath. “Why she tried to kill herself?”
“I can’t share anything Heather tells me without her permission. But I’d like to ask you some questions.”
“Sure, anything.”
“Did you know how depressed she’s been?”
He rubbed his chin, his face bleak.
“Since we lost the baby, she won’t eat or get out of bed. Most days she won’t even shower. I thought it was postpartum, or whatever it’s called, and she just needed some time…I keep thinking about how quiet she was when I left last night. I was late for work—I’ve been picking up odd jobs in the evening to make some extra cash—so I was in a rush.” He shook his head. “If I’d stayed with her …”
He was the type who blame themselves. I leaned forward.
“This isn’t your fault, Daniel. If you’d been there, she’d have waited until you weren’t and tried again. People as troubled as Heather always find a way.”
He looked at me—long enough, I hoped, for my words to sink in—then his face clouded over.
“Her parents are going to take this really hard.”
“They don’t know?”
“They’re on an RV trip in Northern BC. I tried to call, but they must be out of range. She hasn’t talked to them for a while.”
“What about her friends?”
“She never wanted to do anything with them, so they stopped phoning.”
I wasn’t surprised that Heather had pushed people away, except for Daniel. A classic symptom of depression was detaching from friends and family.
“What do you do for a living, Daniel?”
“I’m a carpenter.” That explained his build, and his deep tan. He smiled as he looked down at his rough hands. “Heather and I came from different worlds, but the minute we met, we had this instant connection, like on the deepest level. Neither of us had ever felt that way before.” He looked at me as if expecting skepticism.
I gave him an encouraging nod.
He continued. “She’d just gone through a breakup—her ex was a real jerk. But we started hiking and doing yoga together. It seemed to cheer her up.”
It had been a good idea on his part. Exercise is one of the best natural aids for depression.
“So you noticed some signs of depression before you got married?”
“I guess…She’s the kind of person who’s always trying to take care of everyone else, so it’s hard to tell sometimes. She’d get really quiet or start crying, but she wouldn’t want to worry me, so I wouldn’t know what she was upset about. But when she got pregnant, she was really happy about the baby, picking out names, buying toys …” His v
oice wavered. “I don’t know what to do about the baby’s room or all the clothes she bought.”
My mind flashed to Paul painting Lisa’s nursery strawberry red with apple green stripes because our child would be different, would skip to her own beat. Which she had, always—a trait I’d admired, until she danced away from me.
“Let’s take it one day at time,” I said, as much to myself as to him. “You can work all that out later.”
“When can Heather come home?”
“She’s been involuntarily admitted into the hospital so we can keep an eye on her. We can’t release her until she’s no longer a danger to herself.”
“What if she tries…you know.” He swallowed hard. “What if she tries to do it again?”
“We won’t let her here. And we won’t send her home until she’s stable and has a good support system in place.”
“Can I see her? I brought some of her things.”
Normally, we’re strict about visiting hours—they’re only from four to nine in PIC, where everyone has to be buzzed in and out. We don’t allow visitors before noon, so patients can attend programs, and we can make our rounds. But he looked desperate, and I thought seeing him might help Heather settle in.
“She’s resting right now, but you can say a quick hello.”
We didn’t talk as we rode up the elevator to Psychiatric Intensive Care on the next floor. Daniel seemed lost in thought, and I was busy counting my heartbeats while focusing on my breathing. I’ve suffered from claustrophobia for years, a fact that would probably shock my patients. Various coping techniques help, from mental imagery to breathing exercises, but when I first heard the elevator seal shut, I had to restrain myself from hitting the panic button.
We were buzzed into the unit. In PIC, the nurses’ station is behind glass, and a security guard is always at hand. One side of the unit is for high-risk patients like Heather, and the other is the step down unit, where they go when they don’t need the same level of monitoring. If they continue to improve, they are moved down to the next floor, where they have more freedom.
The nurse searched the bag Daniel had brought for Heather to make sure there wasn’t anything she could hurt herself with—the frame was removed from their wedding photograph, same with the tie from her robe. When the nurse was finished, I showed Daniel to an alcove in the lounge area, where they could have some privacy but still be in view, then went to get Heather.