Masterson was at the other end of a long, carpeted corridor when he finally had the presence of mind to look around. Pausing at a doorway, he waited until I caught up with him, then ushered me inside. I helped myself to a chair while he took his position behind his desk and automatically began tamping tobacco into an expensive briar pipe.
“Needless to say, Dr. Scarpetta,” Dr. Masterson began in his slow, precise way as he opened a thick file folder, “I am dismayed by Al Hunt’s death.”
“Are you surprised by it?” I asked. “Not entirely.”
“I’d like to review his case as we talk,” I said. He hesitated long enough for me to consider reminding him of my statutory rights to the record. Then he smiled again and said, “Certainly,” as he handed it over.
I opened the manila folder and began to peruse its contents as blue pipe smoke drifted over me like aromatic wood shavings. Al Hunt’s admission history and physical examination were fairly routine.
He was in good physical health when he was admitted on the morning of April tenth, eleven years ago. The details of his mental status examination told another story.
“He was catatonic when he was admitted?” I asked. “Extremely depressed and unresponsive,” Dr.
Master-son replied. “He couldn’t tell us why he was here. He wasn’t able to tell us anything. He didn’t have the emotional energy to answer questions. You’ll note from the record that we were unable to administer the Stanford-Binet or the MMPI, and had to repeat these tests at a later date.”
The results were in the file. Al Hunt’s score on the Stanford-Binet intelligence test was in the 130
range, a lack of smarts certainly not his problem, not that I’d had any question. As for the Minnesota Multiphasic Personality Inventory, he did not meet the criteria for schizophrenia or organic mental disorder. According to Dr. Masterson’s evaluation, what Al Hunt suffered from was
“a schizotypal personality disorder with features of borderline personality, which presented as a brief reactive psychosis when he cut his wrists with a steak knife after locking himself in the bathroom.”
It was a suicidal gesture, the superficial wounds a cry for help versus a serious attempt to end his life. His mother rushed him to a nearby hospital emergency room, where he was stitched up and released. The next morning he was admitted at Valhalla. An interview with Mrs. Hunt revealed that the incident was precipitated by her “husband losing his temper” with Al during dinner.
“Initially,” Dr. Masterson went on, “Al would not participate in any of the group or occupational therapy sessions or social functions the patients are required to attend. His response to antidepressant medication was poor, and during our sessions I could barely get a word out of him.”
When there was no improvement after the first week, Dr. Masterson continued to explain, he considered elec-troconvulsive treatment, or ECT, which is the equivalent of rebooting a computer versus determining the reason for the errors. Though the end result may be a healthy reconnecting of brain pathways, a realignment of sorts, the formatting “bugs” causing the problem will inevitably be forgotten and, possibly, forever lost. As a rule, ECT is not the treatment of choice in the young.
“Was ECT administered?” I asked, for I was finding no record of it in the file.
“No. Just at the point when I was deciding I had no other viable alternative, a small miracle occurred during psychodrama one morning.”
He paused to relight his pipe.
“Explain psychodrama as it was conducted in this instance,” I said.
“Some of the routines are done by rote and are warm-ups, you might say. During this particular session, the patients were lined up and asked to imitate flowers. Tulips, daffodils, daisies, whatever came to mind, each person contorting himself into a flower of his private choosing. Obviously, there is much one can infer from the patient’s choice. This was the first time Al had participated in anything at all. He made loops with his arms and bent his head.” He demonstrated, looking more like an elephant than a flower. “When the therapist asked what flower he was, he replied, ‘A pansy.’