Excerpts

Chapter One You gotta wonder why they shoot spies. Soldiers rape, pillage, burn and shoot everybody in sight. They'll run a tank over your house with you in it. Spies, on the other hand, obey traffic lights, don't jaywalk, and mostly take pictures of military installations, or whatever. There's something weird about this. If the Japanese had caught the bombers of Hiroshima and Nagasaki they would have been required to read them their rights as prisoners of war and make sure they got the right amount of mail from the Red Cross -- although they may not have been in the mood -- but those are the rules. If they'd caught a spy taking pictures of the rubble, they could have shot him on the spot. I dragged my obsessing little mind out of the netherland, where it lives a good deal of the time, and back to the business at hand. I was sitting in my office waiting for a man whose name I didn't know with a problem I didn't know anything about. It wasn't par for the course but it wasn't completely unusual, either, given what kind of psychologist I am. I assess and treat perpetrators and victims of various kinds of violence. Given that, it wasn't like everybody just fesses up over the phone. Whether you were the victim or perp, it was a rare person who wanted to talk about it over the phone to a complete stranger. But usually, I knew the person's name or at least something and this time I knew nothing at all. My mysterious caller had identified himself only as Reggie. When I told him I couldn't assess or treat him without knowing who he was, he said he'd prefer to give me his name when he came in. I didn't recognize the voice but, given his secretiveness, I assumed I'd know the name or the face, which wouldn't surprise me. Given a world where a Nobel Prize winner was caught molesting boys, where a university president was taped making obscene phone calls, where one judge was found molesting another's child at a judges' conference on sexual abuse, given all that, it would be hard to imagine a famous name that would surprise me. I looked him over carefully when he showed up, but his face, at any rate, didn't ring any bells. He was a well-dressed man with a beard, in his early forties, tall and distinguished looking with short, dark hair. He wore horn-rimmed glasses, an expensive suit and a Rolex watch. The watch and suit spoke to more than money. Half the surgeons I knew wore jeans and small, cheap digitals -- one I knew roller-skated to work -- and God knows they made enough money. So I had in front of me one of those conspicuous consumption types who wanted the world to know how successful he was. He walked from the waiting room into my office and immediately went over to the wall where my credentials hung. I watched curiously. There was nothing wrong with my credentials -- my Ph.D. hadn't come in the mail, I was licensed to practice in the state -- but few people bothered to examine them. People who had concerns usually checked me out before they came. And ten to one he had, too. So why was he making this elaborate ritual of reading the fine print on every commendation and award on that wall? I said nothing and waited. Whatever hand he was playing, I'd let him play it. "Harvard," he said. "Not a bad school. I did my undergraduate work there. Didn't take many psychology courses but I did take Larry Kohlberg's. Did you, by any chance?" I smiled and said, "I'm sure we have a lot in common, but I have the feeling your time is very valuable and I wouldn't want to waste it. Do you have any concerns about my credentials? I'd be happy to answer any questions you have." "Oh no," he said, walking over to sit down across from me. "I'm at Boston Harbor View Hospital and you were suggested to me by the hospital. I'm afraid my lawyer has checked you out quite thoroughly." "Boston Harbor View? That's a bit of a drive." As in three hours. I let the question hang. "I'm sure it's worth it," he replied smoothly, then he laughed, "Besides, to tell the truth, my mother lives in the area and it's a good chance for me to visit." "Then what can I do for you?" I said. "For starters, what's your name?" "Reginald Larsen," he said, watching me for a reaction, "but call me Reggie." I glanced at the credentials on the wall, where the Reginald Larsen Teaching Award was hung. "Are you any relation...?" "I'm his son." "Really," I said, surprised. Reginald Larsen was a former chairman of Pediatrics at Jefferson University where I worked. He was the first originator of the Teaching Award that I had won several years ago and which was named after him. I had been based in Psychiatry, but because I worked in child abuse, I had also been on the faculty of Pediatrics. It wouldn't have mattered where I was. Everybody in the medical center knew Reginald Larsen. He was a legend in Pediatrics. He had been gone over a decade and he was still talked about. Dr. Larsen had a kind of extraordinary warmth, especially with patients, and he was visionary about the department, always seeing the future, always building for it -- unlike any chairman since him. I still heard faculty say, "If Reginald were here...Reginald would never have...I wonder what Reginald would think..." as though the decade since he had died of a heart attack was only a couple of months. I was silent for a moment trying to think if this made my seeing his son a conflict of interest. Would I be influenced by the fact that he was Reginald Larsen's son? Maybe. I hadn't known him that long or that well but the memory was still vivid in my mind. "I don't know if I can see you," I said. "I knew your father and his influence is still felt in the medical center. I'd be happy to hear what the problem is, though, and refer you if I can't see you myself." "I certainly hope you don't turn me down," he said with a touch of bitterness in his voice. "There doesn't seem to be anybody on the East Coast who didn't know my father, especially in Boston, where he spent decades. Driving to Vermont is bad enough. I hope I don't have to commute to the West Coast to get an evaluation." "I'll have to think about it," I said. "Why don't you tell me what the problem is?" He sighed and paused, seeming to have trouble getting started. "I'm an anesthesiologist," he said finally, "at Boston Harbor View. I've been there over twenty years. Before that I was in Fort Wayne...I did my training in Texas. It was about as far as I could get from my father's influence," he said. His laugh had a strange sour sound to it. Larsen had dropped his voice a notch when he said "Fort Wayne" and he had let the words trail off slightly as though he were sorry he had mentioned it. I made a mental note about that. I didn't know what Fort Wayne had to do with the current problem, but maybe something. I put on my Ericksonian hat. Milton Erickson was as famous in professional psychological circles as Freud. He was a genius at -- among other things -- microanalysis of tiny body language changes in his interviews with clients. He listened for the catch in the voice, looked for the raised eyebrow. He watched on what words the person blinked, looked for changes in respiration patterns and when they occurred. And from all that he could tell what really mattered to people and what was just fluff. "In any case," Reggie went on, his voice rallying, "things have gone very well professionally. A few years ago I started a line of research on adverse reactions to anesthetics." His voice picked up energy and his respiration deepened. He was in safe territory now. "To make a long story short, I devised a test that will tell whether someone is likely to have a life-threatening adverse reaction to a major anesthetic that's used in about eighty-three percent of all operations. "The test works like a skin test that's commonly used with allergies. Thus far, ninety-two percent of the people who had adverse reactions to the anesthetic have an adverse reaction to the skin test. We're double-checking the data now, but it looks like we can dramatically reduce allergic reactions to the drug during surgery by testing prior to it. "I don't have to tell you the advantage of finding out before you're in the middle of a major operation whether or not the patient is going to have a reaction to the anesthetic. If we knew that, there's another family of drugs we could switch to. They're trickier to use so they're nobody's first choice, but very few people have an adverse reaction to both." There was an undercurrent of excitement in Reginald's voice even though he seemed to be trying to mask it. Maybe he loved his work. Then again, maybe he just had some kind of patent on the test. Whatever his motivation, I was as impressed by his achievement as he wanted me to be. If this was true, the man in front of me was about to become exceedingly famous in medical circles, and maybe beyond. Unfortunately for him, being famous would also increase the chances everybody from Fort Wayne to Siberia would find out what his problem was. Famous people -- even people just famous in their own fields -- had a whole lot of trouble keeping their secrets to themselves. "That's incredible," I said quite honestly. "If it works, it would be a major contribution." "Yes," he said, "yes, it would." He looked off for a moment. What, I wondered, was going through his mind? Did he want to be on the cover of Time or did he just want Dad to say he was good enough? "But it's not why you're here," I said gently. He had found safe ground and, left to his own devices, he'd probably stay on it. "No," he said, and for a moment his face fell. The contrast between his Nobel Prize fantasy and the reality of whatever brought him to my office was probably pretty big. "I...the hospital referred me...I mean..." His voice trailed off. "Okay," I said patiently, "why?" "Why what?" "Why did the hospital refer you?" "Because...well...the truth is...I don't know. I mean, I think I know but I'm not sure." "Excuse me?" He shifted uncomfortably in his seat. "They won't tell me what the charges are. All I know is that I am being accused of some kind of sexual impropriety with somebody." "A patient?" "They won't even tell me that. They say it could be with a patient or with staff...but I think it's with a patient." "Why do you think that?" "Because it's true." He looked straight at me and for the first time I saw his father in him. I sat back and almost smiled. The smile was totally inappropriate for what he was saying but I was remembering the first time I learned his father was a man to be taken seriously. It was over fifteen years ago and I was new in Psychiatry and bitterly discouraged. In one of my first days in the department I had sat through a case conference where a man who shot and killed his wife in front of their children was described, not as a murderer, but as an accessory to suicide. It was "suicide-by-proxy," the clinician had said, because the wife had dressed up and told her husband she was going out to party with other men. The clinicians in the room seemed to think her actions made the whole thing a kind of suicide. I had pointed out that they were only hearing one side of the story -- the other side being dead -- and what did they expect a convicted murderer to say, that he killed her for the fun of it? My comments were about as welcome as toxic waste. I was so depressed by the whole thing that for the next few days I thought seriously about quitting and doing anything else -- selling hot dogs for a living looked good -- when there was a bad incident in the Intensive Care Nursery. A premature infant narrowly escaped dying when a nurse left an IV valve open at the wrong time. The line had flooded her tiny body with potassium and it had thrown her into cardiac arrest. It had taken an all-out code to save her. The case was staffed at the Pediatric M&M, the Mortality and Morbidity conference where medicine tries to learn from its mistakes. The issue came up of what to tell the parents. People were just warming up with a lot of bullshit about how telling the parents a nurse had nearly killed their child would destroy their trust in the child's caretakers. I couldn't believe they were going to get away with lying to the parents to protect their own tails and, worse, justifying it. I was mentally getting out my application for a hot dog vendor's license when Reginald said, "I don't think we need to spend our time on this. It's obvious what we're going to tell the parents." No one spoke. It wasn't obvious to anyone else, not even me, what he meant. I'm sure Reginald read the silence but he didn't make anyone admit they didn't know, he just said matter-of-factly, "We'll tell them someone made an error and left the valve open." Again, no one spoke. Finally, the person from Risk Management said, "Ah, Reginald, I appreciate that but, uh, the question is, why would we tell them that? There are..." "Because it's true," Reginald had said and looked straight at him in much the same way his son was looking at me now. Probably I was in the field right now because I heard at least one person say, "Because it's true." I turned my mind back to this Reggie Larsen. "So tell me about it," I said, but I knew at that moment I shouldn't take this case. This Reggie was riding on his father's coattails with me. I was predisposed to like him, Rolex watch and all, and that was very bad. This Reggie might be a carbon copy of his father and, then again, he might not. Some apples fell close to the tree and some fell in the next county. "I had an affair with a patient," he said, sighing, "but it was years ago. I don't have any idea why it's coming up now. And I don't know why they won't tell me what the charges are. They're acting like she's afraid of me. But what can I do? Sue her for telling the truth? "Look, I'm not proud of it. The truth is she had a fibrosarcoma, a tumor attached to the back of the abdominal wall. They got it but she had a lot of pain, afterward, that just wouldn't remit. She was referred to me for pain management. I've thought a lot since then about whether she really wanted to get involved with me or whether she was afraid to alienate the person who was managing this rather significant amount of pain." Good question, but there was another one as well: how much would somebody with acute, chronic abdominal pain feel like having sex with anybody? "So what happened?" I asked. "Nothing," he said. "It was right after I was divorced and -- I know it's no excuse -- but I was terribly depressed and she was just a very nice lady. When I came to my senses, I stopped it. We really didn't have that much in common, anyway. That's about it." "What happened to the pain?" "Oh, that. It eventually got better. She's doing well -- at least she was the last time I saw her." "Which was when?" He paused and thought for a moment. "A couple of years ago, I think. She was moving and she came in for a last checkup. She had had some minor flare-ups, but nothing significant." "What was that meeting like? Was she angry with you?" "No, not at all. She seemed fine. The affair seemed light-years ago. She was remarrying -- she was divorced, too -- and she was moving to where her fiancé lived." "So, why do you think this is about her?" "Because there's nothing else it could be about," he said simply. "There isn't anything else." I was writing notes as we spoke and I took a moment longer to write so I could think about it. He was quite believable. Actually, he was totally believable. But then, so were a lot of people who were lying through their teeth. I hated the fact that I had seen enough, heard enough, that I no longer believed anything without corroboration. It was a sad business, but true, that doing my job well meant being suspicious of everything that breathed. And there was one minor thing, Larsen's body language was subtly wrong. His hands, which gestured freely when he was talking about his work, had stopped moving the moment he started talking about the affair. This was not a good sign. Research showed that people who normally used their hands when they spoke tended not to when they were lying -- probably because they were concentrating so much on what they were saying. And there was one other thing. Not huge, but there. He wasn't reacting physically to anything he said, not even when he was talking about having an affair with a woman who was dependent on him for pain control. And I knew that when anesthesiologists talked about a "significant" amount of pain, they weren't kidding. And he should have been reacting physically. If it was true that he had done something he had worried about ever since, the pitch should have changed in his voice, even just slightly. His pupils should have contracted when talking about worrisome things. His respiration should have been slightly faster, but it hadn't been. Something. The fact was, he was showing no signs that he was feeling any emotion at all when he was talking about emotional things. So maybe he didn't really believe there was anything wrong with having an affair with a patient who was depending on him. Or maybe he was just naturally calm and out of touch with his feelings. Or then again, maybe he was making the whole thing up. All put together, I couldn't rule out the possibility that Reginald Larsen's son was lying to my face. "Why are you here?" I said to Reggie. "What are you looking for from me?" "The hospital has put me on leave," he said. "They are insisting on an evaluation before I return to work. I want to get it done as soon as possible. The longer I'm out the more the cover story about 'personal reasons' is wearing thin. I'm going to be ruined if this gets out, even if the charges are proven false. And the timing couldn't be worse. Word is getting out about the anesthesia test and I'm getting calls and e-mail from all over the country. Hell, they won't even let me use my office." That was odd, very odd indeed. Medicine wasn't like business. People weren't routinely locked out of their offices while they were being investigated. They weren't even locked out of their offices when they were fired. "Are they prepared to tell me what this is all about?" I asked. "Why?" he said, surprised. "Do you have to talk to them? Can't you just evaluate me? I think that's what they want." "No," I said, "I can't. Let me tell you a little about what this process involves so you can decide whether you want to go through it or not. I won't evaluate you unless I have the details of every charge against you. I have to know what the problem is supposed to be. "Second, an evaluation in a situation like this is tricky. There is no interview technique and no psychological test that will say absolutely whether someone is a sex offender or not. If you're being accused of raping a patient in an elevator, for example" -- Reggie paled slightly -- "no matter what technique I use I can't say for certain whether you did that particular act or not. Ultimately, guilt and innocence of a specific crime is a question for the courts." At the mention of court, his color paled a little more. "But the more I learn about what kind of sexual problems you have and how honest you are about them, the more I can figure out what you need in terms of treatment -- if you need treatment -- and what you need in terms of a work setting where you'd be unlikely to reoffend. "To do that kind of an evaluation, I need to compare what you tell me with what the complainants tell me. That way I learn something not just about your problems but about how honest you are about facing them." "But the complainants could be lying," Reggie sputtered. "They could," I replied calmly, "but so could you. That's part of what I have to sort out. Maybe not to the same level of proof needed for a court of law, but with enough certainty to figure out whether you need treatment, what that treatment would be, and whether you can do the same kind of work in the same setting again." "Just for the record," Reggie said, "I object to your talking as though I'm some kind of sex offender. I don't want to whitewash the affair with the patient, but it wasn't exactly like raping somebody in an elevator." "The point is," I said coolly, "I don't know whether you're a sex offender or you're not. You may be an innocent man or you may have molested every child in the pediatric ward. I don't know. That's one of the reasons I have to know what the charges are, so I know at least what you are accused of being." "But I told you..." "You told me you didn't know, you were guessing what the charges were. Even if you told me you knew for sure, I'd still get it from them. You have to understand, a lot of people who are accused of sexual improprieties don't tell the truth. No offense, but I don't have a clue whether you are being truthful or not." "Well," Reginald said, sighing and sitting back, "if that's what you need -- " "I haven't finished," I said. "That's just the beginning. After I get the complaints, you will need to write down every deviant sexual act you have ever committed. It's called a 'deviant sexual autobiography.' I'm not interested in consensual sexual experiences with other adults. I want to know about child molestation, rape, exhibitionism, voyeurism, etcetera. Anything to do with children, with violence, or with violating other people's boundaries." "Jesus Christ," he said, and I noticed I was seeing the shallow respiration, the contracted pupils, the raised pitch that told me he was finally emotionally involved in the conversation. "Now you're saying I'm a child molester. I have never in my life even looked at a child sexually." "Then it won't be a problem for you," I said calmly. "Sex offense evaluations are standardized these days. We ask about every possible type of deviation. I won't bore you with the research unless you want me to, but the bottom line is that a whole lot of sex offenders have multiple deviancies." "But I don't," he said angrily, "and I told you. I'm not a sex offender." "Good," I said, "there's nothing wrong with a short deviant autobiography. There's nothing wrong with a blank piece of paper." He looked relieved and his breathing started to recover. "But remember, you'll have to take a polygraph on whatever you write." "What?" he said. "That's crazy. Polygraphs aren't admissible in court." "This isn't court," I said flatly. "This is an evaluation and we get to use whatever tools we feel are appropriate. "But just for your information," I added, "they're admissible one way or the other in thirty-eight states, but that's beside the point -- for now." There was no way around it. Doing an evaluation of an alleged perpetrator meant selling fear. You had to be some kind of fear merchant with perps to get anywhere. The saving grace of the whole process was that people who were innocent were a whole lot less afraid than people who were guilty -- which was as it should be. "But they're not accurate," he said. "Well, actually, that's not true either. With the right examiner the new computerized polygraphs are reporting about ninety percent accuracy rates in detecting innocence and far higher than that, ninety-six to ninety-eight percent, in detecting guilt, at least according to the Department of Defense Polygraph Institute and Johns Hopkins University. In any case, they've been better for decades than people are at telling who's lying." "I'll have to think about it," he said. His ardor for an eval seemed to have cooled considerably at mention of a polygraph. "You should," I said. "It's a very involved process and I'd advise you to think about it and to run it by your lawyer. I have to think about it also, because of the connection with your father whom I respected very much. Why don't you give me a call next week?" "Next week is too long," he said quickly. "I'll decide by tomorrow. I have to get this evaluation done right away or it's not going to matter what the outcome is. The rumor mill will kill me." "Run it by your lawyer first," I said. Fair was fair. People faced with sex offense charges didn't always think straight. I didn't mind pressuring people from here to Shinola if they had someone to represent them, but I felt like I was taking advantage of desperate people if they didn't. We set up a time he would call me and he got up to leave. At the door, he paused and turned back around. "My mother knows you," he said. "She said my father always had confidence in you. He said you were the best thing that ever happened to Psychiatry. She said if it was my father's career, you'd be the one he'd choose. She said to say hello." He left before I could respond. Afterward my chest felt tight and the weight of the world descended. A decade of fighting in Psychiatry had left me immune to attack, but strangely vulnerable to trust. I wanted nothing more than to give something back in exchange for all that faith. And why not believe Reginald Larsen, Jr.? He'd sounded good and he'd looked good -- sincere as hell. But the nagging in my head wouldn't go away. The things that Reggie didn't have conscious control over -- pupil dilation, changes in voice pitch and respiration -- hadn't been there when they should have been. And there was something else: the small business of what he denied and what he left out. People lie more often by omission than commission. If you don't force people to lie, most of the time they just leave out what they did, they don't openly deny it. I had raised rape, child molestation, voyeurism, exhibitionism, a whole host of nasty hobbies. The only one he had waxed indignant about was child molestation. Maybe he just thought it was worse than all the rest. Or maybe it was the only one he wasn't guilty of. And what would Mrs. Reginald Larsen, Sr., whom I remembered very well, think of that? Copyright © 2000 by Dr. Anna Salter Excerpted from White Lies by Anna Salter All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.