The Silent Patient - Alex Michaelides Page 0,11

She didn’t look up. I studied her for a moment. Her face was expressionless, blank. A medicated mask. I wondered what lay beneath.

“I’m glad you agreed to see me.” I waited for a response. I knew there wouldn’t be one. “I have the advantage of knowing more about you than you do about me. Your reputation precedes you—your reputation as a painter, I mean. I’m a fan of your work.” No reaction. I shifted in my seat slightly. “I asked Professor Diomedes if we might talk, and he kindly arranged this meeting. Thank you for agreeing to it.”

I hesitated, hoping for an acknowledgment of some kind—a blink, a nod, a frown. Nothing came. I tried to guess what she was thinking. Perhaps she was too drugged up to think anything at all.

I thought of my old therapist, Ruth. What she would do? She used to say we are made up of different parts, some good, some bad, and that a healthy mind can tolerate this ambivalence and juggle both good and bad at the same time. Mental illness is precisely about a lack of this kind of integration—we end up losing contact with the unacceptable parts of ourselves. If I was to help Alicia, we would have to locate the parts she had hidden from herself, beyond the fringes of consciousness, and connect the various dots in her mental landscape. Only then could we put into context the terrible events of that night she killed her husband. It would be a slow, laborious process.

Normally when beginning with a patient, there is no sense of urgency, no predetermined therapeutic agenda. Normally we start with many months of talking. In an ideal world, Alicia would tell me about herself, her life, her childhood. I would listen, slowly building up a picture until it was complete enough for me to make accurate, helpful interpretations. In this case, there would be no talking. No listening. The information I needed would have to be gathered through nonverbal clues, such as my countertransference—the feelings Alicia engendered in me during the sessions—and whatever information I could gather from other sources.

In other words, I had set into motion a plan to help Alicia without actually knowing how to execute it. Now I had to deliver, not just to prove myself to Diomedes, but, far more important, to do my duty to Alicia: to help her.

Looking at her sitting opposite me, in a medicated haze, drool collecting around her mouth, fingers fluttering like dirty moths, I experienced a sudden and unexpected wrench of sadness. I felt desperately sorry for her, and those like her—for all of us, all the wounded and the lost.

Of course, I said none of this to her. Instead I did what Ruth would have done.

And we simply sat in silence.

CHAPTER EIGHT

I OPENED ALICIA’S FILE ON MY DESK. Diomedes had volunteered it: “You must read my notes. They will help you.”

I had no desire to wade through his notes; I already knew what Diomedes thought; I needed to find out what I thought. But nonetheless I accepted it politely.

“Thank you. That will be such a help.”

My office was small and sparsely furnished, tucked away at the back of the building, by the fire escape. I looked out the window. A little black bird was pecking at a patch of frozen grass on the ground outside, dispiritedly and without much hope.

I shivered. The room was freezing. The small radiator under the window was broken—Yuri said he’d try to get it fixed, but that my best bet was to talk to Stephanie or, failing that, bring it up in Community. I felt a sudden pang of empathy with Elif and her battle to get the broken pool cue replaced.

I looked through Alicia’s file without much expectation. The majority of the information I needed was in the online database. Diomedes, however, like a lot of older staff members, preferred to write his reports by hand and (ignoring Stephanie’s nagging requests to the contrary) continued to do so—hence the dog-eared file in front of me.

I flicked through Diomedes’s notes, ignoring his somewhat old-fashioned psychoanalytic interpretations, and focused on the nurses’ handover reports of Alicia’s day-to-day behavior. I read through those reports carefully. I wanted facts, figures, details—I needed to know exactly what I was getting into, what I’d have to deal with, and if any surprises were in store.

The file revealed little. When she was first admitted, Alicia slashed her wrists twice and self-harmed with whatever she could get her

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