VII

Going Along Together
by Frank Albrecht
Chapter 8

    "Allison is depressed," said Allison’s mother, Monica Huerta. She nodded toward her 13-year-old daughter, who slouched on the far end of Wolfe’s couch, a closed-off expression on her face. She stared indifferently but determinedly out the window.
    Tall for her age, chubby as if still carrying baby-fat, Allison had prominent eyebrows, straight black hair, and cream-in-your-coffee skin. Her plump cheeks, short chin, and broad forehead combined with large, dark eyes to made her look cute but not quite real, as if she were an Hispanic babydoll. Ponytail and bangs accentuated the impression. The unattractive short plaid skirt and bulky, long-sleeved white blouse required by her Catholic school, St. Mary’s, didn’t help things. She seemed entirely uninterested in whatever her mother and her new shrink might say about her.
    Wolfe watched her for a moment. She seemed not to notice. "Allison," he said finally, "do you think you are depressed?"
    She flicked her eyes at him for about a millisecond. "Yeah, whatever," she responded.
    "Allison," said her mother, her voice on edge.
    The girl looked at her mother. Nothing much seemed to happen but Allison looked back to Wolfe, this time for a good half second. "I am depressed," she said in a flat, uninvolved tone, and looked away again. As she spoke her lack of interest seemed to grow from supreme to monumental. It pervaded the room.
    Monica looked disapprovingly at her daughter. She was a slight, pale skinned, dishwater blond non-Hispanic-looking white woman wearing what Wolfe’s mother would have called a "going to town" dress. High neck, calf length skirt, three-quarter sleeves, belt, no frills or fancy features, not flashy enough for a party but too "good" for a house dress. With this dress the woman wore carefully subdued makeup and pale pink nail polish. She sat up very straight on the couch next to her daughter.
    "Allison was brought up with better manners than this," she said to Wolfe. He muttered sympathetically and asked for more information.
    About eight months previously, in June or July, Allison had started showing what her mother called "this bad attitude." Normally active, always on-the go, she had become quiet and moody. She lost interest in going out with her friends and stayed in her room most of the time, listening to music or watching TV. When the family went sailing she refused to go with them. The previous year she’d been an enthusiastic participant on field hockey and softball teams but this year she hadn’t even tried out for them. "She’s lost interest in everything," the mother concluded.
    Allison looked around abruptly. "I’m interested," she said to her mother. "I keep telling you that. But I don’t feel like doing it"
    "Oh, darling," Monica said, making a sad face. "Can’t you see that’s just an excuse?"
    Allison’s face seemed set in stone, an angry mask. She looked away.
    "Last year," Monica resumed, sadly, "Allison had perfect attendance at school, and she had all A's."
    In a contemptuous tone, without looking around, Allison murmured, "I got a B in music."
    Her mother stared at her and kept talking. "This year she’ll make up any excuse to stay home. And she’s so ingenuous about it!" She learned a little toward her daughter and put her hand on her thigh. "Really, darling," she said, "if you’d put as much cleverness into doing your work as in getting out of it, you’d be doing fine." Allison did not move a muscle. After a moment Monica straightened, withdrew her hand, looked around at again at Wolfe. "She’s flunking everything," she said in an almost conspiratorial whisper.
    All this seemed pretty standard—depressed teens often feel angry rather than sad. Frequently their behavior is aggressively hostile. The stark contrast between mother and daughter in skin tone and hair color was unusual, but Wolfe already knew about that, because he had a superficial, chatting-on-the-dock acquaintance with Allison’s black-haired, brown-skinned father, Angel Huerta.
    Of Puerto Rican descent with a Ph.D. from MIT, Huerta worked for the National Security Agency, a hush-hush electronic spying outfit operating out of nearby Fort Meade. He was said to be an electronic genius. He also seemed to be well off, owning a large house in the historic district and a boat bigger than Wolfe’s. Wolfe had often heard that Angel had a WASP wife who had inherited money but he had not met her before.
    Wolfe asked Monica to leave him alone with her daughter. She looked relieved and removed herself to the waiting room.
    Allison sat unmoving, looking away, her body tensed against attack.
    "Apparently something is wrong with you," Wolfe said to her.
    "No duh," the girl responded, still apparently fascinated by the sky outside his window.
    "I wonder," he asked her, "if we could talk about what that is without using the words ‘depressed’ or ‘depression.’?"
    She shrugged a shoulder, just enough that he could see it. Her eyes didn’t move at all.
    "You didn’t get into sports this year, " he went on, "because you ‘don’t feel like doing it.’ Is that right?"
    Another indifferent shrug.
    "Could you tell me more about that?" he asked. "Explain it a little."
    She almost smiled, though still she didn’t move. "Which word in the sentence, ‘I don’t feel like doing it,’ don’t you understand?" she asked him.
    "’Feel like,’" he said calmly. "I don’t understand what you mean by ‘feel like’."
    That brought her head around. She stared at him angrily. "Are you stupid"" she asked. "I don’t feel like it. What’s to explain?"
    "Feeling like doing something, or not feeling like it, those are ways you are inside yourself," he told her. "But the words can mean different things. You can not feel like doing something because you don’t like it, or because you want to do something else, or because you’re tired or in a bad mood. So when you don’t feel like playing softball, what is that like inside yourself?"
    As he spoke she had looked away again. But something in her face seemed more neutral than it had been. She didn’t speak so he went on.
    "Is it red, yellow, green, or black?" he asked "Is it big or little? Where inside you do you does it not feel like playing softball—behind your eyes, in your chest or belly, in your butt or your big toe? Where?"
    She looked back and almost smiled. "Well it’s not in my butt," she said.
    "So where?"
    She thought about it. "Everywhere," she said finally. "Like when I try to do something I get weak. Sometimes I get weak just thinking about doing something."
    "Weak?" he asked. "What kind of weak?"
        Her tone was now almost conversational. "I get dizzy. Or my legs don’t work right. I can feel my heart banging."
    These are not standard symptoms of depression. Maybe anxiety, he thought.
    "Do you feel scared when your heart goes fast like that?"
    "No," she said, as if surprised at the idea.
    "Do you get short of breath when your heart goes like that?"
    She looked thoughtful. "Sometimes I get short of breath going up a flight of stairs, unless I go real slow" she said. "But not just if my heart is going fast."
    This is how you stumble on the possibility that someone has Chronic Fatigue Syndrome. You fall over it when you’re expecting something else.
    Wolfe was silent a minute, looking at her. She was staring off to the side again but without the same rigid posture as before. She seemed to droop, like a wilted flower.
    "You don’t really think you’re depressed, do you?" he asked.
    She glared at him in sudden anger. "I’m not sad! I don’t cry much. I care. I’m not upset about anything. I don’t have problems with my friends. School’s all right, or it was till this happened. I want to do things. Once in a while I think about killing myself, but only because I feel so shitty all the time. Dr. Orris keeps asking me about those things and I keep saying no, no, no, I don’t have those things, I don’t have problems! Except I feel so bad. Why can’t anybody just accept that?" Suddenly she had tears in her eyes but her face was still stiff with anger. "Well fuck them," she said. "Fuck all of them, all those fucking doctors. I don’t care anymore what they think." She paused for breath and her gaze on him sharpened. "Fuck you, too," she added with enormous intensity. "Fuck whatever you think, just fuck it!" Twisting her body away from him and staring down at the floor, she crossed her arms in front of her chest, as if embracing herself, and became motionless again. Her tears dried and her face was like stone.
    "Well," Wolfe said slowly, rather tentatively, "I don’t think you’re depressed."
    For a moment she didn’t move. Then she raised her head a fraction of an inch. She was listening.
    "I think you might have a physical illness," Wolfe said. "It’s called Chronic Fatigue Syndrome. Did you ever hear of that?"
    She shook her head for "No."
    "I need to ask you some questions, to check on my suspicions. OK?"
    She nodded slightly.
    He kept a checklist in the coffee table drawer. He got it out and ran though it. She told him that her pediatrician, Dr. Orris, had done a number of tests—thyroid, sugar, she didn’t know what all. But apparently he had found nothing. Allison told him she had never before in her life tired easily, or felt too weak to do things she wanted to do. She estimated she was only about 30 percent as active as previously. She was better some days than others but always felt dragged out when she woke up in the morning, no matter how well she slept. It did not help her to rest for several hours when feeling especially tired or weak. She had a persistent sore throat, usually had a slightly elevated temperature, had sore lymph nodes at the base of her throat, had frequent headaches, had muscle aches that were like having the flu. None of these things had been a problem before the previous summer. All her symptoms would get much worse if she tried to exercise, or even if she walked a lot, such as around a mall. Usually she slept poorly, she often had trouble concentrating or remembering simple things, and bright light hurt her eyes. Heat made her dizzy or very tired, so she never took hot showers anymore. If she stood up for very long her legs would get purple. Wolfe had her stand several minutes and watched that happen.
    By the time he had finished the checklist she was looking at him with a friendly expression. "I keep telling Dr. Orris about these things," she said. Dr. Orris was a local pediatrician. "He just looks at me and doesn’t say anything. I think he thinks he like to complain."
    "Do you?"
    "I hate to complain. Every time I say anything everybody thinks I’m crazy!"
    "Are you?"
    "Am I crazy? Are you asking me?"
    "Yeah. Are you?"
    "No!" she exclaimed.
    "You’re sure about that?" he insisted. "You couldn’t be making a mistake about it, could you?"
    "Yes I’m sure!!" she almost shouted at him. But she was laughing.
    "If I was crazy," she added, "would I admit it?"
    "I don’t know. Would you?"
    "Stop that," she giggled. "It’s question with a question. It’s not fair."
    "Who told you…" he started and then paused.
    "That life is fair?" she finished for him, giggling again.
    He smiled at her and went out to the waiting room to get her mother back into the room. As she came in, Monica glanced curiously at her daughter’s changed posture and facial expression. She listened without comment to what Wolfe had to say. When he had finished all she said was, "Doctor, may I speak to you alone for a moment?"
    He glanced at Allison, who shrugged an indifferent shoulder. "No problem," she mumbled. But at the door, out of her mother’s range of vision, she paused and looked back, giving him a conspiratorial look and a little smile of shared secrets. "Now you’re going to find out something I know but you don’t," the look seemed to say.
    "I don’t approve of what you are doing," Monica told him when Allison had left.
    "Excuse me?" he said.
    "You’re pretending to agree with her fantasy that she is ill," she said, "in order to gain her confidence. I don’t believe you should do that."
    "Ah," he said.
    Monica probably thought that expression was of surprise at having his stratagem so easily discovered. In reality it emerged from him as a muted cry of horror. There was a crazy person in this family after all! But it wasn’t Allison!
    "I believe it is best to be honest with people about their problems," she went on.
    Now there was a theme calculated to set him right off his rocker! Monica and Ann must know each other, he suddenly thought!
    "But in addition," Monica continued, "this ‘chronic’ something is unacceptable. Allison cannot have anything chronic."
    "Why not?" he asked.
    "Because she must get better," the woman answered.
    "Ah," he said again. He had a feeling he had met his match and was about to go down for the count.
    "We have a social position," Monica continued. "We have obligations. And Allison has a future! She’s going to be a physician. Did I tell you she made straight A’s last year?"
    "Ah," he said again. But he nodded. He tried to smile encouragingly.
    "I’m sure she’ll be able to get into Wellesley," Monica added, her proprietary tone letting him know how important that was. Monica must have gone there herself, Wolfe thought.
    "So she must get better!" the woman concluded. "Surely you can see that?"
    He closed his eyes and tried to look greatly pained and very sad. After a few seconds he reopened his orbs and stared intently into Monica’s own baby blues.
    "If you want me to treat your daughter," he said in a very definitive tone, "you have to let me do it in my own way."
    She looked at him reflectively. "You do come most highly recommended," she commented.
    Wolfe thought her tone was the same she might have used about a brand of soap.
    "Please do as I have suggested," he told her firmly. "Take her back to her doctor with what I have told you. I will talk to him about it also."
    "But surely she should see you too," said the mother.
    "Oh yes," he said. "Bring her back next week. She definitely needs my help."
    A bright, sensible girl living with this mother—and God knows what her father was like under his veneer of spooky success. Of course she needed his help!
    Orris was an old-school pediatrician who was getting close to retirement age. He was easy to get along with but hard to influence. "I don’t believe in that condition," he told Wolfe when he brought up Chronic Fatigue Syndrome.
    "The Centers for Disease Control believe in it," Wolfe responded.
    "They seem to think it might be important."
    "So’s the tooth fairy," Orris responded. "That doesn’t make it real."
    "I think Allison meets the published criteria for it," he insisted.
    "Where’s that?" he asked.
    "Annals of Internal Medicine, volume hundred and eight, 1988, page 387."
    "All right I’ll look at it." Wolfe waited while the physician made a note. "What do you want me to do about it?"
    "Take it seriously. Look for symptomatic treatments."
    "The girl’s depressed. Treatment resistant. I tried stuff. The new meds, everything. Nothing works."
    "Let me worry about the depression. Just take her physical symptoms seriously."
    "I’m not going to take acting lessons. I say what I think."
    "I understand that."
    "I do feel sorry for her," Orris concluded. "Her mother’s nuts."
    "My mother’s nuts," Allison told him next week.
    "Whenever I get bad," the girl went on, "she gets upset. She goes around banging doors and yelling at people. It really gets on my nerves. Like it’s my job to act healthy so she can feel good!"
    "Do you know other people who have this thing?" she asked him at the end of the session.
    "Sure."
    "Could I meet one? Maybe then I wouldn’t feel it’s me by myself against the world."
    "Sure," he said again. He was thinking of Barbara.
    You really shouldn’t introduce your teenage client (or any other client) to your sort-of girl friend. It makes for problems. But this did seem a good way to provide Allison some help.
    He got Allison’s mother’s permission by talking about how Barbara was "a high level financial executive" in spite of having the same illness as Allison. At the end of his next session with the girl Barbara came in and was introduced. After some chitchat Barbara took Allison out to lunch. They loved each other.
    "She’s just wonderful!" Barbara exclaimed to him that night on the phone. "She’s so sick, so tough about it, so brave, so sensible—and bright and beautiful too. How did you find such a lovely person?"
"I found you, didn’t I?"
    "Aw shucks, Mister. I bet you say that to all the sickies."
    "I like her so much!" Allison said during their next session. "She understands. She’s just like me except she knows how to win. And she’s so pretty, too. Gee!"
    "You’re in love with her, aren’t you?" the girl added.
    Wolfe’s heart thumped! "We’re friends," he said, trying to demur.
    "I saw how you looked at her."
    "Look," he said, "this is not about me."
    "Unnh, hunn. But you’re married to someone else, aren’t you?"
    "Not your business," he told her.
    "Oh right!" the girl said. "But I bet Barbara will tell me."
    "Don’t tell her," he said to Barbara on the phone later that day.
    "I’ll try," was the best he could get out of her. She and Allison were already thick as thieves, e-mails back and forth, on the phone to each other, having more lunches, finally spending a day together.
    "She helped me clean the house," Barbara explained. "That was a sight—two sick and tired people trying to mop and scrub!"
    One day Barbara had lunch with Monica.
    "You did WHAT!" Wolfe almost shouted into the phone when Barbara told him that.
    "I took her to lunch at the Crate. Is there something wrong with that?"
    The Crate was an upscale lunch and catering place on West Street just above Church Circle. They had politically correct (and delicious) sandwiches and salads.
    "There’s nothing wrong with the Crate," he said. "But that woman is a danger."
    "Trust me, Pie. I pulled her fangs."
    "You don’t understand," he protested. "This is getting all mixed up. Allison is a client. You are my friend, but more than that. And we’re married. This could get very confusing for Allison. Plus I’m sure Monica and Ann know each other."
    "Actually, she mentioned how much she likes your wife," Barbara told him.
    "OhUnh," Wolfe muttered. He felt ill.
    "And you’re right," Barbara went on. "The situation is is very confusing to Allisson. So I told her the whole story."
    "You WHAT!!!" This time he did shout.
    "It’s all right. She understands it now."
    "Did you tell Monica all about it too?!"
    Annapolis is a small town. Gossip gets around like wildfire. He knew thirty or more people who knew Angel. Even if Monica and Ann hadn’t know each other they would have had dozens of mutual acquaintances.
    Barbara responded in her "Dr. Wolfe" tone. "Really," she said, "do you think I’m a fool? All I did with Monica was wear my five hundred dollar suit, carry my two hundred dollar handbag, and gush a lot about Allison’s brain power."
    "The object being…?"
    "The object being to make Monica think that CFS is respectable, okay for her girl to have. If I own all this stuff, Allison can too."
    "This is devious," he said.
    "Oh, Pie, for heaven’s sake! How do you think things get done in this world—by reasoning with people!!??"
    Actually, he did think that.
    But he wasn’t like Ann. He thought shooting people was all right, too, if they deserved it. And just then he felt like shooting Barbara! This was impossible. His client, Allison, was now involved in his personal life, so his relationship with her was fatally skewed. He should refer her to another therapist. But he couldn’t do that because he didn’t know of anyone else who would understand Chronic Fatigue Syndrome and continue to protect Allison from her mother by pretending to treat her for depression.
    Besides, if he got rid of Allison Barbara would probably shoot him!
    This conversation with Barbara happened late on a Wednesday afternoon in summer. Later that day Wolfe broke off brooding about it and went down to Annapolis Harbor, to the Yacht Club, because he had promised Dickie Johnson he’d crew for him that day in the Wednesday Night Races. Dickie had a C&C32 and often called on Wolfe when he was short a man. Wolfe wasn’t much of a racer but it was fun for him to crew from time and time. He learned a lot that way too.
    He was still roiled about Allison, Monica, and Barbara when arrived on the docks where Dickie was tied up. His mood was muddy, unclear, stirred up. And there, standing on Dickie’s foredeck, was Angel Huerta—said to be a good man with a spinnaker. Seeing him sent Wolfe’s unsettled feelings halfway to the South Pole.
    There were seven in the crew—Dickie, his wife, Angel, Wolfe, Joe somebody who taught at the sailing school, Joe’s girl friend, and a college students from somewhere. This was more than needed if it was going to be light air, which is what it looked liked. But it never hurts to have extra ballast. And Dickie didn’t really care if he won. He liked racing, the experience, and if he placed well all the better. They shook hands all around and Dickie motored out toward the start line. Wolfe was a winch grinder and stayed out of the way, avoiding Angel. He hated being on a boat with someone from a client’s family—there’s no convenient escape when confidences or questions loom. Being stuck with Allison’s father on that particular day seemed just too much.
    "I’ve got to refer her to someone," he decided. "I can’t do this."
    It was typical summer weather on the Chesapeake. There’d been a decent little breeze during the morning. Midday had been flat calm. In the late afternoon enough air stirred to kick up a few whitecaps. But now, with the sun low, the wind fell off to shifty puffs here and there, pushing catspaws over otherwise smooth water. Reaching or going upwind in these conditions you have to work hard to catch every little puff just right. So you’re at your station, on edge every second. But downwind there’s nothing to do but set the sails and wait. You ghost along at a knot or less, tempted to start blowing your own breath onto the sails, anything to keep them from hanging so limp. Then some air stirs the water around you, the sails lift, you hear water gurgling around the hull as you accelerate up to two or more knots, you feel like you’re boiling along—for a few seconds. Then the breeze dies and you glide silently again. Sometimes you stop altogether. You’re dead in the water, you can’t even keep the boat headed correctly because there’s no movement past the rudder to steer with. If that goes on too long the race is called. But usually that doesn’t happen. These are fast boats with a lot of sail, designed to race in light air. It doesn’t take much to move them.
    Meanwhile, though, caught in the calm, there’s nothing to do but watch the water and sit waiting. You’ve got ten to twenty boats drifting around, going nowhere, nothing to disturb them but engine noise and wakes from passing stinkpots. So people talk.
    Angel settled next to Wolfe. "I understand you’re seeing my daughter," he says.
    Wolfe glanced at him, gave him a minimal nod.
    There were three big sailboats within twenty feet of them, each with several crew aboard, plus their own crew. Here and there on the boats people were talking, plus there was powerboat noise in the background. In spite of this covering racket twenty or so people would be able hear anything they said, if they cared to listen.
    "My wife’s not too happy about it," Angel says, persisting.
    "Me neither," Wolfe wanted to say but didn’t. He glanced again at Angel.
    "How it’s going, I mean," the man added. "She’s happy enough with you but she can’t see how it’s getting anything done. Allison’s not much better, she says."
    Wolfe nodded, reluctantly. He smiled so Angel wouldn’t think he felt insulted.
    "She says if things aren’t better when school starts again she’s just going to keep her home."
    Wolfe looked at him in surprise. "Keep her home?"
    "Put her on home teaching, not let her go out at all till she gets it through her head she can’t be like this. You know, lock her up till she makes more of an effort."
    Wolfe stared out at nearby boat. People on it were drinking beer and not even looking at their sails. They’d given up, he thought. It was twilight with just the upper limb of the sun peeking over the horizon, but it was hot and muggy and there was no breeze.
    "I wouldn’t advise that," Wolfe said, finally.
    Angel made a face, shrugged. "A woman with her daughter… you have to let her do what she thinks best." Wolfe didn’t say anything. "With my son, now," Angel added, "I decide. But the daughters, that's for her."
    "Is that a Puerto Rican thing," Wolfe asked, "to see it that way?"
    Angel looked surprised. "I don’t know. I never heard that. It just seems obvious. Don’t you think so?"
    Wolfe shook his head. He didn’t say anything. He looked at the nearby boat again. Nothing had changed. Anyone looking at Wolfe would have seen no change either. But on the inside he was fighting memories of a teenager locked up.
    "My great aunt had this," Angel said. Wolfe looked around, interested. "I didn’t know her very well because she only spoke Spanish and my own Spanish was not so great, even back there when I heard it some in my family. But you could see with your own eyes, she couldn’t do much. They said she was always tired. ‘La fatiga’ people called it. Like it was a definite thing, you know?"
    "You tell your wife about that?"
    "Yeah, but she says it’s not the same. She says this is alienation. I ‘m not sure what she means by that but she says you get over it if you want to."
    "What do you think about that?"
    He shrugged. "I don’t know. I’m a science guy. I understand electrons pretty good but that’s about as far as I go. This stuff you do, I don’t get much of it."
    A cats paw was ruffling the water thirty yards off their stern. Behind that there was flat silvery looking water but further off a large stretch of water looked darker. This meant its even surface was being stirred by steadily moving air. An evening breeze was coming up.
    Suddenly their sails filled. The shrouds creaked from sudden pressure. In the boat next to them the crew down put their beers. Angel moved off toward the foredeck, light-footed but slowly, helping keep the boat in trim. Water gurgled happily around the bow and they moved off.
    The next day he phoned Orris. "I want you to give Allison a trial of Ritalin," he said.
    "Hmmf. What for? She doesn’t have ADD."
    ADD is Attention Deficit Disorder. Ritalin and other amphetamines are used to help people with this problem of keeping their attention on what they are doing.
    "I know she doesn’t," Wolfe assured him. "But she does lack energy and have problems keeping her mind on things."
    "Oh, come on Wolfe. I can’t put people on stimulants just because they’re gathering wool."
    "Suppose she is depressed. That’s what you really think, isn’t it? Then it would be all right."
    "Ritalin for depression? Who told you that?"
    "I can send you literature on it. Amphetamines are often used for depression that doesn’t respond to other treatments. That’s actually the oldest drug treatment there is for depression."
    "Hummf. All right, I remember that now, from med school. But I never did it. Back then kids didn’t get depressed so we pediatricians didn’t have to worry about it."
    "We didn’t know they got depressed. But they did. Not so often, maybe."
    "Let me get this straight, now," Orris said. "You don’t think this girl is depressed, but because I do think that you want me to treat her for it with an odd choice of medication. Is that about right?"
    "Ah… I wouldn’t put it just that way."
    "No doubt."
    "It just might work," Wolfe pleaded, "at least well enough for her to succeed in school. I’ve heard of cases of adults with CFS who were able to keep their jobs that way. And if you think she’s depressed it’s logical for you to try it."
    "You think it’s logical for me to try it. And where did you get your medical license, by the way?"
    "George, please, give it a shot. If it helps it will help right away. And I’ll keep a close eye on her."
    "You will indeed. Very close. And if you stop seeing her, you will let me know so I can stop giving her that stuff. I don’t care what the hell good it’s doing her, you keep seeing her or I cut it off. You hear me?"
    "I hear you. I’ll be right there."
    If the Ritalin worked Allison would be better in school. That would pacify Monica, at least enough that she wouldn’t close her daughter up in the house. But he felt like Br’er Rabbit, who got his hand stuck to the tarbaby so he tried to push it away with his other hand. Now both hands were stuck to it! So he kicked it—and got his foot stuck too. On and on he went, making his plight worse and worse. Ritalin was one more kick to Wolfe’s own tar baby—if it worked.
    And if it didn’t he’d have to find something that did!
    "I am NOT taking that stuff!" Allison told him when he mentioned the Ritalin.
    "Why not?"
    "That’s for bad little boys. I’m not touching it."
    "There are lots of quiet girls who take the same thing. You just don’t know about it."
    "NO!!!!"
    It was a reputation thing. Ritalin doesn’t stay in the body very long so to get through a school day on it you have to take a dose around lunchtime. That means going to the nurse to get the pill, which in turn means everyone knows what you are taking.
    Allison finally admitted that she did know some girls who took Ritalin.
    "So?" he said. "What’s your beef?"
    "They get teased."
    "What would you rather do, flunk or get teased?."
    "Flunk!"
    She wouldn’t budge from that position. Getting teased was social death. She’d rather have rabies.
    "If I felt better," she said, "no one would mess with me. Anybody who opened their mouth I’d paste them right in the chops, they know that. But like now I can’t defend myself."
    Talking like that with the face of an angel!
    Flunking is serious," he said. "Even poor grades—there are consequences."
    She knew what her mother planned to do if her work didn’t improve, but she remained defiant.
    "I DON’T CARE!" she shouted at him. "Is this a complicated message? Do you need help understanding it? I DONT’T CARE AND I WON’T TAKE YOUR CRAPPY PILLS."
    Ahhhhhggg!! Teenagers, bah!
    He phoned Orris. "I wonder if you could try Allison on Dexedrine instead of Ritalin?" he said to him.
    This question produced unpleasant silence from the other end of the line.
    "Dex can be given once a day," he explained. "So she wouldn’t have to go to the school nurse and have everybody know she takes it."
    "I hear that crap all the time," Orris growled. "Kids are embarrassed, parents are embarrassed. Too bad. Ritalin is what they get, unless they can’t tolerate it. If they won’t take it for some kind of silly-ass reason they can suffer the consequences."
    Wolfe finally worked out an arrangement by which Allison would take a morning dose for two weeks, after which he and Monica would survey her morning and afternoon teachers about her performance. Then they would plan the next step.
    Wolfe had an afternoon appointment with Allison half way through her first week on the medicine. She came by herself after riding the West Street bus from school.
    "I feel like shit," she said, throwing herself and her book bag onto the couch. She was dull-eyed and her legs, bare as required by the school uniform, were heavily mottled.
    "How are you in the morning?"
    "I feel like crap in the morning, too. But I can do stuff. And my legs don’t get like this. I do all right. In the afternoon I’m a waste."
    "So the medicine does help?"
    "Yeah-boy! But now… Christ, I think I’m going to die." She had her feet up on the coffee table. She twisted sideways and sprawled her upper body down onto the seat, so she was lying on her side with her legs stuck out in front of her onto the table.
    "Well," he said, trying to be very tactful, "what do you want to do about that?"
    "Take the pill at noon. Maybe after school too, if I have homework."
    "Ah," he said, relieved at her matter-of-fact surrender.
    "Not the way you think, though, from the nurse." she added.
    "What else can you do?"
    She looked at him like he was stupid. "I’ll get my own and take it when no one’s looking."
    "Oh come on," he said, "where are you going to get your own Ritalin?"
    "I’ll buy it."
    "You can’t buy Ritalin!"
    This got him the stupid look again. "What town do you live in? There’s probably five guys down on city dock who sell it for fifty cents a pill. Well, not on the dock, really. They hang out around the market and like along the sidewalk near Riordens. And there’s a boy at school who never takes his. He fakes it. He’ll give you whatever he has if you let him feel you up."
    "Feel your breasts?"
    "Well, them too. That’s not his top choice."
    "Ugg. That’s disgusting."
    "I think it’s funny. I mean, what’s the big deal?"
    Now he felt suspicious. "How do you know he’ll do that, Allison!?"
    "Because he told me so, Pie!" she came back.
    "Pie?! Who told you that name?"
    She looked not abashed at all. "Barbara said I shouldn’t call you that," she admitted. "She thinks I should be respectful and call you Doctor Pie."
    He tilted his chin up and rolled his eyes, stared dolefully at the ceiling. Giving him such a hard time was making her smile a little. She was still splayed out in her awkward-looking position and her legs were still purple, but her eyes had some life in them.
    "Look," he said after a moment. "This doesn’t make sense. You need this stuff but you can’t be giving out sexual favors for it or stealing money from your mother for it either. We can get it legal, you just have to take it from the nurse."
    "I’m NOT doing that."
    "You’ll buy it on the dock? Seriously?"
    "Sure."
    "With what? Are you rich all of the sudden?"
    "Do you spend your time on Mars?" she asked, giving him a look that should be reserved for a particularly backward species of insect. "Mother hands out twenties as if they were M&Ms. She gave me two the other day but I said it wasn’t enough so she gave me two more. She doesn’t want us ever to feel deprived, she says."
    "Listen to me, Allison," Wolfe said. "You haven’t thought this out. If you get caught buying dope you could get arrested. Or at least they’d tell your mother about it. And if you get caught in school you’d be expelled."
    "I don’t like that school anyway. I want to go to Annapolis." Annapolis Senior High School, she meant.
    "You’d rather get expelled than teased?"
    "You got it, Bubba."
    "I really think your values are distorted," he told her.
    "When I’m your age," she told him calmly, "I can have ‘good’ values like you do. But right now I have my own values and I like them just fine, thank you very much. Pie!"
    He needed another approach. Taking a deep breath he said, "I’ll have to talk to your mother about this," he said.
    She sat up and shouted at him. "YOU CAN’T TELL MY MOTHER ABOUT THIS STUFF!!!"
    "Hey, calm down. I don’t mean about buying drugs on the street or about that boy wanting to touch your… " He stopped myself to search for a delicate word.
    "My pussy," she filled in.
    He shuddered. "You shouldn’t say that," he said.
    "It’s an English word," she responded. "What’s wrong with it. Pussy. PUSSY!"
    "You’re too young to talk like that."
    "Oh, come ON!"
    He closed his eyes, shuddered again, opened his eyes again, peered at her as calmly as he could.
    "You know how to get me," he said.
    "Adults go ape-shit when a kid says something dirty," she responded. "It never fails." She lay back down, this time flat on her back with her feet up on the arm of the couch. "It’s kind-a fun to get you going. But my parents…! If I talk like this to Mother she gets evil and if it’s my Dad he looks at me like I’m proposing a puzzle or something. I end up feeling like a math problem."
    "I’m glad I’m such fun for you," Wolfe told her. "But I still have to talk with your mother about getting you to take pills from the nurse."
    "I don’t like you to talk with my mother!"
    "Sometimes I have to. You’re a kid and she is your mother!"
    "I don’t care if she’s Tinkerbell, what we talk about is none of her business."
    "I still have to."
    "Then don’t think it will do you the slightest good. Because it won’t. I’m not taking pills from that airhead nurse. So you might as well skip it"
    "I have to talk with your mother," he kept insisting.
    But he didn’t. He told Barbara, who worked it out. Scandalously!
    Barbara went to her own doctor and told him she herself needed Ritalin.
    "Didn’t we try that before?" he asked her.
    "I think it might help now," she told him blandly.
    He wasn’t worried about her abusing anything and he was used to her trying all kinds of things she’d read about or discussed with someone online or had had recommended to her by a specialist. So he nodded agreeably and wrote her a script—three scripts, in fact, postdated at thirty-day intervals. The federal drug agencies rightly consider Ritalin a dangerous and highly addictive drug, so they allow only a one-month supply to be given at a time. Doctors often get around the bother of writing a script every month by writing several at once, dating them 30 days apart.
    Barbara filled each script when it came due and gave the pills to Monica. Monica put them into a pill bottle with Allison’s name on it and gave the bottle to Allison, who hid it in a zippered pocket deep inside her handbag.. She had sworn to her mother, on an actual Bible, and also had promised Barbara, that she would open this portion of her purse only while seated in a toilet stall with the door closed. After lunch every school day she peed, or pretended to pee, and took her pill washed down with spit.
    Meanwhile she and Monica told Dr. Orris that the morning pill helped Allison through the afternoon too. That was fine with him. He was careful, though, to verify that she was still seeing Wolfe regularly.
    Barbara didn’t tell him about this scheme till it was in place and functioning.
    "All of you are breaking state and federal laws," he told her. "And if Orris finds out about it he’ll have my head!"
    "Don’t worry, Pie," Barbara told me. "If we get caught we’ll swear we never told you."
    The tarbaby thing again! Now he was an accessory to a crime and was involved in deceiving a professional colleague. And he couldn’t do anything about it.
    "What, me worry?" he told himself.
    Not that he didn’t enjoy seeing Allison. He adored her almost as much as Barbara did. She called him Pie, Doctor Pie, Poopkins, Hey Stupid, and Doctor Dolt. She flirted with him in the mild, silly way that young girls flirt with fathers and favorite uncles. She let him help her negotiate her path through the treacherous he saids and she saids of American adolescence, enlightened him about the stupidities of parents and teachers, thrust upon him algebra problems she couldn’t do, demanded he explain the intricate boring puzzles of sentence diagrams, and enjoyed stumping him with textbook questions about history, sports, and science.
    "I’m not supposed to be your homework resource center," he told her.
    "I don’t need a shrink," she responded. "I’m just here so Doctor Orris will give me dope and Mother will stay off my back. So I might as well get you to do something useful."
    But she often cried because she was lonely, she had no social life, she couldn’t go out for teams, she could just get through her schoolwork and collapse. She railed against her illness and against life in general for giving it to her. She also complained, bitched, groused, and showed sneering contempt for the adult world in general, and for schools, parents and shrinks in particular. Her language often was vile, to which he always objected, which always made her worse. Seeing her was a lot of fun but there was no real therapeutic excuse for it. He had to write rather exaggerated case notes to support—should the insurance company become curious—his continued sessions with her. More lies, more fraud!
    When he complained about this to Barbara she told Allison about it and Allison came in to tell him he had it all wrong. "Seeing you does make me feel better," she insisted.
    "I know that," he said.. "You don’t have anyone else you can beat up on so much. But that’s not the point."
    "So what is the point, poop-head?"
    "Seeing a wonderful sunset might make you feel better, too. That doesn’t mean insurance companies should pay for sunsets."
    "So let Mother pay for it. She’s good for it."
    "She wouldn’t. That’s what she has insurance for."
    Allison nodded. She knew he was right about that. Then suddenly her face fell.
    "Actually," she said, "I feel a terrible depression coming on. Yes! There it is now!" And she began to cry.
    "Allison," he said. "Stop that. You’re faking!"
    Tears were steaming down the girl’s cheeks. "I’m not! I’m really not. I was hiding it from you. I feel sad, so sad. I want to kill myself, I think about it all the time!"
    "Stop that!" His voice was rising because he was almost ready to believe she meant what she said.
    Her tears dried. "Well," she informed him proudly, "I did say I wanted to kill myself. You can write that down in your notes. ‘Patient tearful, had suicidal ideation.’"
    He looked at her in astonishment. "You can turn tears on and off like that?"
    She smiled, pleased she had surprised him. "I used to think everybody could do it. When other kids would cry I’d wonder if they were faking because I faked it so much. I still do, sometimes."
    "So now I don’t know what’s real, when you cry…"
    "No, no!" she said, very seriously. "I wouldn’t do that to you. It’s only for play. You knew I was playing!"
    "All right," he said. "I do believe you—I hope! But look—how did you know that phrasing? ‘Patient tearful, had suicidal ideation’?"
    "You think I’m just a kid," she told him, "and that kids don’t know anything. But I actually read books!"

    "You could be dangerous," he said smiling.
    "Yes!" she said, raising a clenched fist.
    Dangerous—and now also beautiful. Ritalin took some weight off her and suddenly she was a babe. And she looked so vibrantly healthy it was hard to remember she was sick.
    "I hurt," she said. "I just plain hurt all over, my elbows and knees, my calves, my hands sometimes when they get red. And my ass drags, I just can’t get in gear half the time. But I have this goddamned smile on my face, it’s a dope smile or something, a Ritalin smile. I can’t get it off. That’s all my friends see, that fucking smile. Inside I’m dying but they’re think I must be unfriendly or something, maybe that’s why I got straight home after school and hardly ever hang out."
    Eventually he heard that a pediatrician at Johns Hopkins, Peter Rowe, had found a treatment for at least some patients with chronic fatigue syndrome—specifically those whose blood pooled in their legs or who would get tired and dizzy if they stood up very long. Wolfe referred Allison. Rowe tested her and then put her on a high salt diet and a new medicine. Within a couple of weeks she was much better.
    Rowe had a colleague who treated adults so Barbara had the same test and the same treatment. But Chronic Fatigue Syndrome is idiosyncratic. What works for one person often does not work for another. The Johns Hopkins medication of choice, Florinef, made Barbara deathly ill.
    This was not a great surprise. Barbara’s quest for a cure had led her to many doctors and to many bad reactions. She went to Charlotte to see Cheney, Incline Village to see Peterson, Seattle for Buchwald, New Jersey for Natelson. Annapolis had a well-known CFS specialist too, Teitelbaum, and she went to him. Each of these gave her serious attention, produced sensible advice, and got her to try medications which either did nothing or made her even sicker than she was already. In addition to these excursions Barbara read everything published on the illness, both online and in print, and went to her local doctor with any suggestions she could find, most of which he good naturedly tried. At one time or another she took, in addition to Florinef, Pindolol, Tegretol, Wellbutrin, Prozac, Tagamet, Sinemet, Desyrel, Ambien, Klonopin, Soma, Ultram, Elavil, Oxytocin, Zoloft, guaifenesen, , nitroglycerin, Cortef, Neurontin, intravenous lidocaine, baclofen, gabapentin, Ritalin, Hydergine, and many others—plus DHEA, magnesium, iron, L-carnitine, malic acid, glutathione, Kutapressin, Coenzyme Q₁₀, gingko biloba, St. John’s Wort, Kava Kava, valarian root, and all kinds of vitamins and minerals. She would have tried Ampligen but it wasn’t available to her. She also tried three different graded exercise schemes, visited chiropractors, massage therapists, herbalists, and homeopaths. Nothing made much difference. Seeing all these doctors, trying all these rumored cures, kept her on roller coaster of hope followed by despair. Eventually she gave up. Except for her brief Florinef fling, she now took nothing but some Desyrel at bedtime for sleep and a combination of Ultram and Tylenol for pain.
    Allison, while definitely improved by the new treatment, was not cured. If she was too active she still would have to spend the next two days in bed. A simple cold could put her out of commission for most of a week. But if she paced herself carefully and didn’t get sick from some other cause, she could live an almost normal life. After a few weeks of treatment he decided she was no longer getting anything from the Ritalin, not even a buzz.
    Now I can get this ethical nightmare off my back, he thought. She can be Barbara’s friend but not my client.
    "You don’t need to get pills for Allison anymore," he told Barbara when she visited him for lunch. "And I don’t have to keep seeing her."
    She looked at him. He knew the look. It stopped him from taking the next bite of his sandwich.
    "All right," he said after a moment. "I understand you don’t like that idea. But she really doesn’t need me anymore."
    "Of course she needs you. She loves you."
    "Not as a therapist though. She doesn’t need a therapist."
    "Her mother needs her to have a therapist," Barbara told me. "Which means Allison does need a therapist. No one else can protect her."
    He felt outraged. "That’s intolerable," he complained. "I shouldn’t have to see someone so her mother won’t be neurotic!"
    Barbara shrugged. "You enjoy talking with her," she said. "So have her to lunch, like you do me. Make her sandwiches."
    He had to shake his head. "Her mother wouldn’t understand," he explained. "She doesn’t believe anybody gets help unless there’s a bill."
    "Then you’re stuck, aren’t you?" Barbara said cheerfully, and bit into her own sandwich.

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