More important, what was he thinking of-escape or revenge?
7
Tuesday, June 25, 2002
I talked with Anderson before leaving my loft in the morning and learned that Billy was still at large. I had a couple hours before my 1:00 p.m. meeting with Julia, so I headed to Mass General for my third visit with Lilly Cunningham.
I expected to see her doing better, but she looked worse. Her skin was even paler than before. Her breathing was erratic. As her eyes followed me in from the doorway, she squinted to bring me into focus.
I pulled an armchair to the side of the bed and sat down. Above me, to the right of the window, the IV tree had grown new branches. A total of five hanging bottles and plastic bags dripped into the central line running into Lilly's subclavian vein. I looked at her leg, still suspended midair, and saw that another serpentine incision had been cut into the flesh to help her abscess drain.
"It's in my heart," she said weakly.
I knew she was talking about the infection having traveled to her heart, probably to the pericardial sac that surrounds it or to the valves deep inside its chambers. But I heard her words in another way, too. Because it was also true that the psychological trauma which had caused her to inject herself with dirt had reached the center of her being, the emotional toxin pumped now with the blood to every tissue, sparing only her central nervous system, walled off as it is by that baffle of membranes known as the blood-brain barrier. The lines of conflict were at last clearly drawn: Whatever had happened to Lilly as a girl had finally laid siege to the kingdom of her body, leaving the soul, and its own miraculous ability to heal, as her last defense-and my greatest ally.
I noted that, during my three meetings with Lilly, she had never had any visitors. Patients with Munchausen's often end up isolated; family and friends become enraged when they learn they have been caring for a person who has made herself sick. A wave of sadness-and, strangely, embarrassment-swept over me. The thought of Lilly suffering so terribly, without a hand to hold, made me want to reach out to her even more.
"The sadness and shame you feel is hers, not yours" the voice at the back of my mind whispered. "Help her own it."
"The last time I came to see you," I said, "you told me how frightened you were of being alone. Where does that fear come from, do you think?"
She cleared her throat. "Probably from losing my father," she said. She closed her eyes and slowly reopened them. "I haven't stopped missing him. I've thought of him every day since I was six."
"There are people you love today?" I said.
"Yes, of course. My husband. My mom and grandparents. A few good friends."
I leaned closer. I decided to gamble that Lilly's fear of being alone would translate into an even more imposing fear of death. "This is a very important moment, Lilly," I said quietly. "The infection is overwhelming your defenses. You could die. And that means saying good-bye to your husband and your mother and each of your friends. It means being completely and utterly alone." She seemed to be listening to me. "The only way to stay with the people you love is to open up to them, to let the truth flow. If you do that, I think all the stress you're under will start to fade away and your body will start to heal itself."
She looked away and shook her head. Several seconds passed. I sat still. Nearly a minute more went by. I was ready to gamble again by telling Lilly that I knew she had injected herself with dirt. But, of a sudden, she turned back toward me. Her eyes had filled with tears. "I did this," she whispered.
"Tell me what you mean," I said.
"I used a needle to inject… I caused the infection. I did this to myself."
I nodded. "I understand," I said.
She started to cry.
"I understand," I said again. I waited while she dried her eyes. "Can you tell me why you did it?" I asked.
"I don't know," she said. "I'm so ashamed."
"But she does know. Ask about the shame" the voice said.
"Is there something that happens to you around the time you inject yourself? Are there memories that bother you?"
She didn't hesitate this time. "I do it," she said, "when I feel filthy. I do it to punish myself."
"And what makes you feel filthy?" I asked.
"Nothing," she said, almost inaudibly.
"I'll never tell anyone," I promised.
She looked into my eyes, seeming to decide whether she could truly trust me. "I have bad thoughts," she said finally. "Terrible thoughts."
"Tell me about them."
She closed her eyes and stayed silent.
"Lilly, you have to let the truth out. You can't tie up your immune system any longer. You need it in order to stay with people you care about."
"I think…" She stopped herself.
"They don't want to lose you," I said. "They don't want to have to say good-bye."
"I think about my grandfather."
"What about him?" I asked. "What are the thoughts, exactly?"
"I think of myself… with him." She closed her eyes and shook her head. "Touching him. Him touching me."
"Were you ever close with your grandfather in that way? Physically?"
"Never." She opened her eyes and stared at the ceiling. "That's the strangest part." She looked at me. "I'm certain he never did anything like that." Her face was a portrait of confusion. "It feels so awful thinking that way about him."
"And thinking that way is what makes you want to inject yourself," I said.
"I would do it right now, if I could," she said. "It would make me feel so much better."
"To punish yourself," I said.
"Yes. The thoughts would stop."
So there it was, the pathogen attacking Lilly's heart. It had taken on the life of a bacterium, but it had been born in Lilly's psyche. Her guilt-and her infection-stemmed from her sexual feelings for the man who had taken care of her after her father's death. The only question that remained was what had cultivated that desire. Had she been the victim of sexual abuse she later repressed? Or could there be another explanation? "You have to be willing to feel all the pain without using a needle to chase it away," I said. "If you're brave enough to do that, then your stress will start to evaporate. The infection won't have a chance of winning. It won't be able to hide from your immune system."
"I want to try," she said. "Really, I do."
"Good."
"You'll help?" she asked.
"I told you I would stay with you through this," I said. "I meant it."
I made it to Bomboa about twenty minutes before my scheduled meeting with Julia Bishop. The place was unusually busy for lunchtime, but I'm a regular there, and K. C. Hidalgo, one of the owners, offered me my usual table right by the window. I told him I'd rather he find me a quiet table toward the back, and that I'd wait for my guest at the bar.
He looked at me with concern. "The bar? That's a new perch for you."
I'd eaten enough dinners alone at Bomboa for K.C. to hear my whole life story in two-minute installments. He was a slim El Salvadorian man in his early forties, with chiseled features and a smile that would have kept his restaurant full if the food was average. But the food was some of the best in Boston, and K.C. was getting rich. He ran his fingers through his thick black hair. "I thought the bar was off limits. 'Physician, heal thyself,' and all that."
"I'm drinking my usual brew," I said. "Coffee."
"Then my place is your place." He walked me to the bar and caught the attention of the bartender. "Coffee for the doctor," he said.
"You're taking good care of me," I said.
"Somebody ought to do it twenty-four, seven, dude," he said. "Somebody much prettier than me." He slapped me on the back. " 'Cause, let's face it, you don't have a great track record taking care of yourself." He smiled that smile, then headed back to his post near the door.